Out of Hours AuditReading and Newbury VTS

2014Dr K Emerson

Health Education Thames Valley

Audit of completion of satisfactory OOHs sessions in ST1/2Reading and Newbury VTS 2014• Are we policing our ST1/2 OOHs?• Are our ST1/2 fulfilling their contractual

obligation to do and record OOHs session?• What should we do with Trainees that we

know are not fulfilling this?

Introduction:• ST1/2 are contractually required to complete 36 hours in ST1 or

6 sessions in ST 2 of out of hours (OOHs). • This is a contractual obligation not educational. • To ensure coverage of curriculum areas such as acute medicine. • Educational supervisors asked to confirm satisfactory

completion of OOHs at the end of ST3• No such requirement within the portfolio for ST 1/2. • Accepted that as long as completed ie 18 months worth by the

end of ST 3 ok.• Recently disputed with the recommendation that insufficient is

a reason for referral to panel.

Criteria • ST1/2 should have completed and have recorded in

their logs the correct amount of OOHs either 36 hours for ST1 or 6 sessions for ST2.

• If they have insufficient the trainee should be discussed with PDs (educational team).

• Consideration should be made re referral to panel.• Those with insufficient should be referred to panel.• If insufficient with no referral there should be an

educator note to explain this.

Standards:• 100 % of trainees should have satisfactory

OOHs recorded within their portfolio or• If they have not 100% of the trainees should:• Have been brought to the attention of the PDs

by the ES• Be referred to panel. • Have reasons for not referring to panel

recorded in their educator notes.

Method:• After completion of the ESR in the first 6

months checked eportfolio to see what OOHs had been recorded and if these were sufficient.

• If these were not sufficient we checked to see if:We had been made aware of this by the ES, There was an explanatory note within the Educator

notes, either stating why or if future sessions booked, or sessions done but not yet recorded.

The trainee had been referred to panel.

Results:• Of the 4 ST1s in general practice only one had recorded sufficient OOHs

hours.• The range of hours recorded was 26-36.5.• Of the 7 ST2s in general practice 1 excluded as yet to complete the 6

month equivalent of time. • Only 4 out of 6 had recorded sufficient OOHs sessions• Range from 1-10 sessions.• Overall only 5 out of 10- 50% had recorded sufficient.• For these one ES had recorded within the ESR that numbers were short.• No other ES had commented • None had recorded an educator note.• Only one ST had been reported to us and that was not for lack of OOHs.• None had been referred to panel for OOHs.

Conclusion:• We are not checking for satisfactory completion of OOHs for ST 1 and 2 s.• Is this a reflection of our lack of policing or a belief that it is acceptable to leave to make up in ST3?• Do panel really wish all those that are short to be referred? What outcome will they get? Should there

be clear deanery or national guidelines on how to manage this?• Discussed with the panel chairs, the Dean, posted a discussion on the DALS noodle site and asked Dr

Jonathan Foulkes FRCGPMedical Director Quality Management & Training Standards RCGP for guidance his response was:

• “ I think most deaneries do give either an OC 5 (if there is still chance for then trainee to make up the deficit somehow) or an OC1 with dire warnings added to the additional comments box in the ARCP Panel report. As you say, all other OCs are inappropriate. However at the end of the day, so much depends on each individual deanery/LETB. Every deanery/LETB seems to have its own set of rules. The college is as you know concerned with overall competence in OOH care at the end of ST3. Exactly how many hours/sessions are done is up to the deanery just so long as the trainee follows COGPED guidance (which is very non-specific anyway). As a result, to date, there has been no national consensus on how to approach the problem of the ST1 or ST2 who has not fulfilled their OOHs requirement in a GP Post. The responses from the DALS Moodle site 3 saying they would refer to panel but give an outcome 1 with strict notes to make up the time in ST3. One deanery was giving outcome 5s

• In summary at present there is not clear guidance on this area.

Out of hours requirements:Guidance;• ST1- 36 hours • ST2- 6 sessions 2013-2014 after which -36 hours• ST3- 72 hours unless starting ST3 year before Aug 13• If ST1/2 have completed less than their full OOHs at the end of

their GP placement they should be referred to panel at their 6 month review or at their end of year/ gateway review which ever is the first review after the GP placement.

• If ST3 has completed less than their full OOHs (unless up to 2 sessions booked, recorded in educators notes), at their end of year/ final review they should be referred to panel.

• All above apply even if trainee is otherwise making satisfactory progress.

Plan:• Advise all ES of this guidance.• Advise trainees of the importance of OOHs and

meeting contractual obligation.• Re-audit June 2014.