GP Training: Urgent and Unscheduled Care (Including Out-of-Hours)

To obtain the Certificate of Completion of Training (CCT), GP trainees must demonstrate their ability to provide Urgent and Unscheduled Care (UUC) to patients, which also includes Out-of-Hours (OOH) services. This article will discuss everything you need to know to ensure you complete your urgent and unscheduled care requirements set by the Royal College of General Practitioners (RCGP).

 

What is Unscheduled Care?

Unscheduled and urgent care essentially refers to a doctor’s ability to deliver medical, surgical, and mental emergency care that is distinct from planned care. This includes providing care after hours, as well as showing competence to deal with an emergency during usual working hours. 

Urgent GP appointment reasons can be rather diverse and vary in severity; the RCGP therefore puts great emphasis on the UUC/OOH component of your training. The key capabilities pertinent to such emergency medical services as outlined by the RCGP include:

• The delivery of safe patient-centred care

• Effective communication utilising the range of modalities encountered in delivering this care

• Maintaining continuity for patients and colleagues, including coordination across services

• Enabling patient self-efficacy

 

UUC/OOH Requirements

Although the RCGP does not specify a number of hours or log entries needed in the unscheduled care division, there are particular features most likely experienced in a primary care urgent care setting that necessitate an educational focus, such as working in isolation with lack of support. 

Therefore, you need to spend a significant amount of time in these environments to gather and provide adequate evidence of capability in all five of the Professional Capability Areas, into which the 13 RCGP Professional Capabilities (Table 1) are organized. 

Note that in some regions of the UK, a GP trainee’s contractual agreement may require them to complete a certain number of hours as an out-of-hours doctor. 

 

Professional Capability Area	Professional Capability
Knowing yourself and relating to others	Fitness to practice
	Communication skills
	Ethical Approach
Applying clinical knowledge and skill	Data gathering
	Clinical examination & procedural skills (CEPS)
	Making decisions
	Clinical management
Managing complex and long-term care	Managing medical complexity
	Working with colleagues & in teams
Working well in organisations and systems of care	Performance, learning, and teaching
	Organisation, management, and leadership
Caring for the whole person and the wider community	Practising holistically and promoting health
	Community orientation

Table 1 The RCGP Professional Capability Areas pertinent to Urgent and Unscheduled Care / Out-of-Hours.

 

The RCGP curriculum utilises Miller’s pyramid of clinical competencies as a framework to map the type of opportunities and experiences that contribute to the achievement of the Professional Capability Areas. In accordance with this model, the types of sessions for the development of capabilities articulated by the RCGP are summarised in Table 2.

 

Type of Session	Stage of Training	Details
Observational	Typically ST1	Observing health professionals in urgent and unscheduled care settings without input Attending relevant courses
Direct	Typically ST1/2	Consult patients under supervision (time off in lieu given if after hours)
Near	Typically ST3 (ST1/2 if competent)	Consult patients independently with the approved clinical supervisor readily available in the building (time off in lieu given if after hours)
Remote	ST3 only	Consult patients independently with the approved clinical supervisor available by phone (time off in lieu given if after hours) Must have completed at least 6 months of whole time equivalent “Near” sessions.

Table 2 Types of UUC/OOH sessions.

 

There is a range of NHS emergency settings where patients present in an unscheduled and urgent manner, including:

• Duty Doctor for the surgery (i.e. on-call surgeries) 

• Out of Hours Emergency GP Centres 

• GP centre attached to A&E departments 

• GP Extended hours work where the appointments are for acute unscheduled problems and not routine

• Other primary care emergency/acute services delivered within a secondary care or community care provider

Although it is recognised the knowledge and skills to provide urgent and unscheduled care can be gained “in-hours” – such as GP emergency appointments, doctor home visits, or working as a doctor on-call at your practice – it does not suffice to meet the RCGP Professional Capabilities. 

Therefore, you MUST engage in both GP out-of-hours work and GP in-hours emergency work; you will gather most of your evidence from these two areas.

Your experience from placements in A&E as an emergency doctor, Paediatrics (especially Paediatric Emergency Assessment Units), Medical Assessment Unit, as well as Psychiatry on-call can count towards your UUC requirements.

Nonetheless, this should only be viewed as supplementary evidence rather than being the prime focus of your documentation. You must engage in a mixture of services to showcase you have developed the full range of UUC capabilities.

You must discuss your learning with your Education Supervisor in a focused manner, relating to one or more professional capabilities and in the context of your work as a future GP. It is your responsibility to ensure you have gathered enough experience of sufficient diversity.

Your Educational Supervisor will then determine whether your presented evidence is satisfactory and sign off the final Education Supervisor Report (ESR).

 

UUC/OOH Documentation

Documentation of UUC can be done in two ways:

1. Clinical case reviews: this refers to sessions where new learning has occurred upon which you wish to reflect.

2. Completing the UUC/OOH session feedback form with your Educational Supervisor for each session and uploading it to the Supporting Documentation Form of your learning log. 

In the case of a contractual agreement to complete a certain number of UUC/OOH hours, you will need to document the number of sessions and hours on a spreadsheet, which should be uploaded to your ePortfolio under OOH/Supporting Documentation. Beware this is not the equivalent to fulfilling the NHS unscheduled care agenda and evidence for this should be gathered and signed off by your Educational Supervisor separately.

 

References

1. Urgent and Unscheduled Care – Trainee and ES Guidance. Royal College of General Practitioners.

https://www.rcgp.org.uk/training-exams/training/mrcgp-workplace-based-assessment-wpba/urgent-and-unscheduled-care/uuc-trainee-and-es-guidance.aspx

2. Supporting the Educational Attainment of Urgent and Unscheduled Care Capabilities in General Practice Specialty Training. Committee of General Practice Education Directories. 2019.

https://www.rcgp.org.uk/-/media/Files/GP-training-and-exams/WPBA/UUC-OOH/WPBA04---COGPED-Position-Paper-Urgent-Care-Capabilities-March--19.ashx?la=en

3. York GP Training Scheme – Urgent and Unscheduled Care (UUC). NHS Health Education England.

https://gp-training.hee.nhs.uk/york/your-training/ooh/

4. Urgent and Unscheduled Care (UUC). NHS Health Education England.

https://heeoe.hee.nhs.uk/general_practice/urgent-and-unscheduled-care