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Home » Training & Assessment » Curriculum » Clinical Chapters » Urgent and Unscheduled Care

Urgent and Unscheduled Care

Urgent and Unscheduled Care (OH)

  • Urgent and unscheduled care is a core component of general practice, requiring GPs to respond effectively to acute presentations, often with limited information, time, or prior relationship with the patient. Whether managing sudden illness, deterioration of chronic conditions, or patient crises, GPs play a key role in early assessment, decision-making, and coordination of care; both in-hours and out-of-hours. 

    This area of practice demands confidence in clinical reasoning, rapid risk assessment, and prioritisation. It also requires clear communication, effective safety-netting, and an ability to work within the resources and constraints of primary care. GPs must be skilled at recognising red flags, knowing when to refer or escalate, and equally when a patient may be best managed in the community. Respect for patient autonomy, especially when individuals decline recommended investigations or hospital admission, is a vital aspect of ethical care. 

    Unscheduled care highlights the value of continuity, clinical judgement, and trust. This chapter aims to prepare GP trainees to deliver safe, timely, and compassionate care in urgent scenarios, while maintaining person-centred values and a calm, structured approach. 

    1. OH1. Manage acutely ill patients in both routine clinical and unscheduled/out-of-hours settings, using evidence-based practices to ensure timely and effective care.
    2. OH2. Generate a differential diagnosis for acute presentations, including but not limited to:
      • Cardiovascular: Eg Chest pain, arrhythmias, dyspnoea, oedema, syncope, haemorrhage
      • Neurological: Eg Reduced consciousness, seizures, dizziness, limb weakness, paraesthesia, headache, visual disturbances
      • Abdominal: Eg Abdominal pain, dysphagia, haematemesis, melaena
      • Endocrine: Eg Lethargy, polyuria, polydipsia
      • Renal: Eg Dehydration, oliguria/anuria
      • Respiratory: Eg Wheeze, stridor, respiratory distress, cyanosis, haemoptysis
      • Sepsis: Eg Fever, tachypnoea, hypotension, altered mentation, meningism
      • Mental Health: Eg Psychosis, Suicide Risk Assessment
      • Palliative Care: Shortness of breath, distress in terminally ill patients
      • Trauma: Eg injuries including head trauma
    3. OH3. Perform key urgent/unscheduled care clinical skills including:
      1. ECG interpretation
      2. Basic Life Support (BLS) including AED use
      3. Haemorrhage control
      4. Wound assessment and suturing/gluing
      5. Acute urinary retention catheterisation
      6. Acute anaphylaxis management and adrenaline administration
      7. Mental state examinations and risk assessments
      8. Peak flow measurement and interpretation
      9. Urinalysis including pregnancy testing
      10. Vital signs assessment (RR, BP, HR, Temp, O2 saturation)
      11. Stroke recognition and acute management
      12. Practice Setting specific skills (e.g., fracture/dislocation management, obstetric emergencies, pre-hospital emergencies)
      13. Administration of Buccal Midazolam for acute seizure
      14. Administration of a nebuliser 
      15. Administration of glucagon 
    4. OH4. Demonstrate effective communication skills in unscheduled care, including teleconsultations and face-to-face interactions.
    5. OH5. Manage requests for unnecessary antibiotics in unscheduled/out-of-hours care settings.
    6. OH6. Communicate effectively with other professionals responsible for ongoing patient care.
    7. OH7. Provide culturally sensitive support during crises or bereavement.
    8. OH8. Coordinate and collaborate with healthcare providers to ensure continuity of care.
    9. OH9. Demonstrate cultural, social, and ethical competence in acute care settings.
    10. OH10. Address inappropriate health-seeking behaviours in unscheduled/out-of-hours settings.
    11. OH11. Understand patient autonomy in clinical decision-making, especially in urgent care.
    12. OH12. Apply the concept of ‘ceiling of care’ in unscheduled and urgent settings.
    13. OH13. Identify patients with chronic/comorbid diseases at risk of acute events and provide tailored prevention and safety netting.
    14. OH14. Understand legal frameworks governing acute healthcare, including mental health emergencies.
    15. OH15. Develop personal stress management strategies for high-pressure healthcare environments.

    For each problem or disease, consider the following areas within the general context of primary care:  

    • the natural history of the condition, including whether acute or chronic
    • the incidence and prevalence, including in different demographic groups
    • typical and atypical presentations  
    • recognition of normal variations throughout life  
    • risk factors, including lifestyle, socio-economic and genetic factors  
    • diagnostic features and differential diagnosis  
    • recognition of ‘alarm’ or ‘red flag’ features  
    • appropriate and relevant investigations  
    • interpretation of test results  
    • management, including initial and continuing care, chronic disease monitoring and emergency care  
    • patient and carer information and education  
    • prognosis.   

    Signs, Symptoms & Presentations

    • Cardiovascular: Eg Chest pain, arrhythmias, dyspnoea, oedema, syncope, haemorrhage
    • Neurological: Eg Reduced consciousness, seizures, dizziness, limb weakness, paraesthesia, headache, visual disturbances
    • Abdominal: Eg Abdominal pain, dysphagia, haematemesis, melaena
    • Endocrine: Eg Lethargy, polyuria, polydipsia
    • Renal: Eg Dehydration, oliguria/anuria
    • Respiratory: Eg Wheeze, stridor, respiratory distress, cyanosis, haemoptysis
    • Sepsis: Eg Fever, tachypnoea, hypotension, altered mentation, meningism
    • Mental Health: Eg Psychosis, Suicide Risk Assessment
    • Palliative Care: Shortness of breath, distress in terminally ill patients
    • Trauma: Eg injuries including head trauma

    Common and Important Conditions

    • Acute Psychosis
    • Anaphylaxis
    • Appendicitis
    • Asthma Attack
    • Bites
    • Cardiorespiratory Arrest
    • Choking
    • Collapse
    • Death – assessment, confirmation and legal requirements
    • Drowning
    • Hypoglycaemia
    • Intestinal Obstruction or Perforation
    • Laceration
    • Limb Ischaemia
    • Mania
    • Meningitis
    • Mental Health Crisis
    • Myocardial Infarction
    • Ovarian Torsion
    • Pneumonia
    • Pregnancy Related Issues
    • Pulmonary Embolus
    • Respiratory Distress
    • Respiratory Tract Infection
    • Road Traffic Accident
    • Seizure
    • Sepsis
    • Spinal Cord Compression
    • Stroke
    • Subarachnoid Haemorrhage
    • Suicide Risk
    • Superior Vena Cava Obstruction
    • Testicular Torsion
    • Trauma

  • Wherever possible learning resources included here are peer reviewed and externally maintained. This is to ensure that trainees have access to quality assured information that is kept up to date.

    Self-Directed 

    Blended Learning Resources (Education Platform)

    Adult (Non-Maternity) Sepsis in GP

    Workplace Based Learning

    Workplace-based learning is essential for developing the skills needed to manage urgent and unscheduled care across various settings. In general practice, out-of-hours services, and home visits, trainees gain experience assessing and managing a wide range of acute presentations; often with limited background information and under time pressure. Emergency department (ED) rotations complement this by exposing trainees to high-acuity cases, structured triage systems, and multidisciplinary teamwork. In the ED, trainees refine their skills in urgent assessment, interpreting investigations, and recognising red flags for serious illness. Across all settings, trainees learn to manage clinical uncertainty, make safe and timely decisions, and apply effective safety-netting strategies. They also encounter scenarios where patient autonomy is central (such as when individuals decline hospital admission) requiring sensitive communication, documentation, and shared decision-making. Supervised clinical shifts, debriefs, and case-based discussions help consolidate these skills and prepare trainees to deliver competent, compassionate care in a variety of urgent care environments.

    Day Release

    Day release teaching provides a valuable opportunity to explore the complexities of urgent and unscheduled care in a structured, reflective environment. Sessions can cover a wide range of scenarios, from acute medical presentations and mental health crises to safeguarding concerns and end-of-life decisions. Using case-based discussions, clinical reasoning exercises, and peer-led reflection, trainees can develop skills in rapid assessment, prioritisation, and risk management. Topics such as when not to refer, how to approach the ceiling of care, and respecting patient autonomy (particularly when patients decline recommended treatment) can be explored in depth. Simulation exercises, including telephone triage or acute home visit scenarios, can further enhance decision-making and communication under pressure. These sessions help trainees build the confidence and judgement needed to provide safe, timely, and compassionate care in unpredictable situations.

    Registrar Tutorials

    Registrar tutorials offer an ideal space to consolidate learning in urgent and unscheduled care through focused discussion, case reflection, and practical teaching. These sessions can explore high-stakes topics such as acute presentations, red flag recognition, safety-netting, telephone triage, and managing uncertainty. Tutorials also provide a valuable opportunity to debrief after busy or challenging out-of-hours shifts, allowing registrars to reflect on difficult decisions, emotional responses, and lessons learned in a supportive setting. Discussions around when to refer, when to hold back, and how to communicate the ceiling of care sensitively with patients and families can deepen understanding and confidence. Reviewing real cases from on-call experiences helps translate theory into practice and fosters peer learning, clinical judgement, and resilience in urgent care settings.

  • Entrustable Professional Activities (EPAs) underpin workplace-based assessment in this curriculum. Each EPA represents an integrated clinical task that General Practitioners must perform safely and independently, assessed through direct or indirect observation in real clinical settings.

    The curriculum and EPA framework are closely aligned: the curriculum defines the required knowledge, skills, and professional behaviours, while EPAs assess their application in practice. Together, they create a coherent approach to developing and demonstrating readiness for independent clinical work.

    The examples show how specific activities within general practice & chapters of the curriculum align with particular EPAs.

     EPA 9: Manage the care of adults, including older people with acute presentations

    A patient presenting with acute chest pain and hypotension provides an opportunity to demonstrate EPA 9. If the GP Trainer observes the consultation and examination, including ECG interpretation and immediate stabilisation, a PIP-C and PIP-P can be used to assess systematic assessment, formulation of a differential diagnosis, and effective escalation of care. A succinct case entry could be: “assessment of acute chest pain and hypotension.” Reflection should explore clear communication with emergency services, documentation of clinical reasoning, and strategies for supporting the patient and family in crisis.

    Core Knowledge Test (CKT)

    • Formulating an appropriate management plan for acute anaphylaxis.
    • Management of burn injuries
    • Assessment of patient presenting with acute shortness of breath

    Clinical Competency Test (CCT)

    • A patient presenting with acute onset shortness of breath.
    • A patient presenting with acute wheeze.
    • A parent is on a telephone consult regarding a child with a fever.

    Disclaimer: The examples provided within this section are intended to be indicative only and are included to illustrate how elements of the curriculum may be assessed in the Clinical Competency Test (CCT).

    Examination questions in the CCT test the ability of candidates to integrate knowledge, skills, and professional behaviours across multiple curriculum areas to address the challenges posed by the question.

    The indicative content should therefore be used solely as a general guide as to some of the topics that may be introduced. Actual examination questions will assess a greater depth and complexity of understanding than the illustrative examples provided.

    Please note that a number of CCT questions will require candidates to undertake a physical examination of the simulated patient. In some circumstances, for example in the case of an intimate examination, candidates may be required to display their examination skills through use of a manikin or other device.