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PatientPlus articles are written for doctors and so the language can be technical. However, some people find that they add depth to the articles found in the other sections of this website which are written for non-medical people.

GP Appraisals

What is appraisal?

Appraisal is a two-way process of reflection of an individuals performance and for doctors it forms an important part of continuing professional development (CPD). It is continuous process and forms an established aspect of numerous organisations to date. For doctors appraisal allows time to reflect on one's performance and then plan further education and training needs for personal development and growth.1

Department of health defines appraisal as follows (2002):2

"Appraisal for GPs is a professional process of constructive dialogue, in which the doctor being appraised has a formal structured opportunity to reflect on his or her work and to consider how his or her effectiveness might be improved."

However, it is not simply the "filling in of papers" and such should only occur provided there is appropriate time, resources and support. If these are not available then it is likely to be ineffective. Appraisal is also not synonymous with assessments. The latter can be defined as "measurement of an individual's performance at a particular point in time, usually against predetermined standards".1 Assessments can form part of appraisal if appropriate, however it is better that they be separated from the appraisal such that it is validated prior to the discussion.3

Revalidation is a process by which doctors will demonstrate at regular intervals, usually five years that they are up to date and fit to practice. It also involves reflection and relates directly to a doctors performance.

In the NHS Plan of June 2001, annual appraisal was confirmed as a contractual obligation. The reasons for the obligation is related to clinical governance and thus maintaining standards of care and the publics confidence in the delivery of healthcare. This concerns the following groups at present: consultants, career grade doctors, GP principals and non-principals. PCG/PCTs began introducing the scheme in April 2002.

The School of Health and Related Research (ScHARR) report "Appraisal for GPs" defines appraisal as a process for:1

  • Exploring expectations, priorities, and setting and aligning individual and organizational objectives at a local level
  • Reviewing progress towards achieving previously agreed objectives and agreeing future objectives
  • Recognising, acknowledging and valuing achievements
  • Exploring what is needed from the organisation to help and support the individual

What does appraisal cover?

This is based on the GMC's document Good Medical Practice and covers the following core principles

  • Good medical practice
  • Standards of care
  • Competency
  • Expected conduct of doctors
Elements of an appraisal process
  • The right setting - senior management commitment to develop a good and effective appraisal system for all staff; engaging all involved e.g. study days
  • Training of appraisers and appraisees - having experienced being an appraisee before being an appraiser helps
  • Preparation - arrange well in advance; adequate time for meeting; no interruptions and in a private secluded area
  • The meeting belongs to the appraisee - they should be committed and attend with well prepared thoughts
  • Confidentiality
  • Outcomes - a summary of the meeting in the form of action points should be set which forms the basis of the personal development plan (PDP); each outcome should be "SMART" (see below)
  • Regular review of appraisal systems4

SMART outcomes1

SMART outcomes or objectives
S - specific
Relate to specific tasks and activities, not general statements
M - measurable
Should be possible to assess whether or not they have been achieved
A - attainable
Should be possible for the doctor to achieve the desired outcome
R - realistic
Within the doctor?s capability
T - timed
The next appraisal date, or earlier, should be agreed as the time for reviewing the achievement
Documentation
Appraisal documentation
Form 1 Personal details
Form 2 Work related activities e.g. number of hours worked, emergency work, any other NHS or non-NHS work
Form 3 Covers aspects of good clinical care, maintaining good medical practice, relationships with patients and colleagues, teaching and training, probity, management, research
Evidence and information to be used for appraisal e.g. curriculum vitae, peer review, risk management, audits, outcome of investigated complaints, letters from public, 360 degree surveys
Form 4 Summary of agreed action and personal development plan - filled out during the meeting
Form 5 Detailed confidential account of interview
  • Forms 1-3 are filled out by the appraisee prior to the meeting; form 3 requires a fair amount of thought.
  • Form 4 is filled out by the appraiser and the appraisee agrees to it. These forms are then copied and passed on to the trust or primary care organisation. Form 4 summaries should be kept by the PCT and the appraisee also.
  • Form 5 is an optional form for the appraisee to keep a more detailed account of the meeting. It does not have to be forwarded to any other persons.

In February 2007 the NHS Clinical Governance Support team and the National Association of Primary Care educators jointly decided on core valid and verifiable evidence for the appraisal process. They also divided up evidence as personal and organizational (both necessary) and optional evidence which the appraisee can decide on what to include.This requires the following forms at the following times:3

Essential evidence for appraisal
3
Frequency of completion
Which forms
Annually
  • Completion of new forms 1,2,3
  • Provision of on-going PDP, with clear description in Form 3 of degree of attainment
  • Last year’s appraisal summary
  • Data collection/audit with structured reflective template (SRT)
  • Significant event audit SRT
  • SRT on last year’s learning
  • Full declaration of all other professional roles
  • Other professional roles SRT
  • Probity SRT
  • Health SRT
Twice a year
  • Case review structured reflective
  • Template (SRT)
At least one annually
  • Complaint SRT(s) or declaration of no complaints
Within past three years
  • Patient survey SRT
  • Multi-source feedback SRT
Who should be the appraiser?

Senior doctors who are on the medical register should carry out appraisals. For general practice this applies to GPs who have worked for 3 years as a non-principal or principal.2 However, it helps if they are motivated and they should undergo training beforehand. Newly appointed appraisers should be supported for their first three appraisals and it is anticipated they participate in between 3-20 appraisals per annum. Appraisers should be changed every 2 consecutive years. Appraisees can request for a different appraiser if they wish - this is important as that person should be someone they trust and respect. Appraisal work should be balanced out within a practice if this is possible.

Quality assurance of the appraisal system
  • The appraisal system needs to be regularly evaluated and quality assured
  • A self-assessment audit is available for organisations5
  • An appraisal guide with advice may be useful


Document references
  1. BMA; Appraisals a guide for medical practitioners; Oct 2003.
  2. ABC of GP appraisal; National Association of Primary Care Educators
  3. Evidence for Medical Appraisal; Statement of NAPCE/CGST conference; Feb 2007.
  4. Appraisal for GPs; Department of Health; Feb 2007.
  5. Assuring the Quality of Medical Appraisal; Clinical Governance Support team; NHS; July 2005.

Internet and further reading Acknowledgements EMIS is grateful to Dr Gurvinder Rull for writing this article. The final copy has passed scrutiny by the independent Mentor GP reviewing team. ©EMIS 2008.
DocID: 2207
Document Version: 21
DocRef: bgp24611
Last Updated: 15 Aug 2007
Review Date: 14 Aug 2009




















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