Trainees must work a minimum of 36 hours of shifts in every 6 month GP post including Integrated Training Posts (ITPs) unless doing on call in the secondary care part of the post. Less than ful time trainees work a pro rata minimum number of hours. They are supervised initially by a clinical supervisor who is present with them and later may be only available by telephone. This OoH work is funded in the current salary. Most of the time, in most places, the supervisor will NOT be the trainer. Detailed arrangements differ amongst the various OOH providers. All trainers are approved OOH supervisors, as are those doctors who have completed the School's OOH supervisors course.
The supervisor creates a record of the shift (OOH1) which the trainee takes back to the trainer, for debriefing and for recording in the educational record of that trainee. The session record should include the shift duration in the title and OOH1 be scanned onto the learning log entry for that date.
Trainees will always work under close supervision, until their competence for remote supervision is confirmed by the trainer using the OOH3 and OOH4 forms . The traffic light system is used i.e.
- Red = Not ready for own OoH caseload (OOH5)
- Amber = Can manage own shift, with supervisor present (OOH3)
- Green = Can manage own shift with remote supervision (supervisor on the phone, actively supervising and available to attend centre if needed) (OOH4)
Green shifts might be solo (at quiet more rural centres) or alongside a non-supervising doctor in a more urban centre (with the supervisor typically at home or nearby). All green and amber shifts should have protected time for feedback.
A trainer may wish to record additional information onto the form which may help to inform the OOH provider and supervisor eg the trainee consults at X minutes. The trainee needs a higher level of supervision for mental health problems.
Each form should be scanned onto e-portfolio under OOH. The title should include the type of shift and the number of hours worked.
Safeguarding and CPR competence when working OOH
- It is a requirement for GPSTRs to have a current ALS certificate on joining the programme.
- It is a CCT requirement for all GPSTRs to have a current ( within 3 years) BLS certificate at final ARCP
- OOH providers require evidence of CPR competence to align with their operational requirements. This can be via an ALS certificate (last 3 years) or BLS updated every 12months.
- It is a personal professional responsibility to ensure that each trainee has an ‘in date’ Life Support certificate.
- Updates can be obtained either during GP posts (as part of the practice training, and therefore free), in hospital posts (where it should be possible to claim back from the Trust-administered allowance part of the placement fee) or self-sourced. There are recognised providers for this e.g. NE Ambulance. Trainees need to pay for these themselves.
- Some Training Programmes provide a BLS training course in ST3 prior to final ARCP. Check this with your individual programme
- Some trust posts require additional specific courses to be completed in order for a trainee to work in that department e.g. Paediatric Life Support. In such cases the trust will organise the training or forward details of such course to the GPSTR and the trust will cover the cost of the training.
Trainees working green shifts also need evidence of level 3 safeguarding training. Level 2 training needs to be done prior to level 3. This can be achieved either through an appropriate course or other equivalent learning. If a course certificate is not available, the trainer needs ensure that adequate evidence is logged on e-portfolio and sign the OOH4 form if the requirements have been met.
The easiest way to demonstrate level 2 and level 3 course completion is to do an e-module. These are available at http://www.e-lfh.org.uk/projects/general-practitioners/ in the section:
e-GP 3.04d - Care of Children and Young People: Safeguarding
Just doing these modules is not recommended as the only evidence needed for CCT.
GP trainer with direct responsibility for the day to day work of the training must:
The GP Educational Supervisor must:
Ensure that a trainee has done the required number of OoH sessions and total number of hours AND that there is evidence in the portfolio that demonstrates attainment of the OoH competencies. Simply doing the shifts does not provide the necessary evidence. The trainer should see the OoH supervisor's feedback form for each shift.
The easiest way to demonstrate the competencies is to get the trainee to complete a KEEP form detailing where the evidence sits within the eportfolio and to attach this to the eportfolio under OOH. The same form can be used to total up the number of OOH done and recorded on e-portfolio. This should be done for the final ARCP.
If a trainer or trainee has any queries or concerns regarding OoH certification or requirements they should contact their training programme director.
1. GP trainee must:
a. Work a minimum of 36 hours of shifts in every 6 month GP post (including Integrated training posts unless doing on call in the secondary care part of the post), supervised initially by a clinical supervisor who is present with them and later by telephone. This OoH work is funded in the current salary. Shifts should be spread throughout the training period. A trainee who has done all of their shifts within a short time frame may be asked to undertake additional sessions to demonstrate that they have maintained their competencies.
b. Attend all the sessions that they have agreed to.
c. Supply the OoH provider with form OOH3, OOH4 or OOH5 which informs the provider of the level of supervision that they need.
d. Give adequate notice if unable to attend. Late notice of non-attendance puts patient safety at risk. Non-attendance without notice will be regarded as a negative probity indicator and may result in referral to the GMC.
e. Use a learning log entry on their e-portfolio after each shift to inform their educational supervisor of what they have learnt.
f. Demonstrate their competence to the level expected of the GP curriculum, and be prepared to undertake additional training should that be deemed necessary at their annual review.
g. Honour any commitment to undertake out of hours sessions still outstanding when their ARCP is signed off
h. Provide feedback on OoH supervision when asked. Form OOH2 can be used.
i. Maintain CPR competence
j. Ensure that they complete the relevant level of safeguarding training
Advice to Practices about trainee time off before/after OOH shifts
Trainees are contracted to work 40 hours per week by the practice.
This is below the EWTD 48 hour maximum number of hours .
OOH work ( a minimum of 36 hours per 6 months) is on top of this.
Trainees will need time off from practice commitments depending upon the timing of their OOH shifts.
This could affect 12 working days over 6 months.
Trainees often work more than their contracted 40 hours each week and therefore the equivalent time off before/after OOH shifts may well be worked as part of the overall commitment. If, however, trainee's normal working week is at or under 40 hours then practices may ask the trainee to make up the missing hours.
As always, open discussion about this during induction can usually prevent tensions developing, together with the understanding that different practices may have different approaches to this.
Many GP trainees question rest requirements prior to and after OoH shifts in order to meet the EWTD guidance. Please contact the LET
Sessions post final ARCP when outcome 6 awarded
GP trainees may, under certain circumstances, do paid OOH work at the end of training. The conditions for this are in the document below:
AH - Last updated Jan 2014