Guidance to progression of sessions for trainees

Suggested structure to GPST training

As a guide, the 18 month in general practice can be broken into ”three stages”. GPSTs who undertake a GP placement in their ST1 and ST2 years would not normally be expected to move beyond the Red or Amber sessions in that time.

Red Session

(Direct Supervision) First stage (months 1-2)

GP Educational or Clinical Supervisor works an OOH session with the GPST but the GP Educational or Clinical Supervisor sees patients and GPST remains supernumerary.

The GPST should progressively take personal clinical responsibility for a caseload, initially under direct supervision of the GP Educational or Clinical Supervisor, (as in a Joint Surgery format).

The GPST may then, with agreement of their GP Educational or Clinical Supervisor independently see and report back after each consultation to agree a management plan

Amber Session

(Close Supervision) Second stage (months 3-5)

GP Educational or Clinical Supervisor and GPST both attend OOH sessions and both see patients. The GPST should be able to manage most cases without direct reporting to their supervisor.

Green Session

(Remote Supervision) Third stage (months 6-18)

The GPST trainee works the OOH session with the GP Educational or Clinical Supervisor being directly contactable, elsewhere on-site, at home or in a `roving’ car.
The GP Educational or Clinical Supervisor must be able to give advice on request, assess the situation and in very rare circumstances be available for joint consultation. More usually advice on process, necessity for admission or availability of other agencies can be given over the phone.
Please note all OOH must be completed or booked by the final ARCP.
The Cheltenham Trainer’s group have refined the Red Amber Green system and added more description. The group have defined the level of supervision of the colours to mean the following in practical terms:

Red

Amber

Green

All clinical contact observed or all cases assessed before end of session

Random cases assessed

Problem cases assessed

However it is important to differentiate telephone triage, face to face base sessions, and face to face visiting sessions as progress along the traffic light system is likely to vary between the different roles, with telephone triage being the most challenging. The table below allows progress to be recorded:

 

Red

Signed by ES

Amber

Signed by ES

Green

Signed by ES

Car Face to Face

Date Achieved

 

Date Achieved*

 

Date Achieved*

 

Base Face to Face

Date Achieved

 

Date Achieved

 

Date Achieved

 

Telephone

Date Achieved

 

Date Achieved

 

Date Achieved

 

The Educational Supervisor is responsible for assessing the evidence provided and signing off a trainee as they achieve each level for the different OOH roles. However before a GPST can progress from doing closely supervised (Amber) shifts to remotely supervised (Green) within the OOH organisation it is good practice for the OOH Supervisor who has been supervising the GPST to sign a declaration that they have no concerns with the GPST’s performance. This should then be shared with both the OOH organisation and the GPST’s Educational Supervisor. Such a declaration will be based on observed practice whilst under close supervision

I confirm that I have no concerns with the clinical performance of .................................................with regard to.......................................................

Role

Clinical Supervisor Name

Clinical Supervisor Signature

Date

Car Face to Face Consultations

 

 

 

Base Face to Face Consultations

 

 

 

Telephone Triage Consultations

     

* Some OOHs provider organisations do not permit GPSTs to visit unaccompanied by their Clinical Supervisor.

Telephone Triage

Telephone triage skills are included in the GP Curriculum Statement 3: Care of Acutely Ill People and were mentioned in the original COGPED competency framework. Telephone triage is a very important aspect of OOH work and vital for the safe, effective delivery of OOH services as they are currently organised. Telephone consulting requires additional consultation skills as visual cues are not available. Safe and effective triage requires high order decision making and risk management skills along with a good knowledge of locally available resources for delivering the required healthcare to patients at the most appropriate time and place. Experienced OOH Educational Supervisors find that most GPSTs will require 10-15 hrs experience of telephone triage at red or amber to feel competent and be able to do a few hours of dedicated telephone triage at green level.

Recommendations for Recording Sessions and Level of Supervision to Inform Clinical Supervisors

While the ideal would be to have all recording electronic in the e-portfolio the reality is that OOH clinical supervisors do not currently have access to a trainee’s e-portfolio so a practical system to allow clinical supervisors to be able to quickly review a trainee’s previous OOH experience and current level of OOH supervision needs to be in place. It is suggested that trainees keep a file/folder containing a summary log of their OOH sessions to date (Trainee Workbook Appendix G); the record of their progression through the traffic light system (Appendix F) and the hard copies of their individual session log sheets (Trainee Workbook Appendix E). This file can then be reviewed by the clinical supervisor at the start of a session. The individual session log sheets are the vehicle for communication between clinical supervisors and educational supervisors. The self assessment tool (appendix A) and identification of learning needs sheets (Trainee Workbook Appendices B, C and D) could also be included in this file. When all OOH sessions have been completed these records could be scanned into the e-portfolio to contribute towards the evidence for attainment of OOH competencies.