Dr Honor Merriman discusses annual appraisal and how keeping a learning log throughout the year can aid the process
Appraisal for GPs is now generally accepted as a method of providing valuable support in professional development. Since the publication of the Department of Health White Paper Trust assurance and safety: the regulation of health professionals in the 21st Century,1 much thought has been given to how appraisal for all doctors will need to change. The White Paper sets out a two-stage process for revalidation:1
- relicensure—all doctors will be required to demonstrate successful completion of an annual appraisal, using information from multiple sources as feedback with assessment being signed off at local level. Whether this sign off is done by either the ‘responsible officer’ in the PCT, or from a local GMC affiliate, has not yet been announced. All doctors will be issued with a licence to practice, which will be renewable every 5 years
- recertification—a process that differs according to the doctors speciality. The exact requirements are to be defined by each Royal College. The Royal College of General Practitioners (RCGP) has yet to announce what will be needed but it is likely that at least 50 hours of accredited continuing personal development each year will be part of it.
The White Paper did not give a definition of a successful annual appraisal but it is now accepted that the appraisal will need to take note of written information that will bear evidence of the GP’s performance. In February 2007, the UK-wide conference on appraisal, co-hosted by the NHS Clinical Governance Support Team, and the National Association of Primary Care Educators, approved a statement on essential evidence for medical appraisal;2 the Leicester statement summarises the minimum essential evidence required for appraisal, but it recommends that doctors supply more information than this.
In order to preserve the appraisal as an opportunity to discuss successes and challenges of the past year and future development plans, it has been suggested that the documents are used only to provide a factual basis to give a personal insight into the doctor who is being appraised. Approval of the forms themselves will be the task of the responsible organisation. General practitioner appraisers will have the role of assisting GPs with the collection of information and helping them to think about what the information might say about their day-to-day practice. Relicensure will therefore be based on a positive affirmation of the doctor’s entitlement to practise, not simply on the absence of concerns.
How can GPs prepare for appraisal?
There are several ways that GPs can prepare for appraisal. These involve:
- collecting information
- seeking advice from the PCT appraisal lead
- eliciting colleague feedback
- keeping a learning log
- recording thoughts on events or learning in practice.
As a minimum, the following information, as listed in the Leicester statement, should be assembled:2
- new appraisal Forms 1, 2, and 3
- on-going personal development form, with clear description in Form 3 of degree of attainment
- previous year’s appraisal summary (Form 4)
- case review structured reflective template (SRT) (see Figure 1)
- data collection/audit SRT
- significant event SRT
- SRT on previous year’s learning
- patient survey SRT
- complaint SRT(s) or declaration of no complaints
- multi-source feedback SRT
- full declaration of all other professional roles
- other professional roles SRT
- probity SRT
- health SRT.
Structured reflective templates have been developed as part of the Leicester statement to allow a doctor to take data relating to organisational or team behaviour, and relate it to his/her own behaviour, thus identifying personal learning.
The information can be collected over the course of the year and stored on the appraisals website (www.appraisals.nhs.uk), where there are prompts and templates to help the recording of reflections.
Figure 1: Case review structured reflective template
|Name of doctor:||
|Date of clinical event:||Patient Identifier:|
|Description of clinical event:
Hints: You may choose a single consultation at random, or you may prefer to choose a case in which you were involved over time. Either way, your involvement should have been significant. You should write from your personal perspective, and reflect on how your own professional behaviour can improve, not that of the organisation, or of others.
|Reflections relating to Good Clinical Care:
Hints: This refers to the systems allowing effective care, and your place within them. Was all information to hand? Was there enough time for the consultation? Was the environment conducive to patient privacy and dignity? Were all required clinical facilities available? Were local guidelines available? What can I do to improve these factors?
|Reflections relating to Maintaining Good Medical Practice
Hints: This refers to your level of knowledge. How do I judge my level of knowledge, or skill around this clinical topic? What unmet learning needs can I identify? How can I address them?
|Reflections relating to Relationships with Patients
Hints: How well did I communicate with the patient? Did the patient feel respected? Did the patient have sufficient opportunity to tell their story? Did the patient feel a partner to the outcome of the consultation? How do I gauge these? What skills can I identify that will enhance these?
|Reflections relating to Relationships with Colleagues
Hints: Did I take account of notes made by others prior to this event? Did I gather information appropriately from others? Did I make comprehensive, legible records for others who may see the patient subsequently? Did I appropriately respect the clinical approach of others, even if it differs from my own? What can I do to improve this area in the future?
|Outcome: For completion at your appraisal
Agreed potential learning needs for consideration for inclusion in your personal development plan, considering how your outcome will improve patient care.
|Reproduced with permission from the National Association of Primary Care Educators
Appraisal leads in PCTs
The PCT appraisals administrator will help appraisers with the tools needed for the data collection, and will send the list of essential information to all GPs, with the arrangements for the appraisal interview.
Obtaining feedback from colleagues will be a new experience for many GPs. For others it will have been tried in the past and found unhelpful. A national format is likely to be published by the Academy of Royal Medical Colleges, but until this is available some simple tools can be used such as those available from the Oxfordshire GP Appraisal Guide,3 or the multi-source feedback tool from the new membership area of the Royal College of General Practitioners (RCGP) website can be adapted for use.4 There are also commercial packages available, which offer, for example, colleague feedback surveys or patient surveys.
Keeping a log of learning over the year is a useful way for a GP to show not only what courses have been attended (and what was gained from them), but is also a way to track self-directed learning. Many GPs spend time each week reading journals and looking up medical information on the internet (e.g. by visiting eguidelines.co.uk). Recording this in a log will build a useful source of personal reference, and will also demonstrate the many hours spent in keeping up to date. This probably represents no less than 50 hours a year, as most GPs spend several hours each week on these activities. The appraisal website has a learning log facility where this information can be stored over the year, rather than entering details at the last minute before the appraisal interview.
Reflections on events/learning in practice
Many GPs already record their thoughts on events or share them with colleagues. Making a habit of setting ideas down is less easy. Sometimes the topic is fully thought through and the learning well applied but it is never recorded, and some would say that ‘life is too short’ for setting things down. However, the act of writing clarifies partly formed ideas into discrete actions and so can only help the process of improving clinical care experientially.
For those who like to read and want to examine the literature carefully there are several tools available on the Centre for Evidence-Based Medicine website (www.cebm.net).
Preparing for change
It is likely that GP appraisal and its link to revalidation will change rapidly over the next 12 months. Becoming accustomed to recording and storing information now will stand everyone in good stead. Even if the forms needed may be slightly different in the final appraisal, the process followed will be the same. The National Clinical Governance Appraisal Support Team became the Revalidation Support Team at the end of March 2008. The appraisals website (www.appraisals.nhs.uk) has been updated with new prompts and guides. Those GPs who are not yet using the website should consider using it now, as this will guide them into the new processes.
- Department of Health. Trust, Assurance and Safety—The Regulation of Health Professionals in the 21st Century. London: The Stationery Office, 2007.
- NAPCE, NCGST Appraisal Support Group. Evidence for medical appraisal: essential/optional. Statement of the NAPCE/CGST Conference February 2007.
- Oxfordshire GP appraisal guide. www.oxfordprimarycarelearning.org.uk