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Out of Hours

COGPED Guidance

Completion of GP Registrar training licenses a doctor to practise independently in any general practice capacity, which includes working in out of hours. The Committee of General Practice Education Directors ( COGPED ) has identified Out of Hours Competencies which should be achieved during General Practice training. GP Registrars are expected to work a minimum one session in out of hours provision for every month based in general practice training to acquire these competencies.  OOH Providers have a responsibility to provide training opportunities for GP Registrars, but the salary for GP Registrars which includes out of hours commitment is paid by the Deanery. Different OOH providers have different arrangements for payment of clinical supervision. 

Clinical Supervision

GP Registrars must at all times work with a clinical supervisor approved by the Deanery. Clinical supervisors are approved after undertaking a clinical supervisor’s course run by the Deanery (check Courses button for details of next course).

Current GP Trainers are automatically approved as clinical supervisors, and the following clinicians may also apply in writing to the Director of Postgraduate General Practice Education for approval on the basis of previous training experience:

  • Former GP Trainer
  • Undergraduate Medical Student Teacher
  • Working in a GP Training Practice as a partner and undertaking regular clinical supervision in the past 2 years
  • Nurse Practitioner Lecturer or Emergency Practitioner Lecturer

 

At no time should the GP Registrar undertake tasks for which he/she has not been trained, nor undertake tasks to a level greater than that for which the clinical supervisor is personally responsible.

GP Registrar Responsibilities

The GP Registrar must be aware at all times of their level of clinical competence, and has professional responsibility for seeking advice and clinical supervision when required. It is the responsibility of the GP Registrar to seek appropriate help with the management of any case which has caused concern, and the GP Registrar should only proceed to take clinical responsibility having received satisfactory advice to cover all areas of concern. Should the GP Registrar not feel competent to take clinical responsibility, it is the responsibility of the OOH organisation and the clinical supervisor to make alternative arrangements for management of that particular patient.

GP Registrars must be insured with a Medical Defence Organisation (a condition of training as a GP Registrar), which will provide indemnity in the event of a clinical error during the management of a patient.

The GP Registrar must liaise with the clinical supervisor at the start of each shift and is responsible for ascertaining how the working and supervisory arrangements of the shift will occur, and when and how the feedback will be arranged.

The GP Registrar is responsible for recording clinical experience and educational supervision in the Out of Hours Workbook, which will be incorporated into the e-portfolio, used for providing the evidence for the Educational Supervisor at the end of the training to confirm OOH Competence for workplace based assessment.

Stages of OOH Training

It may help OOH Providers and Clinical Supervisors to identify three stages in GP Registrar OOH training:

  • Red (should only work fully supervised, supernumerary status, progressively taking clinical responsibility for a case load under direct supervision)
  • Amber (should be supervised on site, taking clinical responsibility for case load, but managing most cases without direct reporting to supervisor)
  • Green (may work with remote supervision, for example, clinical supervisor doing mobile shift but able to attend the patient and GPR in a safe and reasonable time, taking clinical responsibility for the OOH session).

 

All GPRs are expected to be operating at green level by the end of their year in order to be signed up as competent.

Links to Documents:

 

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