GP Appraisals

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.

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

• 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

• 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

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.

• 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