Urgent Unscheduled Care (UUC)/ Out Of Hours (OOH)

Thames Valley and Wessex UUC/OOHs policy can be found here and RCGP guidance here. 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 RCGP’s Trainee and ES guidance states:

“whilst it is recognised that knowledge and skills needed to develop Urgent and Unscheduled capabilities may be gained “in hours” and in varying secondary / community / urgent care services there remain particular features more likely encountered in a primary care urgent care setting that require specific educational focus. Thus, to gain experience of, for example, working in isolation and with relative lack of supporting services GP trainees will need significant opportunities to develop these capabilities in primary care based Urgent and Unscheduled care / Out of Hours provider organisations.”

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 talk to colleagues, your TPDs and your GP trainer). Spending a session observing 111/999 call handlers and clinicians in action is particularly recommended since this is where most patients first contact the urgent care system for navigation onwards to the different services available.

You can use the UUC observation session record form to record your attendance at such a sessions and describe your learning. If this record is attached to and expanded on within a Supporting Documentation 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 some 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 (you shift the timing of your personal study session to achieve this).

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 practices the main provider for OOHs GP appointments is Southampton Primary Care Ltd (SPCL). For trainees in West Hampshire 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 Urgent and Unscheduled session feedback form for each session that you work and get this countersigned by your clinical supervisor for the session. This form should be shared with your GP trainer to confirm 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. It can be uploaded and stored on your ePortfolio as ‘Supporting Documentation’. 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 (i.e. Clinical Case Reviews, CbDs, COTs) and consider where there is need for further development and the best way(s) to achieve this. You can use the Urgent and Unscheduled Care Evidence grid (Appendix 1 of Wessex UUC policy) or the RCGP’s Trainee logsheet linking outcomes to urgent and unscheduled care learning log entries to support this process (one of these documents should be uploaded as ‘Supporting Documentation’ and clearly identified so it is available for the ARCP panel).