Domain 2:

Safety and Quality: SEA for OOH doctors


Learning from significant events has now become an established part of general practice, with the majority of practices undertaking SEA regularly as part of the nGMS contract. They are an equally important learning tool for the OOH doctor.

Your employer should help to provide opportunities for you to participate. Here are some examples of ways in which they can help:

  • Holding regular in-house teaching and learning sessions. It will often be appropriate to have a series of small groups, and occasionally larger group sessions. Small groups allow you to reflect with colleagues in a protected learning space on aspects of your performance which may not have been as good as you would like. Larger groups can be used to share updates and discuss general learning points, but they are not usually the best environment for discussing the kind of personal issues that may come up in SEA.
  • Provide any feedback that has been received by the OOH service in relation to patient contact for reflective discussion. This may include complaints, but it is better to do the SEA after the complaint has been resolved. Remember that SEA reviews need a blame-free culture to provide safe and constructive learning.
  • Being receptive to organisational change recommended as a result of an SEA. There is little point in OOH doctors meeting to discuss an event and agreeing that it might have been better managed if the employer is unwilling to engage in discussion of the outcome. A carefully considered SEA could highlight clinical governance considerations which might add weight to requests for a specific resource, or a newly agreed guideline may be put in place for the organisation.
  • Consider joining or forming a small learning group of OOH GPs. Many of the sessional doctors find this is a useful way to exchange information about common problems, obtain peer support and learn from each other. Some groups have regular educational programmes, and using SEA as a learning tool could support the appraisal process and provide evidence for each group member.
  • If you have a practice for which you also provide regular sessional cover, ask if you can attend any SEA sessions they may hold. It may be possible to include an event where you were one of the professionals involved, and you may gain some support from the process of exploring the difficulties the team members have encountered.
  • If you don't have access to a regular practice, but an event took place when you were doing a one-off session which caused you concern, you could ask the practice concerned if they would consider holding an SEA and including you in it. This may seem threatening for you, but it can often defuse their concerns or misunderstandings about your role as the outsider.

Working solutions for the OOH GP if your employer is unable to help:

If these options seem difficult to arrange, consider a case report proforma. However, this is not ideal, because part of the learning process is to explore with others what went well, what could have been different, and what has been learned from an adverse event. Your appraiser will be able to help you reflect on the case report, but an independent peer or group of peers can allow you to produce a more balanced report to discuss with your appraiser when you meet.

An SEA proforma is available from Turas Learn.

This page was last updated on: 07/03/2018