In recent years the provision of out-of-hours training for general practice (GP) registrars has become a difficult issue in the North Western Deanery and across the United Kingdom. The nature of out-of-hours care has changed, with a diminishing personal commitment by general practitioners (GPs) in favour of out-of-hours centres and co-operatives. Out-of-hours care now requires different skills and competencies from doctors providing it and there is less opportunity for GP registrars to gain experience if their trainers are undertaking less out-of-hours work. Similarly, the style of educational supervision for out-of-hours training has also changed. The New GMS Contract creates new challenges; it allows many GPs, including trainers, to Opt out' of out-of-hours care, with primary care trusts (PCTs) becoming the responsible organisations. The challenge for the deanery is how to ensure that provision of training and assessment of competence. A qualitative survey was conducted in the North Western Deanery, taking views from GP trainers and GP registrars about the provision of out-of-hours training and their concerns about that process. The purpose of the survey was to assess the most important objectives for out-of-hours training, checking the level of concordance of views between GP trainers and GP registrars; to determine current levels of activity in training and supervision by GP registrars and trainers, defining the level of exposure necessary to gain the desired competencies; and, using a qualitative method, identify themes and issues of importance and concern to be addressed by organisations involved in the provision of out-of-hours training. The results suggested that the average activity for out-of-hours duty for trainers was one to two sessions per month. This was matched by the level of duty by registrars as one to two per month, although there were difficulties matching sessions and supervision. Most trainers will opt out of out-of-hours care with the introduction of The New GMS Contract, and there are concerns from both GP trainers and GP registrars as to how out-of-hours training and supervision will be provided post contract. Both GP trainers and GP registrars favour a standardised model of out-of-hours training, with a clearly denned curriculum and competency assessment as opposed to the current 'number of sessions' approach. However, many GP registrars question the relevance of out-of-hours training given the changing agenda for primary care. The themes identified as important aims and objectives for out-of-hours training will provide a useful starting point for curriculum and assessment development. Managing emergencies; telephone communication and triage skills; gaining experience and expertise were ranked highly by both GP trainers and GP registrars. The higher skills, such as problem solving, negotiation, managing risk and uncertainty, were ranked more highly and identified more often by GP trainers than by GP registrars. As a result of the survey, areas of need have been identified across the deanery; there is widespread approval for the development of a standardised competency-based curriculum and assessment package. Key objectives have been identified and ranked and will form the basis of the curriculum. We propose to offer a model of competency-based training and assessment in those co-operatives where training and education is well developed, which could be commissioned by out-of-hours providers locally. This work was done to give guidance for a deanery policy on out-of-hours training for GP registrars. Its findings correlate with work done for the Committee of General Practice Education Directors (COGPED) on key competencies, developing a competency-based log and implications of The New GMS Contract on out-of-hours training for GP registrars. The results from both papers have been used to develop a COGPED Out-of-hours Training Workbook, co-ordinated by Kent, Surrey and Sussex Deanery, setting standards nationally (in committee stage at time of writing). © 2005 Radcliffe Publishing Limited.
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