Out of Hours
Out of Hours (OOH) training and the new Junior Doctor Contract
As a direct result of the new Junior Doctors contract, and the changing nature of how the NHS is delivering unscheduled care to patients, we have had to rethink OOH training.
Under the new contract any time spent working out of hours will not be additional to the 40h working week but will be deducted from it. Therefore, more time spent in OOH working means less time spent in hours. This then alters significantly the educational balance.
After much consideration, and based on national guidance, it was decided that, for all trainees (regardless of whether they were on the old or new Contract) from the August changeover 2017;
First GP post (generally ST1);
- GP Trainees will not usually undertake any OOH work
- Instead they should be prepared for later work in this field by:
- Experience gathered through educational interventions which could include telephone triage, consulting skills in hours
- Observation of urgent / unscheduled care provision within hours
- In Hours experiential work in the practice
- Agreement should be reached between Trainer and Trainee as to whether the sessions are drawn from the educational or clinical sessions. However, there will need to be a level of consistency regarding this; the expectation therefore is:
- Where there is no service delivery - educational session
- Where there is some service delivery - clinical session
Second and third GP posts (generally ST3):
In North Cumbria GP Training Programme, trainees will address their learning needs in this field through the following:
- At least 1 educational session on delivering unscheduled care should be delivered in house by the in-hours GP trainer (clinical supervisor), and one day should be spent delivering such care under close supervision
- CHOC Out of Hours Induction Programme – up to 32 hours to be taken as study leave and delivered in hours where possible at the beginning of the first of the two GP placements in ST2/3. This course will cover management of acutely unwell adults and children, palliative care, intermediate care, mental health, learning disabilities, telephone triage, the company, governance and IT systems. Attendance is mandatory, and in addition to the current regional teaching programme.
- Once certified amber or above by the trainer, the trainee will undertake 36 hours of OOH work in each 6m GP post with Cumbria Health On Call, working within their normal shift pattern where possible, but with no overnight shifts. The time will be deducted from in-house clinical sessions.
- In a standard training programme, the expectation is therefore that trainees will undertake 72 hours of OOH work in total.
- For those trainees who undertook OOH work earlier in their training and prior to the transition to the new Junior Doctor contract, the expectation of a total of 108 hours of OOH work remains (ie. Hours undertaken in ST1 are not deducted from the 72 hours required in ST2/3). However, if a trainee did not complete their full 36 hours of shifts in ST1, there is no requirement for these hours to be “made up” in ST2/3.
- Occasionally the clinical needs of a patient or an unusually timed shift might mean that hours are worked in excess of this norm, but this excess time would normally be taken back from a later OOH shift rather than in house clinical work.
- Where practices provide extended hours clinics (6-9pm and at weekends) either individually for their own patients, or through federations on behalf of practices, there is obviously complementary value in trainees being exposed to this kind of work. It is now a feature of general practice, and there are clear overlaps both with in-hours general practice and “traditional” OOH work. Where practices specify in their work schedules that trainees are expected to experience this kind of work;
- The total hours worked each week should not exceed 40 hours
- EWTD regulations about rest periods should be observed along with compliance of the 2016 T&C’s (available on NHS Employers website)
- When added to the trainee’s work with the OOH provider, the trainee will not work on more than 3 weekends per 6m WTE post
- Such work is complementary to and does not replace OOH shifts
- No hours are worked in the practice between 9pm – 7am.
- Any trainee in an extension or receiving targeted training would have a decision made on a case by case basis by their support TPD, entirely governed by their educational needs and where they would best be addressed, which might involve no OOH work, or that of, but not usually exceeding, an ST3 post. Such trainees should, by the end of their training, have completed, at a minimum, the same number of sessions as a standard trainee.
- Any trainee rated red should be actively withdrawn from their OOH commitments and the matter referred to their support TPD / the Training Programme
A note about the European Working Time Directive
- Please note that this still applies, and any OOH schedule will need to maintain the necessary breaks / maximum shift lengths. The maximum shift is 13 hours and there has to be an 11-hour break. So, for example, if a trainee does a 6.30pm-12.30am shift they can only start work at 11.30am on the day of the shift and 11.30 the day after the shift. If that then results in them working less than 40 hours that week, they will need to work the “missing” hours elsewhere (not necessarily in the same week).
If you need more information or have a question that the description above or linked documents below do not answer, please speak to one of the Training Programme Directors.
It is important that you also visit the HEE OOH area - this provides details of the regulations regarding out of hours training, the EWTD and includes the most up to date versions of forms.
Paperwork requiring completion:
- OOH1 – Form for recording your shifts. Needs to be uploaded to e-portfolio
- OOH2 – Trainee feedback for Clinical Supervisor
- OOH3, OOH4 and OOH5 – Confirmation of Red/Amber/Green status for solo working
OOH Induction Course
Cumbria Health On-Call (CHOC) provide the local GP out-of-hours service.
Before commencing OOH work all trainees must attend the OOH training provided by CHOC at their highly regarded induction course run as a series of training sessions over 3 days in the February of ST2. Once completed attendees can start their OOH work under the supervision of an experienced GP. For some trainees, the course will take place during their last hospital post and so their OOH work will start once they return to practice in their next placement.
Personal Study Half Day and Out of Hours Training Course
This is to clarify the situation with respect to the above. The principles we have established from previous discussions at Trainer Workshops are as follows:
- We expect that all GP registrars will complete the Out of Hours Training Course during their training.
- Time for attendance of the course will be taken out of formal study leave. Application for this must be made to the Training Practice or Hospital Trust (depending on what post the trainee is doing at the time of the course) in good time to ensure that it can be approved.
- The Postgraduate School of Primary Care has made it quite clear that trainees can have a weekly half-day away from patient contact, but that this should be used for personal study. We have called this personal study time and is also separate from study leave allocation.
- Attendance at the out of hours training course entails time out of the practice. We have agreed that this impinges on daytime clinical experience, and that clinical exposure should be a priority.
- The conclusion therefore is that in the weeks that GP trainees take a day out for the out of hours course, they should forgo their personal study time and substitute this with patient contact.
The next course will take place on 27th February – 1st March 2018. This course will run over 3 days (a reduction from 5 days resulting from elements of the course content being delivered earlier in the training programme).
Clinical Supervisors for OOH - Some GP trainees have trainers who do not do OOH work. In these circumstances, the CHoC holds an up to date list of doctors who have agreed to adopt the role of Out of Hours Clinical Supervisor for GPRs other than their own, or are CHOC Salaried GPs. If you are in need of an Out of Hours Clinical Supervisor please contact the CHoC office: 01228 514830 or Email: firstname.lastname@example.org
CHoC OOH Clinical Guidelines - These are found on the CHoC website in the staff area (username and password required). To obtain a password email email@example.com.
Cumbria Health on Call (CHoC. Ltd) Contact Details
Address: Capital Building, Hilltop Heights, London Road, Carlisle, CA1 2NS
Tel: 01228 514830
Fax: 01228 402803