Out of hours work can be a rewarding part of a portfolio career. There are, however, a number of pitfalls you need to look out for if you're considering this line of work.
Below are some top tips on how to avoid them and some key questions to ask.
Check what documentation the out of hours provider requires before you start work as different providers may have different requirements.
For example, are you required to provide:
- recent DBS (disclosure and barring service) check
- proof of GMC registration
- MDO (medical defence organisation) certification
- CPR certificate
- child protection training
Terms and conditions
Establish the terms and conditions of your out of hours work.
Things to ask:
- Will you be employed or self-employed?
- Is there a contract?
- Do you get an NHS or other pension?
- Is there leave (annual/sick/maternity/study)?
- Can you cancel shifts and, if so, how much notice is required?
Check with your MDO (medical defence organisation) what level of indemnity cover you will require; this is likely to be much higher than for in-hours work. Even if the out of hours provider has indemnity cover for you, your MDO will still need to be informed (e.g. the Welsh risk pool doesn't cover criminal or disciplinary procedures).
Make sure you inform your MDO of the number of sessions you do per week or month and don't undercount or you may find they won't cover you in the event of a claim. The MDO will also want to know if you are responsible for nurses, GP registrars or paramedical workers.
Ensure you are familiar with the IT system before starting a busy shift.
Things to ask:
- Do you have an individual login ID?
- How do you prescribe?
Ensure you have access to essential information, such as:
- emergency social workers
- psychiatric crisis response team
- various levels of ambulance response and how to contact them
- the location of the treatment centres and their opening hours
- which hospitals cover your area and their phone numbers
- how to contact the shift manager
- what end of life services are available
Things to ask could also include:
- How do you refer to the community nurses?
- Where is the emergency resuscitation equipment?
- Are emergency admission alternative pathways available?
- What drugs are stocked?
- Is there a formulary you must stick to?
- Is there a list of local pharmacy opening hours?
All out of hours providers differ in what they provide. For example:
- repeat prescriptions
- faxing prescriptions
- drug formularies
- basic kit
- payment for running over time
Other things you can ask:
- Do you have a driver, or are you expected to drive?
- Will you be expected to do a ward round at a community hospital and clerk in patients?
Find out what measures are in place to ensure your personal safety when working out of hours.
Things to ask:
- Does the out of hours provider have a policy for dealing with potentially violent patients?
- Is a chaperone available when needed?
Find out if there is an established process for making complaints. You can ask:
- How are complaints handled?
- How do you make a complaint or raise a significant event?
- What support am I offered if I make a complaint?
Find out if the out of hours provider offers funded training in:
- telephone triage
- child protection
- protecting vulnerable adults
- assessing mental capacity
- end of life care
- use of the resuscitation equipment provided
Under the EWTD (European Working Time Directive) you have the right to an uninterrupted 20-minute break during your working day if you work longer than six hours. This could be a tea or lunch break.
Things to ask:
- Where are the toilets?
- Are there tea and coffee-making facilities?
- Are you allowed a meal break?
Find out what support networks are available to you, particularly if you are working in isolation. You can ask:
- How do you contact colleagues in other bases for advice or to discuss difficult cases?
- Does the out of hours provider give good support in the event of complaints?
- Are there any support or co-mentoring networks?
- Are there links with local sessional GP groups?
- Can information about your work be used for appraisal?
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