This is intended to provide an update to OOH training in Bromley, for trainees, OOH Clinical Supervisors, and Trainers. 

It is not intended as a replacement for the full Deanery guidance to OOH training (revised June 2008), which can be found at: 

http://www.londondeanery.ac.uk/general-practice/files/specialtytraining/london_deanery_out_of_hours_guidance_august_07.pdf

Requirements

§  Full time registrars must attend 12 OOH sessions during their GPR year, pro rata for part-time registrars eg. if a trainee works at 60%, it takes 20 months to do 12 months full-time equivalent and they must do 12 OOH sessions during their 20 months.

§  The duration and frequency of these sessions may vary but normally a 4-6hr session is appropriate.

§  Trainees doing 4 month ITP posts should undertake 4 out of hours sessions during their post.

§  Trainees should maintain a log of all Out of Hours sessions.  Normally this would be in their eportfolio, but trainees are expected to complete a “Record of OOH” worksheet with their supervisor for each session attended, which ideally can be scanned into their eportfolio.  It is hoped that in the near future, this ‘paper’ exercise will be replaced by a suitable form on the eportfolio.

§  Registrars will not receive additional payment for Out of Hours work as their salary already includes a substantial OOH component.

§  In undertaking OOH sessions, registrars should ensure that adequate indemnity arrangements are in place to cover their own individual circumstances.

Supervision & Booking Sessions

§  Appropriate clinical supervision should be available to for OOH sessions. 

§  Clinical supervision may or may not be carried out by the trainer.  However the clinical supervisor should have ‘additional skills to that of being a proficient professional and these will include the ability to observe and feedback to learners.  The clinical supervisor could, for instance, be a clinician who is beginning the process of becoming a trainer or one who has recently retired, or a GP who has appropriate training or previous experience (with F2 doctors or medical students) or who has received specific training as a supervisor.

§  Emdoc holds a list of all current GP Clinical Supervisors and emails a list of all available sessions with these supervisors, via Grace monthly in advance.

§  Registrars are expected to contact the GP Clinical Supervisor, whose session they wish to attend as soon as possible as in many cases only one (or sometimes two) GPRs will be accommodated per session.

§  Registrars are requested to inform EMdoc in advance that you will be attending the session with the GP.  They can do this by emailing EmdocGPRotas@bromleypct.nhs.uk.  This way the EMdoc Shift Supervisor can plan the session and plan the rooms – for example, they will often try to ensure that the GP is allocated 2 rooms adjoining each other in case the GPST is able to undertake independent consultation in an adjoining room etc. 

§  In order for registrars to gain a full range of OOH experience it is important that they book a range of OOH sessions varying as to time (evening, night, weekend and weeknight) and to experience both Base and Mobile GP sessions.

§  Registrars should reflect on their session with their OOH Clinical Supervisor before leaving and ask them to sign and give feedback on their “Record of OOH” sheet for their eportfolio.  These record sheets are available on the Bromley GPTP website and also the London Deanery website.  Ideally, registrars should scan comleted forms into their eportfolio.  It is hoped that in the near future, this ‘paper’ exercise will be replaced by a suitable form on the eportfolio.

§   It is the GPST’s responsibility to use the recommended record sheet for each session. 

§  In order to recommend that a GP Registrar has satisfactorily completed training, trainers must be confident that the GP registrar is competent in the delivery of OOH care.  The e-portfolio and the ‘Record of OOH’ sheets are provided to demonstrate evidence of this.  Trainers will need to see evidence that at least 12 OOH sessions have been attended and that the OOH competencies have been achieved, before signing the registrar off on the eportfolio for their CCT.  Failure to achieve this will lead to a “face-to-face” deanery ARCP panel.

Diversifying OOH Sessions

§  At present the only consistent option available to Bromley trainees for OOH sessions is to undertake sessions at Emdoc with a supervising GP.  This may involve base reviews and telephone triage and also doing visits.

§  At some point during their training, whilst at the Emdoc base it is important that trainees spend some time with the shift supervisors in order to gain an understanding of some of the organisational aspects of Emdoc.  They may also be able to spend some time with the ENPs working at Emdoc.

§  From August 2009 all registrars will attend an induction session at County House (Emdoc HQ) where they will be given induction packs, Adastra passwords, adastra training.  They will also be given the opportunity to gain insight into the Organisational aspects of OOH care inb Bromley, seeing the admin team and the call handlers at work, and also experience NHS Direct who are based in the same building. 

§  In the future there may be times when trainees can undertake sessions with the Hospice team or District Nursing team.  Details of these sessions will be circulated by Emdoc.

Competencies

There are 6 generic competencies within the RCGP Curriculum section on “Care of Acutely Ill People” and registrars are expected to have demonstrated competence in each of these before your final review.  They are as follows:

1.     Ability to manage common medical, surgical and psychiatric emergencies in the out-of-hours setting

Even caring for large numbers at Emdoc, no registrar will ever see every possible emergency.  The training process must address this knowledge base theoretically, whatever the registrar’s OOH experience.

2.     Understanding the organisational aspects of out of hours care

A variety of experiences will help equip the registrar to function in any future situation

3.     Ability to make appropriate referrals to hospitals and other professionals in the out-of-hours setting

4.     Demonstration of communication skills required for out of hours care

OOH care requires specific communication competencies eg. use of telephone consultations, operating with a lack of medical records, communicating with other doctors.

5.     Individual personal time and stress management

This is best accomplished by reflection on direct experience

6.     Maintenance of personal security and awareness and management of the security risks to others

For further information please see the London Deanery training guide.

Natasha Hoare

February 2009