Background
GP trainee hubs have been running since Feb 2021, with positive feedback from trainees, supervisors and operational colleagues alike. The hubs aim to:
- Increase our capacity to support GP trainees gaining the required urgent and unscheduled care experience and competencies in the IUC setting.
- To give trainees the ‘hub’ experience, which reflects how many of us work clinically in the service, with accessible support and as part of a much wider clinical and operational team.
- Enable trainees to share learning with each other and support each other’s development during the shift .
The pilot evidenced a very positive learning experience in which trainees had timely access to supervisor advice, but could also support each other’s learning and share their interesting cases. Supervisors enjoyed the dedicated supervision role. The Osprey environment ensured access to the wider, supportive team in the service. With consistently positive feedback, we have now rolled out a Hub offer as a permanent fixture in the IUC rota.
Booking shifts to supervise GP trainee Hubs at Osprey Court
Hub supervisor shifts will appear on Rotamaster as “Osprey Court Training Hub GP”. Only approved clinical supervisors in IUC can book into these. Most hubs take place at the weekend, although there are a limited number of shifts on weekday evenings.
Your text reminder for Hub shifts will say “Osprey Court Training Hub GP”, and all of these shifts are at Osprey Court.
Once the Hub supervisor has booked in, up to three trainees will be able to book into the Hub. We are encouraging trainees to book as a trio or individually, but aim to ensure that there are three trainees in each Hub as the pilot evidenced that this provided the best educational experience. We have the option to increase the number of Hub shifts available if trainee demand requires this, but will also withdraw Hub shifts which are consistently under-utilised.
We ask that you report to the Shift Manager when you arrive for your hub shift who will be able to show you where you will be based.
Workstations and equipment
See the final section of this document for full information about the operational set up for these shifts.
- Please log in at your own workstation for the shift. There will be a headset there for you too.
- Each trainee should also login at their own workstation, which will have a web cam and headset to allow video and telephone consulting.
- Ensure the trainees login to CLEO, EMIS and have the BrisDoc weblinks page open. Ask them to open ‘Message of the Day’ via Weblinks (password IUC2019) to see current service updates.
Getting going at the start of the shift
Suggestions for ascertaining how experienced the trainees are at the start of the Hub shift:
- Do an informal initial ‘sense check’ with the group about their previous experience. They should be able to show you their Deanery passports for their Urgent and Unscheduled Care competencies. Ask about the stage of training, and the nature of the work they are doing at their practice. Most, if not all, will also be doing telephone and video consulting during the day. If trainees have identified a learning need to manage specific types of cases (e.g. paediatric, palliative), ask the operations team to allocate accordingly.
- Some may not have done a shift in IUC for several months, but all trainees will have attended a full induction session, including training videos for all of the IT. The majority of the trainees doing shifts with BrisDoc are in ST3, although we also have ST2 trainees working with us. Of the ST3s, some will be much nearer completion of training than others.
- If one or more of the trainees has not used CLEO since induction, open their cases allocation queue and show these trainee(s) how to prioritise the cases that have been allocated to them. Open a case and show them where things are, including seeing the previous Pathways assessment, where to log their notes etc. Show them ‘Pharmacy Locator’ or MiDOS (via Weblinks), so if they identify a script is needed during a call they can still identify the appropriate pharmacy, end the call and use your support to issue the EPS then.
- For trainees who have done shifts in recent weeks/ months and feel more familiar with CLEO, encourage them to prioritise from their queue, and start to consult. Do the same after your initial overview of CLEO for novice trainees.
- Ensure that the trainees know that if they have concerns or want to ask anything during the consultation, they can wave to get your attention and either mute or end the call with a plan to call back once they have spoken with you.
- The Hub environment allows you to discuss cases before they start consulting, and to hear each of their telephone/ video consultations as they happen. We envisage that you do not need to listen into each trainee’s first consultation(s) as you might do with an unknown trainee at the start of a base shift in separate rooms. Instead, keep your ears open for what they are each doing. If you think the trainee is going off track or there may be an issue you need to pick up, you can intervene in a timely way.
- Using Sesui for Training Calls:
- Our transfer to Sesui for calls in IUC has required changes to the way in which we facilitate trainees or trainers to listen in to calls within IUC. The digital team have created specific Sesui accounts that are to be used for this purpose.
- The system works by the person who is listening to the call using a training account designed to 'drop in' to the call.
- For example, if you are training and require the trainee to listen to your calls, you will log into a 'standard' Sesui account and make the call. The trainee will log into a separate computer, on one of the 'training' accounts, and will need to 'drop in' to listen to you. Conversely, if as a trainer you are listening to a call made by a trainee, the trainee will log into a ‘standard’ account, and you will log into one of the training accounts.
- It is very important that whenever you drop in to a call you immediately select the ‘mute’ option to prevent the caller hearing two people.
- All regular trainers have had an email with the training credentials on them, but these can also be obtained from the shift manager. We would also ask that you liaise with the shift manager before logging into one of the accounts to ensure that it is not already in use.
- Thank you to all our trainers for their support in helping the next generation of IUC clinicians.
- In general, HCP cases should be reserved for trainees who are more experienced, as there are a number of additional considerations when consulting with HCP colleagues. This is however an important competency for them to develop, and IUC and the Hub environment provides an invaluable opportunity for this.
During the shift
The Hub should provide opportunities for trainees to support each other either with IT queries or clinical issues. Encourage them to share difficult/ interesting cases so that the whole group can gain from the learning. This is particularly useful around risk holding, managing uncertainty, and the more borderline decisions such as holding off admission etc.
An interesting observation from the early shifts has been that the shifts have provided an appreciated opportunity for trainees to meet each other in person. It means you may need to take care to manage ‘chat time’ to ensure that it is focused on learning and that the trainees are consulting throughout the shift. This ensures that the Hub shifts contribute to their own competency development.
Your supervisor role on shift – supervision/ clinical work
Your own work during these shifts will depend on how many trainees are on shift, how busy the service is and how experienced the trainees are. We aim to have three trainees in each Hub to optimise the educational experience for all.
- If there are three trainees in the hub, your shift can be focused on supervising and supporting them. Please bear in mind that this means each trainee should undertake at least 4- 6 cases per shift, but ideally 2/hour on average or more towards the end of training. See more information about caseload for Hub shifts. When the service is busy and you have capacity (particularly if the some/ all of the trainees are nearing the end of their training), you will likely be able to do some of your own clinical work. This may be relatively straightforward cases such as those requiring an EPS, or some of the less complex cases. This would be much appreciated.
- If there are two or fewer trainees in the hub, you will need to undertake clinical work alongside them. You can do this by asking the operational team to allocate cases to you, although it may give better flexibility to take these yourself from the advice queue, allowing you to support the trainees as and when needed. Please follow the usual guidance to identify priority cases (Breeched on CLEO, or those labelled/ identified as “Priority cases”). However, if a case looks obviously complex you may need to leave these for other colleagues (or one of the trainees). This is to avoid you getting very tied up so the trainees do not have to wait a long time for you to become available to support them.
- The trainees will usually complete a form to log their shift through Clinical Guardian. You can sign it off then and there whilst it is open in the trainee’s Clinical Guardian account. Alternatively, the trainee can send the form to you to complete at a later date, in which case it will go through to your Educational Guardian account. This will be necessary for trainees working their first shift as their Clinical Guardian account won’t be set up until the proceeding Monday. The alternative for new trainees is for a paper form to be completed. This can be downloaded and printed from the Severn School of Primary Care website. Trainees do not need to complete the form fully before you complete the supervisor section. If trainees open the “Recent Work” Recent Cases tab on CLEO,
Pace of work/ number of cases
BrisDoc does not receive additional funding to support registrar training. As such, it is not possible for us to pay you to supervise unless the registrars deliver at least the number of cases that would usually be expected from a GP undertaking an independent telephone/ advice shift. For this reason, the Hub team needs to consult at least 12-24 cases per 4-hour shift to ensure that the Hub is cost effective and does not impact adversely on patient care. If three trainees are on shift, this correlates to at least 1-2 cases per hour on average for each of the trainees. If there are two or fewer trainees in the hub, it is less likely they will manage sufficient cases to replace the GP shift and this is why we ask that you also undertake clinical work during these shifts.
It is also worth noting that competency at the end of training should be considered as being able to undertake an IUC shift as a qualified GP, working independently but with access to the Clinical Co-ordinator for advice/ support when needed. This would equate to 3-4 cases per hour. Please bear this in mind when you are signing off trainees, particularly those nearing the end of their training who need to be able to demonstrate competency. It is helpful to log the number of patients the trainee has consulted during the shift in your section of the feedback form.
Towards the end of the shift – registrar sign off
With 2-3 trainees in the Hub it will take you a bit of time at the end of shift to sign off their shift. I suggest that you aim that they are all wrapping up their final case by 15 minutes before the end of the shift. However, if one of the trainees has a gap between cases anytime from 30 minutes before the end of the shift, use this opportunity to sign their paperwork. The trainee can pick up another case after that, while their colleagues’ paperwork is completed.
The trainees will usually complete a form to log their shift through Clinical Guardian. You can sign it off then and there whilst it is open in the trainee’s Clinical Guardian account. Alternatively, the trainee can send the form to you to complete at a later date, in which case it will go through to your Educational Guardian account. This will be necessary for trainees working their first shift as their Clinical Guardian account won’t be set up until the proceeding Monday. The alternative for new trainees is for a paper form to be completed. This can be downloaded and printed from the Severn School of Primary Care website. Trainees do not need to complete the form fully before you complete the supervisor section. If trainees open the “Recent Work” tab on CLEO, this will bring up the list of cases they have consulted during the shift which you and/ or they can review as part of the sign off. You can log the number of patients the trainee has consulted during the shift as well, and use this as evidence around the pace of work required once competent. Please ensure that you include free text comments, including constructive development suggestions for their next shifts (e.g. work on more independent decision making, sharing options with patients, undertaking video consultations, pace of work, familiarity with prescribing in the IUC context etc).
What to do if you have concerns about a trainee
If you have concerns about a trainee, please try to speak with them 1:1 if possible. The Hub model may make this more difficult though. Please use the shift feedback form as an opportunity to flag a concern or possible concern. If you are unsure whether to be concerned, or how concerned to be, you are encouraged to contact Joanna.edwards3@nhs.net to share the issues and agree the next steps. We can link in with the trainees’ in-hours supervisor and/ or the Deanery if needed.
If you have concerns about your supervisor experience in the Hub
Similarly, we also need to know if you have had concerns or issues from a Supervisor point of view. Please email Joanna.edwards3@nhs.net in the first instance so we can reflect on your concerns and agree any changes we need to put in place. Operational support and advice is available throughout the hub shifts – please liaise with the shift manager, who will always be working at Osprey.
13.1.25
Dr Joanna Edwards
Lead GP, SevernSide IUC
Operational information and set up for Hub shifts
Set up prior to the start of the Hub shift
All workstations, including one for the supervisor will be set up and ready for clinicians to log into by the IUC operational team.
Each workstation has:
- web cam
- headset
Should the hub supervisor want to listen into calls during the hub they will require access to a training account in SESUI, please communicate this requirement to the IUC ops team. Information on how to use SESUI can be found on Radar: Sesui-Shift-Manager-guide-Version-5.1-1.pdf
Trainees have been asked to ensure that their smartcard has been authenticated prior to a hub shift, however if this has not been actioned, please see the IUC shift manager.
Operational challenges/ feedback about the Hub shifts
Please liaise with the Shift Manager if problems arise on shift, and ensure these are logged on the on the shift report.