Out of Hours.

Number and length of sessions

COGPED guidance on OOH indicates a MIMIMUM benchmark of one 4-6 hour session per month during all GP Practice placements. Therefore, in some training programmes, depending on the length of sessions from local providers, trainees could have as little as 72 hours experience over their training (24 hours for each 6 months). The GP School considers this to be the bare minimum required to demonstrate experience and learning and stresses that a minimum of EIGHTEEN SESSIONS is considered necessary to provide appropriate exposure and learning. It would normally be expected for trainees to complete a minimum of SIX sessions during each half year of full-time WTE training.

The LENGTH of any session is ultimately defined by the local circumstances of OOH provision and the length of the Clinical Supervisors session. Each session should include sufficient time for debrief and the opportunity to record the session on the e-portfolio. The maximum amount of hours allocated to any single session should be 6 hours.

It is recognised that some OOH sessions provide more experience than others and therefore it is considered the responsibility of the trainee to provide clear evidence of the learning they have derived from their OOH sessions on their portfolio. If the GPStR is in an integrated training post based in General Practice they should undertake the same number of sessions as those in traditional General Practice placements.

View further RCGP guidance.

Trainee’s responsibilities regarding OOH during GP Placements

As well as training and educational issues linked to failure to gain the RCGP defined minimum experience or demonstrate competence in the Care of the Acutely Ill: Trainees can help by making their experience clear to ARCP panels.

  • File any entry under Out of Hours
  • In General Practice placements one out-of-hours session per each month WTE is considered the minimum exposure for the registrars (pro-rata). 
  • You must keep a record of all your OOH sessions on your portfolio. This should be complemented with a ‘Record of OOH session’ signed off by the Clinical Supervisor present and uploaded for each session.
    Record of OOH session.
  • Educational supervisors are expected to check the number of OOH sessions during the formal review of the ePortfolio – therefore your experience should be highlighted for your review – this is helped by using the ES workbook
  • Phone triage is acceptable for part of out of hours experience providing there is an appropriate balance with face to face sessions.

Availability of Sessions

We aim to work with OOH providers to ensure that there is sufficient capacity for OOH sessions for all Training Programmes in the School.

As it is the responsibility of each trainee to demonstrate that they have attended the required OOH sessions expected of them and gained educationally from them (evidence from the OOH supervisor is expected for all sessions), trainees can help avoid problems by arranging OOH sessions from the beginning of their post rather than leave them all to the later months. We therefore recommend that trainees have discussions with their Educational supervisors and Training Programme Directors at the beginning of General Practice placement to plan accordingly.

If there are any problems with booking sessions, the trainee should formally inform their TPD and add an entry in their portfolio – the Training Programme should also highlight this in Educator Notes to help with clarity for ARCP panels. 

Problems due to scarcity of sessions in OOH providers

ARCP panels are aware that OOH providers can experience problems providing sessions from time to time in different schemes across the school. During these times, Training Programmes are asked to consider alternative possibilities of demonstrating OOH competency and to discuss these options with their trainees that allow demonstration of OOH competence in line with the latest COGPED guidance (2010). This states "OOH continues to be taken to mean the type and style of working that takes place between the hours of 18:30-8:00 am for urgent and unscheduled patient contacts and does not include any experience gained in the GP Training Practice during extended hours (when pre-booked patients and not acutely ill patients are seen). Options could include working with Mental Health Crisis teams, Community Urgent Care teams, Palliative Care OOH team etc. We would also accept sessions outside of normal surgery hours, seeing acute patients in a CCG/Federation/Locality based surgery providing extended OOH GP services – as funded by the Prime Ministers Challenge Fund.

It would be expected that any such problems were highlighted in the E-portfolio as described above.

This guidance will be reviewed in April 2017

School lead for GP Out of Hours

The school lead for Out of Hours issues is Dr David Rose david.rose@hee.nhs.uk