When the GP contract was renegotiated in 2004, out-of-hours medical services were transferred to PCTs and so was the responsibility for training GP registrars.
This training was included in the contracts awarded by PCTs to out-of-hours service providers, with the proviso that GP trainers retained educational governance and certifying achievement of out-of-hours training requirements. The responsibility for organising out-of-hours training and ensuring that the required number of hours is achieved is, however, left with the individual GP registrar.
Some GP trainers work in the out-of-hours service and can supervise the GP registrar personally, making the whole pro- cess simpler. However, this seems to occur infrequently and the GP trainer is under no contractual obligation to do this.
In the majority of cases the GP registrar has to establish which out-of-hours service providers the PCT has commissioned for patients in their trainer's area. Usually the trainer will be able to supply this information, and will have relevant contact details. If not, the officer overseeing out-of-hours in the PCT will provide this information.
The out-of-hours service provider should be accredited to provide out-of-hours training for GP registrars, and it is important to ensure this is in place.
This can be checked with the relevant deanery, which has the responsibility of approving both out-of-hours service providers and clinical supervisors working in out-of-hours care.
Once contact has been made, the out-of-hours service provider will request current copies of the following documentation:
- GMC registration.
- Membership of an indemnity organisation.
- Inclusion on the local PCT's performers list.
- A recent enhanced Criminal Records Bureau check.
The name and address of a GP trainer's practice with an out-of-hours contact number for the trainer is usually requested, as well as the GP registrar's email address and mobile number.
The out-of-hours service provider will also send a copy of their IT and confidentiality policy document to be signed and returned. A pro forma allowing the GP registrar and GP trainer to confirm the GP registrar's training status (ST1, ST2 or ST3) and an assessment of any particular training needs can be sent for completion.
Once all the documentation has been approved, the out-of-hours service provider's out-of-hours training officer will arrange sessions with suitable clinical supervisors. Ideally, there should be a central booking service, which can confirm the sessions, ensuring that the mix of telephone triage, primary care centre (PCC) and home visiting hours are easily arranged. The clinical supervisors will usually be GPs, but may be emergency care practitioners or nurses.
The first session will include an induction and GP registrars will be expected to provide evidence of recent basic life support training (within 12 months) and child protection training (within 24 months).
While most out-of-hours experience will be in telephone triage, and PCC and home visits, it is acceptable to use time spent with ambulance crews when responding to emergency calls.
Most ambulance services will allow GP registrars to accompany crews as observers, but they will not be involved in the treatment of patients.
It is important that the sessions are either with a suitably qualified clinical supervisor or a clinical supervisor is available remotely during the session and can perform the end of session assessment and debrief.
The level of equipment a GP registrar is expected to provide varies between providers, with some requiring full diagnostic tools. It is best to assume a need for at least the following:
- Patella hammer.
- Glucometer and test strips.
It is also usually a good idea to have a copy of a prescription formulary.
Out-of-hours service providers expect GP registrars to follow the same level of dress and behaviour they would adhere to in the GP training practice (consistent with the GMC's Good Medical Practice).
It is important for GP registrars to regularly update their ePortfolio with evidence of out-of-hours sessions. Carrying blank copies of the RCGP record of out-of-hours session is helpful.
Finally, because the GP registrar must not only achieve the required number of hours, but also show competency in care of the acutely ill, it is important to allow plenty of time to arrange relevant sessions. The sessions should average six hours a month to achieve the target of 108 hours. The out-of-hours service providers have a responsibility to provide sufficient training capacity, but cannot be expected to provide sessions at short notice at the end of a GP registrar's training period.
- Dr Law is a medical adviser on out-of-hours services for East of England Ambulance NHS Trust in Essex
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