Dr Honor Merriman discusses the suspension of the appraisal process at a time when reflection and peer support are crucial

Photo of Dr Honor Merriman

Dr Honor Merriman

Independent content logo

Read this article to learn more about:

  • the suspension of appraisals until further notice
  • the implications of ‘approved missed’ appraisals for revalidation
  • how to access online learning and support while appraisals are suspended.

The past few months have featured new experiences for everyone. Most people describe these times, in which the country has faced the COVID-19 pandemic, as ‘extraordinary’. Most have found them very difficult. At the start, it was anticipated that every doctor would be needed to care for affected people; hence, a decision was made to suspend appraisals so that time could be devoted to clinical work. As the outbreak progressed, it became clear that GPs were having differing experiences of the effect of the virus on their work patterns, but found it helpful not to have to consider having an appraisal.

It is now time to think about what will be needed when the appraisal process resumes. It is not yet clear when this will be, but it may begin in October 2020. Protected time to discuss their experiences during the pandemic will be valued by GPs when appraisals restart. Everyone will need this, but some may be slow to seek it for themselves. The appraisal discussion may be conducted remotely, but will encourage reflection. Appraisers can use the opportunity to signpost colleagues to further sources of help if this is needed.

What does the suspension of the appraisal process involve?

On 19 March, Professor Stephen Powis, National Medical Director of NHS England, wrote to all medical directors and responsible officers in England recommending that: ‘appraisals are suspended from the date of this letter until further notice, unless there are exceptional circumstances agreed by both the appraisee and appraiser. This should immediately increase capacity in our workforce by allowing appraisers to return to clinical practice’.1 On 20 March, all GPs were informed, and local area teams sent the information to their local appraisers; in most areas, no appraisals took place after 21 March.

The situation for most GPs

The RCGP has collated information about appraisal and revalidation during the COVID-19 pandemic, which has been gathered into a frequently-asked questions document.2

All GPs who were due an appraisal from late March (the exact cut-off date varies between different area teams) were told that they would have an ‘approved missed’ appraisal for this appraisal year.1 This missed appraisal will not affect their revalidation date if it does not fall between March and October 2020. GPs due to be revalidated before the end of September 2020 have had their revalidation date automatically deferred by 1 year by the General Medical Council (GMC).1,3

Because revalidation occurs in a 5-year cycle, it may be that this ‘approved missed’ appraisal is not the only one in the cycle. This will not matter. The topic is covered in more detail in the Royal College of General Practitioners (RCGP) mythbusting guidance: ‘Myth: I must have five appraisals before I can have a recommendation to revalidate’.4

Some GPs have been contacted and offered an appraisal in these months. The usual reason for this is to allow the GP to show compliance with ‘conditions’ on practice. The aim of letting these very few appraisals go ahead is to return GPs to their usual work patterns.

Some GPs had appraisals before 21 March, which demonstrated that all the necessary information had already been submitted for revalidation. These GPs have been recommended for revalidation. They will already have received (or will soon receive) confirmation of this from the GMC.

The situation for GPs working for a small designated body

Some responsible officers chose to postpone appraisals rather than giving doctors due to be appraised in the near future an ‘approved missed’ appraisal. Postponements are made if it would be possible to facilitate appraisals for all doctors later in the appraisal year without putting undue pressure on the medical workforce.

What about CPD?

Many courses and conferences have been cancelled over the past few months. However, there are numerous sources of online learning available—for example, both NB Medical Education and Red Whale have produced many online courses, webinars, and resources, some of which cover the wellbeing of healthcare professionals at this challenging time.5,6 In addition, the RCGP’s entire eLearning content is temporarily freely available to support all returning GPs and primary healthcare professionals in the response to COVID-19.7

Coping with COVID-19 has been a steep learning curve for everyone, and it is a major part of GP learning at present. GPs should make a note of items they have used that have proved helpful in clinical practice. In the ‘soft reboot’ of the GP appraisal process, there is now no requirement for a detailed reflective note for every item. However, it remains acceptable for some GPs to produce reflective notes—some find that writing down what they have learned is part of their learning process. If making a note helps them make sense of their learning, then they should go ahead and do it.

GPs have had to work differently in the pandemic. There has been an increase in the use of telephone consultations, and this has involved service redesign in most practices. The redesigned service that GPs have had to work in will have been, in many practices, subject to a quality improvement process—which should also be noted in an appraisal portfolio. This is just one example of the changes in ways of working necessitated by the pandemic, but there have been many others that should also be added to the year’s achievements and celebrated at appraisal.

Recording how you have maintained your health in the pandemic

The past few months have caused all sorts of difficulties and changes for GPs. If they have been lucky enough not to contract COVID-19, they have had to cope with having to work wearing personal protective equipment or working remotely. Many GPs have had their non-clinical work stopped and this has, in some cases, caused financial hardship when the clinical work they were supposed to do instead was unavailable. A plethora of advice and support has been issued by sources such as the BMA,8 but little has been primary-care focused. In many areas, training hubs have offered a personal support service; for example, Thames Valley has a mentoring service.9

A discussion about how you maintain your health and wellbeing is an important part of your appraisal discussion. Making a note about what support has been available to you, and how you used it, is helpful; it will show which useful support was there and where the gaps were. Considering what else was needed and then finding out how to get it will prove very helpful in the longer term. Discussing this in your appraisal may reveal further resources and, thus, future-proof you in the longer term.

Looking ahead

Many of the items we had hoped to achieve may not have been done, but under current working conditions, this is not a failure at all. There is so much more that we have achieved, and this should be recognised and celebrated.

The past few months have caused many of us to think more about our roles at present and where they may take us in the future. Perhaps a different type of work would appeal more now. Getting these thoughts down in words can help to crystallise them and make the options easier to discuss at appraisal. Although many GPs do not complete this part of the various appraisal websites, now may be a good time to start.

There is currently no certainty around a start date for appraisals or the form they will take. Some are suggesting a simpler, post-pandemic appraisal, focused on the doctor’s wellbeing. This proposal has been put to the GMC, but as yet no decision has been made.

What can GPs do now in preparation for their appraisal?

In short, nothing needs to be done right away until there is news of a start date. The ideas in this short article are useful whatever form the appraisal takes. Many GPs with approved missed appraisals have said how much they missed their appraisal this year. Supported thinking time with a peer is hugely valued: there has been no other time when peer support has been needed more.

Dr Honor Merriman

GP Appraisal Lead, Thames Valley

References

  1. Powis S. Covid-19 and professional standards activities (including appraisal and revalidation). Letter to all responsible officers and medical directors in England. 19 March 2020. Available at: www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/03/letter-from-prof-powis-to-ros-and-mds-19-march-2020.pdf
  2. Royal College of General Practitioners. Appraisal and revalidation during the COVID-19 pandemic. www.rcgp.org.uk/-/media/Files/Revalidation-and-CPD/2020/RCGP-FAQ-appraisal-and-revalidation-covid19-march-2020.ashx?la=en (accessed 12 June 2020).
  3. General Medical Council website. Guidance on supporting information for appraisal and revalidationCoronavirus (COVID-19) – doctors revalidating before September 2020.www.gmc-uk.org/registration-and-licensing/managing-your-registration/revalidation/guidance-on-supporting-information-for-appraisal-and-revalidation (accessed 12 June 2020).
  4. Royal College of General Practitioners. The role of appraisal in the regulation of doctors. www.rcgp.org.uk/training-exams/practice/revalidation/mythbusters-appraisal-and-revalidation/the-role-of-appraisal-in-the-regulation-of-doctors.aspx (accessed 12 June 2020).
  5. NB Medical Education. Webinars. www.nbmedical.com/NBListWebinars?Website_Category=Free+Webinars (accessed 12 June 2020).
  6. Red Whale. Webinars & online courses. www.gp-update.co.uk/webinars (accessed 12 June 2020).
  7. Royal College of General Practitioners. RCGP learning. elearning.rcgp.org.uk/ (accessed 12 June 2020).
  8. British Medical Association. Your wellbeing. www.bma.org.uk/advice-and-support/your-wellbeing (accessed 12 June 2020).
  9. GP Mentoring. Welcome to the GP Mentoring scheme in Buckinghamshire, Oxfordshire & Berkshire West. www.gpmentoring.co.uk/ (accessed 12 June).