Getting the best out of your out-of-hours
In the second in a
two-part series on
out-of-hours, Dr Mei Ling Denney looks at how to make the most of your sessions
Out-of-hours sessions can often be busy, and you need to be organised if you are to get the best out of the time available. A number of skills and competencies have been identified that are necessary for working in an out-of-hours environment.
Regardless of your future intentions for GP work, you need to be equipped with
these competencies by the time you have completed your vocational training. It is worth considering the three headings of:
Get to know the COGPED out-of-hours workbook for registrars and make use of it as soon as possible. Read through the guide first to get an overview of the areas you are expected to cover, and the competencies required for them. There are five key competencies for out-of-hours care:
1 Ability to manage common medical, surgical and psychiatric emergencies.
2 Understanding the organisational aspects of out-of-hours care, nationally and locally.
3 The ability to make appropriate referral to hospitals and other professionals.
4 The communication and consultation skills required for out-of-hours care.
5 Individual time and stress management.
Next, take a look at the competency assessment tool – this is there to inform and supplement the structured trainer report that your trainer needs to be able to sign before you are deemed fit for independent practice. From this you can see that each key competency area may be further subdivided, such as competency 1 – 'Ability to manage common medical, surgical and psychiatric emergencies' – which is divided into:
1a Knowledge of clinical conditions
1b Knowledge of symptoms
1c Ability to carry out basic life support
For each competency area or subdivision, there are three headings at the top: novice, competent and proficient. Under each heading there is a description of the competency expected of a registrar for this level. You are not expected to be 'competent' or 'proficient' at the start of your out-of-hours training, but needless to say you should progress towards this with increasing experience.
In keeping with much of your postgraduate education, you are expected to be a reflective learner. Over the year you will undertake three reviews with your trainer, one at the start of training, one around the mid-point and one towards the end of training.
Before embarking on these you need to look at each competency area and, using the guidance, decide whether you are novice, competent or proficient in each. There is another box where you can write in the evidence for this, and a further box for your trainer or supervisor to add comments.
Finally, there are sheets on which to keep a record of each out-of-hours session. Print these out and bring at least one along to each session. There is space for you to fill in the date, type and length of session, the case types seen and any significant events, and the learning needs to be identified.
The clinical supervisor has space to add debriefing notes, and it is important to get their signature at the bottom.
While working in the out-of-hours centre, you should get to know the roles of staff and other healthcare professionals involved in the care of patients. Find out how they work as a team, and how they and you can communicate effectively. The list could include:
• Practice staff, drivers and managers
• Healthcare assistants, nurses, extended care practitioners or nurse prescribers
• Ambulance and paramedic services
• District nurses and intermediate care nurses in the community
• Social services; palliative care services
• Police and police surgeons
Make sure you know your way around the office, and how to use any intercoms, phones, radios and computers. How do GPs send in information about specific patients about whom they have concerns? Is information about at-risk patients or violent patients made available?
How does information get fed back to the GP? What about patients who cannot speak English, or who need to communicate through sign language?
It is helpful to see as many different patients as you can, and consider whether you are covering the range of conditions that can present in an out-of-hours situation.
The evidence you need to collect to demonstrate your competence in an area could include some clinical case reviews that reflect the differences between daytime normal GP care and out-of-hours care.
Try to target your learning appropriately by asking others to look out for specific patient types or scenarios, and point you in their direction, such as:
• Dealing with a death
• Managing a terminal care patient
• Dealing with drug and alcohol problems
• Mental health sectioning of psychiatric patients
•Pregnancy and its complications
• Social care problems requiring district nursing or respite care
Finally, make sure you write up relevant out-of-hours experiences, and store these safely. Get the opinion of your trainer or educational supervisor regarding any identified learning needs, as well as suggestions of how to address these.
At the end of the training year your trainer must have sufficient evidence that you are competent in the delivery of out-of-hours care. You will have benefited from the experience, and will be in a good position to take up work in an out-of-hours centre as a fully qualified GP.
Mei Ling Denney is a GP in Peterborough and a trainer in the local out-of-hours centre