Training in Emergency Psychiatry: Out of Hours Working
All psychiatry trainees (at Core and Advanced level) must gain competencies in emergency psychiatry. These will be clearly outlined in the relevant curriculum. The new curriculum states ‘Demonstrate proficiency in devising safe, effective, collaborative systemic treatment and management plans, depending upon the differential diagnoses, comorbidities, reproductive status, clinical situation and risks in an emergency, as well as in the short, medium and long term’. Emergency psychiatry is also in the Silver Guide.
Core trainees will be on different rotas depending on where they are working and what stage of training they are at. Generally, more junior trainees (at CT1 and/or 2) provide predominantly ward cover while more experienced trainees (at CT2/3) should be involved in some first line emergency assessments such as in the local Emergency Departments, or by working with a Crisis Team.
All advanced trainees are expected to take part in out of hours working. This is likely to include carrying out Mental Health Act assessments, providing support and advice to non-medical colleagues and supervising more junior psychiatrists who are covering wards or crisis teams. Out of hours working is an essential component of training: trainees identify different skills gained from undertaking this work. In some parts of the Severn region, Trusts have changed their out of hours service to be 'all age', i.e. there are no separate on call arrangements for children/young people or for older adults. Severn School of Psychiatry has taken the view that advanced trainees are working out of hours to meet training competencies so that they cannot be required to provide an 'all age' service. However, with the increased use of these arrangements in mental health trusts, experience of this way of working could be an advantage when taking up a Consultant post.
In keeping with the Junior Doctor contract, all trainees are entitled to take compensatory rest after out of hours working, if required.
Out of hours activity and experience form part of competency attainment so will be considered at ARCP.
Where trainees have particular circumstances that might make working out of hours difficult, or where there are health reasons that preclude working out of hours, reasonable adjustments to working can be made. The trainee should discuss their circumstances with their Training Programme Director as soon as possible.