Urgent and Unscheduled Care

From August 2019 GP "Out of Hours" training will be changing to "Urgent and Unscheduled Care".

GP Trainees will be required to demonstrate their capability to work in urgent and unscheduled care in order to obtain their Certificate of Completion of Training (CCT) 

Rather than a set number of hours of training as previously this capability will need to be developed and demonstrated throughout your whole training programme - developing evidence whilst in both GP and hospital posts and evidence this as in the flowchart below:

 

 

This page aims to help trainees and educators to understand and adapt to the new process. 

Where can one access urgent and unscheduled care?

This can be accessed in Health Education England (HEE) approved centres working with HEE approved Clinical Supervisors, including extended access hubs within training practices. It is also possible to develop capability within hours during “duty days” in training practices and in the hospital during jobs such as A&E, psychiatry, acute medical units and whilst on call in paediatrics.

When can one access urgent/ unscheduled care training recognised towards GP training?

Most training has to be during GP attachments, and it is likely that the bulk of this will be during ST3. Relevant experience may be accrued during the hospital posts listed above. Observational sessions, in which the trainee attends relevant courses or observes other health professionals, without undertaking any clinical responsibility for patients, can be undertaken as part of the normal weekly protected educational sessions at any time throughout training. This is useful within ST1 and ST2 to demonstrate progression of competence.  

The learner must not embark on this training during sick leave or whilst Out of Programme (OOP). It is possible to undertake observational or direct supervision sessions on Keeping in Touch Days during maternity leave provided this has been agreed with the Indemnity provider, ES and TPD. Near and remote supervision sessions must not be undertaken. 

What are the different types of session?

Observational – Typically ST1. Trainee observes health professional consulting in urgent and unscheduled care but has no input into patient management. Includes relevant courses. The time comes out of protected learning time during the normal working week. 

Direct – Typically ST1/2. Trainees consult patients with an approved supervisor present. This could include a joint surgery on call in the practice as part of the self-directed study time. For sessions undertaken in settings outside of the normal training practice and working hours, time off in lieu should be granted. 

Near – Typically ST3 but could be ST1/2 if competent. Approved clinical supervisor is readily available in the same building. Time off in lieu must be given for sessions undertaken outside of normal working hours. 

Remote – ST3 trainees only. Approved clinical supervisor available by phone. Time off in lieu must be given for sessions undertaken outside of normal working hours.  

What time off in lieu is one entitled to?

Any session that is worked outside of the normal practice hours (excluding study leave for relevant courses) must be compensated by time off in lieu and should be granted by your training practice. This time may be given back at any time during and does not have to be the same week as that which it was worked. Observational sessions within the training practice, approved out of hours settings, extended access hubs or urgent care centres should be taken from the weekly self-directed study time.  

In the unlikely event that practices are not providing time off in lieu you should initially speak to your educational supervisor. If this does not resolve the issue, then your training programme director needs to be informed.  

The lead employer has agreed that the new requirements will not affect the pay of GP trainees, despite them working fewer anti-social hours than in previous years.  

Who can supervise urgent/unscheduled care training?

This should only be HEE approved supervisors. However, observational sessions may be provided by a named supervisor in the organisation who may not be HEE approved. 

What are the urgent/unscheduled care capabilities (competencies)?

a. Ability to manage common medical, surgical and psychiatric emergencies  

b. Understanding the organisational aspects of NHS out of hours care, nationally and at local level  

c. The ability to make appropriate referral to hospitals and other professionals  

d. The demonstration of communication and consultation skills required for out of hours care  

e. Individual personal time and stress management  

f. Maintenance of personal security, and awareness and management of security risks to others 

How does one record urgent/unscheduled care capabilities?

Use the Health Education East of England (HEEoE) GP School “Urgent and Unscheduled Care Observational Session Record” which can be downloaded from https://heeoe.hee.nhs.uk/general_practice/gp-trainees/urgent-and-unscheduled-care. The completed form should be signed by the clinical supervisor and then discussed and signed by the educational supervisor. You are strongly recommended to upload this onto the e-portfolio as it will provide evidence for your educational supervisor as to how you are progressing. Additionally, it is vital to document relevant cases seen when working in urgent and unscheduled care that reflect the required capabilities. 

How much exposure is necessary to achieve the urgent/ unscheduled care capabilities?

Developing capability is a continuous process throughout the three years of GP training and there will need to be evidence of progression at each annual review of competence (ARCP) panel. Capability may be evidenced from a variety of sources but in no circumstances will it include fewer than (and generally will far exceed) 72 hours of sessions worked in traditional out of hours settings. Trainees in their ST 1 and 2 phases, whilst in GP placements, will need to develop their capability by undertaking “observational” and “direct” supervision sessions at an average of 4 hours per month. This will enable them to aim for at least 48 hours of “near” and “remote” supervision sessions within ST3. “Direct” supervision sessions may count within ST3, particularly in those parts of the region that do not allow trainees to consult unaided. If this is the case trainees should endeavour to provide evidence of independent working in urgent and unscheduled care linking evidence, for example, from duty days at the training practice, which may not be counted as part of the 48 hours in ST3. If the OOH clinical supervisor and educational supervisors assess trainees as being competent to undertake “near” supervision sessions whilst in ST2 this should be encouraged.      

Can all the urgent/unscheduled care capabilities be achieved within extended access at the training practice or at an extended access hub in which the training practice is a member?

It is very unlikely that this would achieve the capabilities by itself. There is an expectation that you can consult in an environment where full access to clinical records is unavailable. The capabilities do not relate to the management of routine care. It is anticipated that at least 72 hours will be undertaken in a traditional out of hours setting with additional experience within urgent care centres and extended access hubs providing additional evidence of capability. 

Are there any requirements for WPBA during urgent/unscheduled care training?

You are encouraged to arrange CBDs, COTs, Audio COTs and CEPS as these will provide evidence of your capability. However, they need to be carried out by experienced HEE approved Clinical Supervisors who are well versed with the assessments. 

Who would assess the urgent/ unscheduled care capabilities?

Clinical Supervisor – Identifies capability and indicates this on the Urgent and Unscheduled Care Observational Session Record 

Educational Supervisor – Confirms the assessment of the clinical supervisor using the Urgent and Unscheduled Care Observational Session Record and agrees further developmental needs with the trainee. At the end of year ESR assesses whether the “Urgent and Unscheduled Care Evidence of Capability” form demonstrates satisfactory development. 

ARCP panels – Utilises the assessment by the educational supervisor as evidence for the panel’s recommendation regarding progress. 

How will I know that I am progressing towards achieving urgent/unscheduled care capabilities throughout my training?

You should be reviewing this regularly with your ES. The “Urgent and Unscheduled Care Observational Session Record” should act as a trigger for a professional conversation with your ES, who should assess the evidence collated to that point and suggest further developmental needs that should be recorded as a PDP entry. 

In preparation for my ESR and ARCP panels how should I highlight the evidence supporting the development of urgent/unscheduled care capabilities?

Use the HEEoE GP School “Urgent and Unscheduled Care Evidence of Capability” form which can be downloaded from [insert link here] and upload this using the same title to the e-portfolio. This form may be used to specify all the evidence within your e-portfolio that you feel is relevant including both log entries and WPBA. 

Are there any further additional requirements prior to the final ESR for urgent/unscheduled care training?

You should have completed BLS & AED training. The BLS training is valid for 12 months and ALS training certificate is valid for 3 years, but the training should have taken place during GP training.  The certificates on your e-Portfolio should be valid at the time of your CCT and attached to a shared log entry so that they are visible to your educational supervisor and the ARCP panel.

I’m an ST4 trainee. What do I need to do regarding Urgent and Unscheduled Care?

You should still be addressing your capability by undertaking and evidencing on call work within the training practice, but there is no requirement to undertake any further out of hours work during the ST4 post. 

I’m on an extension of my training. What do I need to do regarding Urgent and Unscheduled Care?

This will depend on the reason for your extension. If you have had an extension due to failure of WPBA it may be necessary for you to undertake further OOH sessions, depending upon the recommendation of the ARCP panel. If your extension is for examination failure and your educational supervisor has adjudged that you have demonstrated full capability in urgent and unscheduled care then you do not need to gather any further evidence.  

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