Dr Honor Merriman provides 10 top tips on how GPs can ensure they are ready for their appraisal, and how to get the most out of it

Honor Merriman

Dr Honor Merriman

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Read this article to learn more about:

  • how to approach appraisal and revalidation
  • the importance of taking reflective notes, and what templates are available
  • gathering supporting information, and ways to ensure that you are prepared for revalidation.

In the ever-busy life of a GP, the yearly appraisal may seem like an added burden. In 2018, the General Medical Council (GMC) and Royal College of General Practitioners (RCGP) simplified the process,1 making it more straightforward to prepare for appraisal. A confidential, supportive discussion is increasingly recognised as a valuable means of improving GP morale, therefore creating a healthier GP workforce. Instead of thinking, ‘I need to postpone my appraisal because I am stressed’, practitioners should think, ‘I need to arrange my appraisal because I am stressed’. A 2019 report published by the British Medical Association revealed that 80% of doctors and medical students are at high or very high risk of burnout, so the opportunity to talk about work should be grasped.2 It is important to remember that appraisals can be used to celebrate successes as well as to clarify thinking about problems, and appraisers can signpost GPs to sources of support.

This article offers 10 tips to help to make the appraisal and revalidation process easier, and allow more time in the meeting to be devoted to discussing current challenges, health, career aspirations, and personal development.

1. Collect information throughout the year

Try to start collecting information early on, ideally soon after you have completed your most recent appraisal. Consider if there is an easier way to record information, perhaps using your phone or tablet. It can be helpful to use a website application to document information on a day-to-day basis, for example Clarity or FourteenFish

Appraisers are still finding that GPs are causing themselves unnecessary stress by leaving their reflective note-taking until a few weeks before the appraisal. Capturing reflections and learning is much harder to do when a learning event took place months ago and opportunities to do things differently may be lost.

2. Request exemption from an appraisal when appropriate

Are you planning to be away from NHS work for the next year? Perhaps you will be on maternity leave, or working abroad for the next 12 months. If so, you will need to apply for an exemption for your next appraisal. Unless in exceptional circumstances (e.g. illness), an exemption request should be made in advance and may be declined if requested retrospectively. Your responsible officer (RO) will be able to send you a copy of the exemption request form if your area team does not have a website to download it from. If your request is granted and you are exempted for a year, you can still be revalidated on a fewer number of appraisals in the 5-year cycle.

3. Know the appraisal requirements for a low volume of clinical work

If it likely that you will be doing 40 sessions or fewer of clinical work in the next 12 months, then refer to the NHS England’s guideline on Supporting doctors who undertake a low volume of NHS General Practice clinical work3 and complete the reflective template found in the appendices. One of the aims of the guidance was to support doctors in this cohort to meet the following GMC requirements:3

  • a doctor must ensure that their appraisal inputs demonstrate fitness to practise across their scope of work
  • the RO must be assured that the doctor’s appraisal inputs and the appraiser outputs support a recommendation of fitness to practise.

4. Be selective about the items you include in your portfolio

Not all meetings or events need to be added to the appraisal portfolio, and continued professional development (CPD) items do not all need to have reflective notes, only the ones where new learning has stimulated a change in practice. This will help to reduce the recording burden. When deciding which CPD items to submit in your appraisal portfolio, choose 50 or more items that demonstrate some form of update in each of your roles as a GP. Add a reflective note of your learning as a whole. For more information, look at the Supporting information guidance page on the RCGP website.

Practitioners should note that submitting huge numbers of CPD credits is unhelpful and shows an inability to organise and display only the items that are key to updating knowledge in all the roles they fulfil as a GP.

5. Review last year’s PDP

Much of your learning over the past year may have been directed by your personal development plan (PDP), so do not forget to add some reflective notes about how useful your PDP items have been for you. Include examples if possible. NHS England has produced a helpful guide on creating PDPs.

6. Remember that reflections can be concise

Reflective notes should cover what impact the learning will have on your practice, rather than a set of notes reiterating a lecture or an educational article. The GMC, in partnership with several other medical organisations, has produced guidance to help doctors summarise the factual details of an event and focus on what has been learned.4 The guidance suggests using the What? So what? Now what? framework to structure reflective notes; however, there are many other models that can be used. The Academy of Medical Royal Colleges (AoMRC) has developed worked examples that document reflective learning using several different frameworks, including What? So what? Now what?.5 Try out the different models in the AoMRC examples and find the one that fits your style and the event you wish to learn from.

7. Know when you are due to revalidate

Always make sure you know when your revalidation is due. If your next appraisal is the last one before revalidation, ensure that you have prepared all the necessary supporting information, including patient and colleague survey results. This information cannot be added after the meeting. The GMC has produced guidance on the requirements for supporting information for appraisal and revalidation.6 The RCGP has also produced a range of resources to support doctors in the appraisal and revalidation process (see tip 4).

If all the necessary supporting information is not presented before the pre-revalidation appraisal, the revalidation will be deferred. Although this is not a disaster, the GMC does not allow repeated deferrals so it is best to be organised and avoid this situation entirely.

8. Provide information for all of your roles as a GP

If you undertake several roles as a GP, consider which of these roles will require additional information for revalidation. For example, if you work for an out of hours (OOH) provider, record feedback and appraisal discussions for your work in that role, year on year. This is particularly important if you work in an area away from your main GP work. A common example of this is a GP who works for an OOH provider in a different area from where they work in hours; any concerns the OOH employer has may not reach the GP’s RO. If you work as a locum you must list, and provide details of, all the practices you have worked in over the previous year.7 This information needs to be supplied every year.

9. Check everything before you submit your supporting information

Four weeks before your appraisal meeting, review your submission, check it is complete, and sign it off 2 weeks before your meeting. This gives sufficient time for your appraiser to read through everything and let you know if there are any missing items. Information from feedback surveys should be thought through before the appraisal meeting so that your ideas can form part of the appraisal discussion. It is not acceptable to turn up to your appraisal meeting with survey results you have received that morning.

10. Make the appraisal your own

Before your appraisal, think about what you want to get out of it. What challenges are you facing? What aspirations do you want to talk about? Use your appraisal as an opportunity to ‘think aloud’—your appraiser will want you to feel able to do this, and pleased that you are using this confidential discussion to share your ideas.

Before despairing, know that the appraisal process has been simplified and should be much quicker to prepare for. Try and aim for a couple of hours of preparation. Keep in mind that if you record your learning as you go along over the year the immediate preparation is simple. Look forward to your appraisal meeting as protected time to think about yourself and how you want to move forward in your career.

Dr Honor Merriman

Clinical Advisor and Interim Appraisal Lead, NHS England Thames Valley

References

  1. Royal College of General Practitioners website. Guide to supporting information for appraisal and revalidation: context. rcgp.org.uk/training-exams/practice/revalidation/guide-to-supporting-information-for-appraisal-and-revalidation/context.aspx (accessed 9 May 2019).
  2. British Medical Association website. Supporting the mental health of doctors and medical students. bma.org.uk/collective-voice/policy-and-research/education-training-and-workforce/supporting-the-mental-health-of-doctors-in-the-workforce (accessed 30 April 2019).
  3. NHS England. Supporting doctors who undertake a low volume of NHS General Practice clinical work. NHS England, 2018. Available at: england.nhs.uk/south-east/wp-content/uploads/sites/45/2019/01/Supporting-doctors-who-undertake-a-low-volume-of-NHS-General-Practice-clinical-work.pdf
  4. General Medical Council website. Being a reflective practitioner. gmc-uk.org/education/standards-guidance-and-curricula/guidance/reflective-practice/the-reflective-practitioner—guidance-for-doctors-and-medical-students/being-a-reflective-practitioner (accessed 2 May 2019).
  5. Academy of Medical Royal Colleges and Conference of Post-Graduate Medical Deans (COPMeD). Reflective practice toolkit. Guidance note. August, 2018. Available at: www.aomrc.org.uk/wp-content/uploads/2018/08/Reflective_Practice_Toolkit_AoMRC_CoPMED_0818.pdf
  6. General Medical Council. Guidance on supporting information for appraisal and revalidation. GMC, 2018. Available at: gmc-uk.org/-/media/documents/rt—supporting-information-for-appraisal-and-revalidation—dc5485_pdf-55024594.pdf
  7. Royal College of General Practitioners website. Scope of practice. rcgp.org.uk/training-exams/practice/revalidation/guide-to-supporting-information-for-appraisal-and-revalidation/scope-of-practice.aspx (accessed 3 May 2019).