Out of Hours

The requirements for Out of Hours and Urgent Unscheduled Care changed in August 2019.

UUC FAQs(Wessex) provides details on these changes and how they are being applied across HEE Wessex – it should answer any questions you may have.

Delivering Urgent and Unscheduled Care is a key responsibility for GPs; it is important you develop and demonstrate your capabilities in this area of practice. The UUC Professional Topic guide in the 2019 RCGP curriculum provides the following guidance:

‘As a GP specialty trainee, you must gain experience of managing patients presenting with urgent and unscheduled health care needs, which is an important feature of both ‘in-hours’ and ‘out-of-hours’ GP care. Because there are particular features of unscheduled care that require a specific educational focus, such as the increased risk of working in isolation, the ‘high-stakes’ nature of clinical decisions, the relative lack of supporting services and the frequent need to promote self-care, it is important that you spend sufficient time in these environments….As part of your training programme, you need exposure to a variety of community-based emergency and out-of-hours models’.

You will need sufficient evidence of providing Urgent and Unscheduled care for your Educational Supervisor to make a judgement of your capabilities in this area. Evidence may be generated throughout your GP training, including whilst in hospital posts. However, during your GP training posts in ST2 and ST3 you must develop and demonstrate capability in UUC work, including OOHs, outside your training practice.

UUC and OOHs in ST2 GP training posts

In ST2 you should organise observational sessions with other community services providing urgent and emergency health and social care in your area (e.g. Crisis Mental Health, Community Palliative Care, Social services, District Nursing Team, Ambulance service, 111/999; for other suggestions see the document on HEE Wessex GP School website, AIT handbook or talk to colleagues, your Programme Directors and your GP trainer). You should use the UUC observation session record form to record your attendance at such a session and describe your learning. If this record is attached to and expanded on within an ‘OOHs session’ learning log entry then it can provide an effective piece of evidence towards attainment of capabilities in UUC. These sessions are entirely educational (you should not provide clinical care or take any clinical responsibility for patients) and therefore contribute to the educational component of your 40 hour working week. Some could be done ‘in hours’ during your personal study session or on Wednesday mornings when you are not attending Day Release, but it is also important that several are done out of hours when there is a more limited range of services available and patients or clients are likely to be unfamiliar to the team.

UUC and OOHs in ST3

UUC experience outside your training practice during ST3 will be done with the Out of Hours provider(s) for your area. You should identify early on who provides urgent primary care services for your practice in the OOHs period and approach them directly to organise training shifts. For trainees in Southampton CCG practices the main provider for OOHs GP appointments is Southampton Primary Care Ltd (SPCL). For trainees in West Hampshire CCG practices the main providers are Partnering Health Limited (PHL – Winchester, Lymington and Ringwood), Tri Locality Care (Romsey, Totton and Waterside) and Eastleigh and Southern Parishes Network (Hedge end and Botley).

PHL also have the contract for the Clinical Assessment Service (telephone triage) and are subcontracted to provide OOHs home visiting service across Hampshire.

The three types of consultation in UUC and OOHs work are Telephone Assessment (triage), Face to Face (clinic) and Home Visiting (car). Gaining experience in all of these is important to develop fully your capability in UUC and OOHs. You must complete an UUC session record form for each session that you work and attach this to an OOH Session learning log entry. This form records the hours you worked (to justify ‘time off in lieu’ from clinical sessions in your usual working week), the type(s) of consultation and level of supervision, learning points, any capabilities demonstrated and future learning needs. It must be countersigned by your clinical supervisor for the session. An example of a completed form is provided. All UUC/OOHs clinical sessions must be supervised – the level of supervision will vary depending on your prior experience and current competence and should be agreed with your clinical supervisor for each session.

Your GP trainer is ultimately responsible for deciding whether or not you have demonstrated the core capabilities across the range of clinical practice including UUC. It is important that you meet regularly to discuss your progression in this area, identify your main pieces of evidence and consider where there is need for further development and the best way(s) to achieve this. Ultimately you must identify the main pieces of supportive evidence within your ePortfolio using the UUC Evidence for ARCP document and upload this so it is available for the ARCP panel to review if required. It may be helpful to review and update this document together regularly during the ST3 year to help guide your future UUC/OOHs work.