Many Educational Supervisors no longer undertake OOHs work so may be less familiar with some of the OOH competences. A list of agreed simple specific competences for OOH supervisors to use which ESs could then understand and link to the existing eportfolio and specific OOHs competences has been developed. All the former competences would have to be completed to achieve “amber status” and all the latter competences completed to gain “green status”.

E portfolio Competences (numbers used in following sections to link to OOH competences)

  1. Communication and consultation skills
  2. Practising holistically
  3. Data gathering and interpretation
  4. Making a diagnosis/decisions
  5. Clinical management
  6. Managing medical complexity
  7. Primary care admin and IMT
  8. Working with colleagues and in teams
  9. Community orientation
  10. Maintaining performance, learning and teaching
  11. Maintaining an ethical approach
  12. Fitness to practise

OOH General Competences

The registrar has been (Miller’s Triangle):

  • educated
  • has reflected on cases seen
  • has demonstrated for cases seen

so that he/she knows

Required for Amber

  • to arrive on time to a shift and not to cancel a shift without good reason. Not to be overtired when working in OOH. To Keep to European Working Directive.
  • the basic health and safety- to be bare below elbows, to use orange bins etc, how to deal with violent patients, fire drill. In OOH, if a primary care centre is being rented the Health and Safety may come under a different employer/Trust.
  • how the OOH services are organised both in their locality and generally and can describe the different routes that provide medical care OOH. (7)
  • how calls are passed to OOH, where the OOH primary centres are located and at what times they are open. (7)
  • how calls are passed to GP surgeries in the area and around the country for the next day (7)
  • how to enter documentation in Adastra including how and when to delete previous operator and clinicians histories, making a comment if previous history is incorrect, copying history from previous consultations, using information from special patients notes, how to complete a call and include comments on completion of a call e.g. “ no action required”, “patient to phone practice” (7)
  • how to use Adastra prescribing module. When to use the OOH formulary and when to prescribe any drug and when to prescribe from the “stock formulary”. (7)
  • how to deal with prescription charges if issued from OOH stock. (7)
  • how to avoid prescription fraud or prescriptions being stolen; how to deal with suspicious prescription requests for drugs of abuse. (11)
  • how to lock a case to give e.g. nebuliser and see another case in parallel or to prevent other users accidentally taking a case which the registrar would like to reserve or to how to swap a case to another user or to hand over a case to another user at the end of a shift. (7)
  • how to access and use local protocols and guidelines e.g. lists of pharmacists, how to contact psychiatrists social workers etc (7)
  • how to access, use and print common patient information leaflets (7)
  • how to type and work quickly but effectively(7)

Required for Green

  • that an average triage time of about 10 minutes and consultation time on 15 minutes should be achieved. It is important to take a break if tired. 12)

OOH Telephone

The registrar has been (Miller’s Triangle):

  • educated
  • has reflected on cases seen
  • has demonstrated for cases seen

so that he/she knows:

Required for Amber

  • how to recognise in Adastra calls that the telephone operator has assessed as emergency/urgent calls or calls transferred from NHS Direct calls (amber/red calls) (7)
  • the importance of the 20 min /60 min national target times and the Adastra traffic light system for showing outstanding calls (7)
  • how and when to forward calls to primary care centres, visits (7)
  • how and when to forward calls to district nurses etc, AE, Social Worker, Crisis Team, in hours teams(9)
  • how to deal with failed telephone calls eg engaged or not answering (7)
  • basic consultation techniques assessed using a telephone splitter/speakerphone to show good verbal “connecting” and verbal “safety netting”. This includes use of appropriate language. (Neighbour). This is especially true for registrars with English as a second language. The doctor is aware of, and recognises the significance of, symptoms of clinical conditions, disorders and problems that need urgent attention or assessment. (1)
  • that if a referral is made to a PCC or a visit that the caller should agree with the option and that the choice is appropriate or the urgency of the appointment is appropriate. (4)
  • the need to recognise emergencies and refer to 999 in an efficient manner.(4)
  • the need to deal with calls forwarded to a primary care centre or a visit in an efficient manner. A full history may not be required and this type of triage should generally be quick. (4)
  • The need to deal with calls completed as telephone advice more carefully including exploring ideas concerns expectations more fully and how the problem affects home and work etc.(2)
  • that good consultation skills are essential for telephone advice, e.g. reflection, patient centre/doctor centred, acting on cues, non-formulaic and effective questioning, how to deal with language problems and access “language lines”. (1)
  • to complete telephone advice only calls with good safety netting and good verbal instructions on simple treatments and check that the patient has understood these properly. (1)
  • to assess calls in order of priority and take the “hanging call” appropriately. Heart sink patients may take longer to be triaged in a system where several clinicians are triaging together which can severely affect triage performance if they are not assessed in a timely manner. (8)
  • how to phone a pharmacist and to acquire verbal agreement for a prescription, how to fax a prescription and send prescription to pharmacy. Controlled drugs and Temazepam cannot be organised as a verbal order.

Required for Green

  • Can telephone consult independently making good decisions without frequently asking for advice . Need examples of several clinical problems and appropriate actions but particularly chest pain possible CVA and shortness of breath. (5)
  • Chest pain & MI
  • Heart failure
  • CVA
  • Sudden collapse
  • Fits faints & funny turns
  • Acute asthma or COPD exacerbation
  • GI bleed – upper & lower
  • The acute abdomen
  • Vascular emergencies including hypovolaemic shock
  • Renal colic, pyelonephritis and urinary retention
  • Ectopic pregnancy/PID/ bleeding in early pregnancy, (including miscarriage)
  • Obstetric emergencies – APH/PPH/ pre eclampsia, reduced fetal movements etc.
  • Acute confusion state and psychoses
  • Allergy & anaphylaxis
  • The ill child
  • Infection such as septicaemia and meningitis
  • Orthopaedic emergencies e.g. cord compression injuries/back pain
  • Acute eye pain/loss of vision

OOH Primary Care Centre (base)

The registrar has been (Miller’s Triangle):

  • educated
  • has reflected on cases seen
  • has demonstrated for cases seen

so that he/she knows:

Required for Amber

  • How to use emergency equipment including defibrillator ECG nebuliser oxygen im drugs iv drugs (5)
  • How to assess walk-ins for emergency and urgent clinical problems. (5)
  • Basic consultation techniques assessed sitting in and by problem and random case discussion to show skills as described in “COT” section of E-Portfolio . The doctor is aware of, and recognises the significance of, symptoms of clinical conditions, disorders and problems that need urgent attention or assessment. This competence requires an experienced supervisor and should really have been done in the in hours setting. It is more important that OOH supervisors recognise the failing registrar, can document this and know how to link with the ES or other supervisors.(1)
  • how to delegate appropriately to nurses if appropriate eg dressing ECG(8)
  • how to give a Nurse Practitioner clinical advice or issue a prescription for a Nurse Practitioner. This includes locking the Adastra record to swap users and understanding the different competences of non-prescribing nurses to full Nurse Practitioners.(8)

Required for Green

  • Can consult independently making good decisions and appropriate referrals without frequently asking for advice. Need examples of several clinical problems and appropriate actions but particularly asthma, ill child, abdominal and chest pain. (5)
  • Chest pain & MI
  • Heart failure
  • CVA
  • Sudden collapse
  • Fits faints & funny turns
  • Acute asthma or COPD exacerbation
  • GI bleed – upper & lower
  • The acute abdomen
  • Vascular emergencies including hypovolaemic shock
  • Renal colic, pyelonephritis and urinary retention
  • Ectopic pregnancy/PID/ bleeding in early pregnancy, (including miscarriage)
  • Obstetric emergencies – APH/PPH/ pre eclampsia, reduced fetal movements etc.
  • Acute confusion state and psychoses
  • Allergy & anaphylaxis
  • The ill child
  • Infection such as septicaemia and meningitis
  • Orthopaedic emergencies e.g. cord compression injuries/back pain
  • Acute eye pain/loss of vision

OOH HOME VISIT

The registrar has been (Miller’s Triangle):

  • has demonstrated for cases seen

so that he/she knows:

Required for Green

no amber depending on provider organisation’s regulations

  • may have to be observed for all consultations depending on provider organisation’s regulations
  • how to use emergency equipment including defibrillator ECG nebuliser oxygen im drugs iv drugs (5)
  • Basic consultation techniques assessed sitting in to show skills as described in “COT” section of E-Portfolio . The doctor is aware of, and recognises the significance of, symptoms of clinical conditions, disorders and problems that need urgent attention or assessment. This competence requires an experienced supervisor and should really have been done in the in hours setting. It is more important that OOH supervisors recognise the failing registrar, can document this and know how to link with the ES or other supervisors. (1)
  • How to deal with frail elderly at home with multiple clinical problems and no access to patients written notes (6)
  • How to make referrals to different hospitals, different crisis teams, and different district nurses if working in a large OOH provider covering a large area. (7)
  • How to work with a driver and what tasks the driver can do to help eg taking temperature, phoning hospital for your (8)
  • Can consult independently making good decisions and appropriate referrals without frequently asking for advice. Need examples of several clinical problems and appropriate actions but particularly palliative care. Experience is that this is also a good opportunity for registrars to undertake a DOPS for IM and IV access as many will not have done this properly during hospital medicine. (5)
  • Chest pain & MI
  • Heart failure
  • CVA
  • Sudden collapse
  • Fits faints & funny turns
  • Acute asthma or COPD exacerbation
  • GI bleed – upper & lower
  • The acute abdomen
  • Vascular emergencies including hypovolaemic shock
  • Renal colic, pyelonephritis and urinary retention
  • Ectopic pregnancy/PID/ bleeding in early pregnancy, (including miscarriage)
  • Obstetric emergencies – APH/PPH/ pre eclampsia, reduced fetal movements etc.
  • Acute confusion state and psychoses
  • Allergy & anaphylaxis
  • The ill child
  • Infection such as septicaemia and meningitis
  • Orthopaedic emergencies e.g. cord compression injuries/back pain
  • Acute eye pain/loss of vision