Urgent and unscheduled care training guidance

GP registrars must demonstrate capability in urgent and unscheduled care as part of GP training. This includes delivering safe patient care, demonstrating effective communication skills, maintaining continuity for patients and colleagues, coordinating across services and enabling patient self-efficacy.

The “Clinical Management” capability specifically requires that GP registrars are able to “[provide] urgent care when needed”, and that GP registrars must “Recognise that responding to unscheduled requests for urgent care is a core part of a GP’s role as a frontline practitioner”.

This guidance will explain in more detail what is required to demonstrate capability within this area.

The mechanism of delivery of Urgent and Unscheduled care (UUC) (which includes Out of Hours (OOH) services) varies across the four countries of the UK. GP trainees have different contractual arrangements in each of the four countries and this affects what they are required to demonstrate and record in their ePortfolio.

The RCGP curriculum does not specify a set number of hours needed to meet the capabilities within this setting, nor a specific number of log entries.

However, the COGPED and RCGP Out of Hours Urgent Care Position Paper states that:

“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 [registrars] will need significant opportunities to develop these capabilities in Out of Hours Services / primary care based urgent /unscheduled care provider organisations.”

The GP Curriculum describes the scope of practice of a GP in the NHS as being defined by the Standard General Medical Services Contract and including out-of-hours services.

It is the responsibility of the individual trainee, in discussion with their Educational Supervisor, to ensure that they have sufficient experience across a range of settings to be able to meet the required capabilities. It is the responsibility of the Educational Supervisor to ensure that they are satisfied that these have been met before signing off the final Educational Supervisor Report (ESR).

In some areas of the UK, GP registrars will have a contractual requirement to complete a specified number of OOH sessions / hours. Fulfilling this contractual requirement should not be seen as equivalent to meeting the curriculum capabilities. GP registrars will still need to be signed off as competent in these capabilities by their Educational Supervisor and this may require more hours than the contractual requirement.

Recording evidence on the trainee portfolio

Experiences and learning from individual cases in UUC / OOH should be recorded in the learning log to demonstrate progression and achievement of capabilities, as for all other settings. These entries should be linked to the clinical experience group Urgent and Unscheduled care (including Out of Hours).

An UUC/OOH form needs to be completed by the UUC/OOH supervisor and GP registrar after each session, (it is recognised this will not be possible when the GP registrar has gained sufficient experience and is working remotely with the supervisor only available by telephone). The GP registrar should share any completed forms with their Educational Supervisor and/ or note relevant cases seen in the session for discussion with their Educational Supervisor. These forms can also be attached by the GP registrar to the supporting documentation section of their learning log. It is recommended these forms are added as evidence of attendance and experience in UUC/OOH.

However, for those GP registrars who have a contractual requirement to complete UUC/ OOH sessions / hours, a spreadsheet will need to be completed and uploaded to the supporting documentation section of their learning log so that it can be reviewed before the completion of training.

Documentation of Urgent and Unscheduled care can be done in 2 ways:

  1. Clinical case reviews, where new learning has occurred allowing for reflection on this learning.
  2. Completing the UUC /OOH session feedback forms with the supervisor for this session. These should be shared with the ES and also uploaded to the supporting documentation section of the learning log. 

The following documents provides further explanations of Urgent and Unscheduled care: