1. Bolton Trainers
Nick Walton

2. Discussion areas 2016 Junior Doctor Contract Update
OOH, Out of Hours and Urgent Unscheduled and Emergency Care
New GP Curriculum and ePortfolio
HEENW Lead Educator role
Trainer contribution to Foundation teaching Programme

3. 2016 Junior Doctor Contract Update
2% Annual pay uplifts for next 4 years
Transitional pay protection
£1,000 a year extra for all LTFT trainees
Study leave and mandatory training
Personalised work scheduling meetings and off-site educational supervisors
Supernumerary status of GP trainees
Additional mileage/expenses for GP trainee home visits

4. Supernumerary status of GP trainees
Doctors in general practice (GP trainees) working in supernumerary training settings are additional, not intrinsic, to the workforce. Doctors in these settings contribute to service provision, however the effective running of the service should not be dependent on their attendance and they will not be used as a substitute for a locum.

5. Out of Hours and Urgent Unscheduled and Emergency Care
Started August 2019
Change from OOH to urgent & unscheduled care
Move from counting hours to Trainee demonstrating capabilities(No minimum required hours)
This includes delivering safe patient care, demonstrating effective communication skills, maintaining continuity for patients and colleagues, co-ordinating across services and enabling patient self efficacy.

6. All trainees will need to add sufficient evidence of engagement with and performance of Urgent and Unscheduled care so that there is sufficient evidence for CS and ES to make a judgement of progression in this area during training and a judgement concerning competence in this area at the end of ST3

7. Development of capabilities may be gained “in hours” and in varying secondary / community / urgent care
Will need significant opportunities to develop these capabilities in Out of Hours Services / primary care based urgent /unscheduled care provider organisations.
GP trainees will need to gain experience in GP / primary care settings in order to develop the requisite capabilities to work across the OOH /urgent / unscheduled spectrum of care

8. May include Post/placement Experience Hospital A and E
Paediatrics - particularly experience gained in Emergency Assessment Units
Medicine including Medical Assessment Units
Psychiatry GP
“In Hours” Urgent and Unscheduled Services in GP practices including undertaking “Duty Doctor” sessions
GP Extended Hours where the service being provided includes provision of urgent appointments and is not limited to only encompass “routine” follow up of long term conditions
Urgent Care / Treatment Centres
Primary Care services delivered within a secondary / community care provider

9. Documentation of evidence includes
Clinical encounters in the learning log
Feedback forms
OOH summary log sheet

10. Level of Supervision required
Change from the established Traffic light system
Observational
Direct Supervision
Near Supervision
Remote Supervision

11. Observational Enable GP Specialty trainees to KNOW about services
Typically ST1 / ST2
Induction programmes
Trainees do not assume any responsibility for the management of patients

12. Direct Supervision
These sessions enable the GP trainee to begin developing their capabilities through the delivery of clinical service and thus KNOW HOW to deliver care
Typically ST1 / ST2
Must be undertaken prior to a GP trainee delivering patient care in any out of hours / unscheduled or urgent care organisation
The trainee does not take final clinical responsibility for any patient: this rests with the clinical supervisor

13. Near Supervision
These sessions enable the GP trainee to continue to learn experientially through supported delivery of clinical service to patients.Trainees will be enabled to SHOW HOW / DOES they deliver such care.
May commence in ST1/ST2 and typically will occur during the ST3 year
The GP trainee consults independently but with timely access to a nominated clinical supervisor who can directly assess the patient in person

14. Remote Supervision
Trainees may be offered opportunities to experience working with remote supervision whilst still in training as preparation for independent practice, but it is not a requirement prior to CCT.
The trainee will demonstrate working at the DOES
Will take place after a trainee has undertaken at least 6 months (FTE) of a GP training placement and the trainee has gained appropriate experience of working under near supervision at ST3
The GP trainee consults independently but can access help and advice promptly from a nominated clinical supervisor via telephone or other appropriate interface

15. Clinical Supervision
GP trainees undertaking direct, near and remote sessions should have an identified individual who will, (for the duration of that session) have the lead responsibility for ensuring the safety of both the trainee and patients and who has been appropriately trained: the clinical supervisor.

16. Developing Capabilities – Summary
Trainees must be able to demonstrate that they have met the intended learning outcomes relating to urgent / care by CCT.
However:
There is no specific urgent / unscheduled / OOH experience / activities in relation to observational sessions which are mandatory for trainees to undertake.
There are no specific types of near and remote supervision sessions that are mandatory for trainees to undertake and without which “capability” could not be deemed to have been achieved.
There is no specific requirement to have undertaken remote supervision sessions prior to CCT

17. Mapping Urgent and Unscheduled Care to the RCGP Curriculum capabilities
Not yet finalised
Area of Capability linked to ‘competencies’ with intended learning outcomes

18. Area of Capability – 1. Knowing yourself and relating to others
Core capability
Specific capability
Learning outcomes relevant to urgent care
Fitness to Practise
Communication and Consultation
Manage the factors that influence your performance
Establish an effective partnership with patients
Comply with professional demands whilst showing awareness of personal needs and preserving your resilience and health
Anticipate and manage factors that influence you day to day performance including your ability to perform under pressure.
Flexibly and efficiently achieve consultation tasks in the context of limited time or challenging circumstances, using a range of communication skills tailored to each patient’s needs in the clinical context.

20. The New GP Curriculum
The GMC requires that all specialty curricula are aligned to the nine domains of the Generic Capabilities Framework

21. The Core Curriculum - five ‘Areas of Capability’

22. Within the areas of capability, are the specific core capabilities that will be familiar from previous versions of the curriculum

23. Topic guides .

24. WPBA and ePortfolio
The new curriculum will be represented by new learning log entries linkage in the ePortfolio from September 2019.
Clinical experience groups replace curriculum headings in the new version of the ePortfolio
8 Clinical Experience groups are as follows -
1. Infants, children and young people under the age of 19
2. People with mental health needs (including addictions)
3. People with long-term conditions and disability
4. Frail and/or elderly people (including multiple morbidity and care of the dying)
5. Gender health (Women’s, Men’s and LGBTQ health)
6.People requiring urgent and unscheduled care
7. People with health disadvantages and vulnerabilities (for example veterans, mental capacity difficulties, safeguarding issues, and those with communication difficulties)
8. Health promotion and people with non-acute and/or non-chronic health problems

25. New methods of WPBA assessment will be introduced in August 2020
Care Assessment Tool
Leadership activity
Quality Improvement project
Prescribing assessment (live now)

26. Evidence of progression
The requirements that must be met at the end of ST2 and ST3 stages of training are now made explicit by including
progression point descriptors under each area of capability
linkage to Generic Professional Capabilities and relevant MRCGP assessments
word pi ctures for ‘end of ST2 - needs further development’, ‘end of ST3 – competent’, and ‘end of ST3 – excellent’.

27. HEENW Lead Educator Role
The GP School recognises that lead educators are increasingly involved supporting educational delivery and monitoring. We would like to formalise this role and provide support and development as part of this process.
The GP school has developed a Lead Educator Network with three distinct pathways for progression.
These pathways could determine progressive development along each individual one or an integration of any of the three to progress towards AD competences.

28. The Role includes New trainer interview panels
Trainer reaccreditation panels
Learning environment accreditation in addition to the patch role.
4th stand alone theme-ARCP Panel member/chair
The time is funded at the standard rate of £500 per day or £275 per half day.

29. Training ½ Day of supported small group work
1 visit where you will be an observer to an AD completing the visit
1 visit where an AD will observe you completing the visit
An independent visit from which you will submit your recommendations to an AD for feedback
Likely 3 months ‘lead educator’ training meetings
QA by patch AD

30. Commitment A minimum of 5 visits within 12 months
and there will be the potential to continue to support the school and the developing learning hubs at 2 sessions per week as a career opportunity

32. GP Trainer contribution to Foundation Programme
2 strands to this
GP Trainers teaching on Foundation Programme
Develop support network for Foundation Clinical Supervisors