Dr Honor Merriman summarises the latest changes to the GP appraisal process in four key learning points

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Dr Honor Merriman

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Read this article to learn more about:

  • how the appraisal process has changed in light of the COVID-19 pandemic
  • the format of the appraisal meeting and what it will cover
  • completing the pre-appraisal template and other preparation requirements.

A recent survey by the BMA found that consistently more than one-third of all doctors had reported negative impacts on their stress levels and mental health due to COVID-19.1 Some GPs have had a massive increase in their workload, others have found themselves without work, and many have been ill themselves with COVID-19 or had family members severely affected. Every GP needs thinking space to make sense of it all and receive support and guidance for sources of help; most importantly they need to have support in seeing their way forward now.

The GP appraisal service was stopped in England in March 2020, on the advice of the NHS England National Medical Director, Professor Stephen Powis; at the onset of the COVID-19 pandemic it was anticipated that all doctors would be needed to focus on providing care for the many people who were affected by the virus. At the end of August, he wrote again to responsible officers (ROs) and Medical Directors to advise a restart from October 2020. In view of the impact of the pandemic, this restart is to enable appraisals to have a different focus, allowing doctors time to discuss their current health needs and future plans, and should be flexible according to local circumstances.

This new model of GP appraisal is called Appraisal 2020. The aim is that the appraisal meeting will require minimal preparation and will focus on GP wellbeing and development. This article will summarise the main points GPs need to know to gain the maximum benefit from the process.

1. Prepare for the appraisal meeting

Preparing for Appraisal 2020 will need much less time since supporting information including reflections will not be required. As with appraisals before the pandemic, the GP will need to:

  • consider the scope and nature of their work
  • review last year’s personal development plan (PDP)
  • identify achievements, challenges, and aspirations.

The information required in the new template (see Box 1),2,3 can be noted down quickly; the form has been piloted in several areas and on average took about 30 minutes to complete.

There is currently no requirement to produce supporting information with reflections. The GP is able to submit this information if they wish; however, appraisers will not press colleagues for it. The reflections will emerge in the appraisal discussion.

The need to produce evidence of at least 50 hours of continuing professional development (CPD) is also not needed; appraisers will ask how learning has helped the GP’s current work, and if any more learning is thought to be needed by the GP—this can be added to the PDP. The General Medical Council (GMC) has never asked for a specific number of CPD hours, it just advises that: ‘CPD helps you update what you learnt at medical school and during postgraduate training to reflect changes in practice, changes in the needs of patients and the service, and changes in society’s expectations of the way doctors work’.4

It is your responsibility to do enough appropriate CPD to remain up to date and fit to practise in your work and to be able to demonstrate this at your appraisals. This applies whether you are in full-time or less than full-time practice.’4

Box 1: Pre-appraisal template3

1. Personal details

  • Name
  • GMC number

2. Scope of work

  • Describe your core roles and significant changes since your past appraisal

3. PDP review

  • What progress, if any, have you made with last year’s PDP? Are there any goals you wish to carry forward?

4. Challenges, achievements, and aspirations

  • What personal and professional challenges or constraints have you faced?
  • What have been your greatest achievements?
  • What do you hope to achieve in the future, personally and professionally?

5. Personal and professional well-being

  • On a scale of 1 (most negative) to 10 (most positive), how are you?
  • Consider:
    • How has the COVID-19 pandemic affected you?
    • How do you maintain your health and well-being and what do you need to do differently if anything?
    • Have you needed any support and what was available to you?

6. CPD, QIA, and feedback from colleagues and patients, including compliments

  • Include any aspects of these that you particularly wish to discuss at your appraisal

7. Significant events or complaints since your last appraisal

  • Please include if any. You will be able to describe and discuss them in more detail with your appraiser

8. Items you have been asked to bring to your appraisal

  • Please include if any. You will be able to describe and discuss them in more detail with your appraiser

9. Your PDP themes

  • What are your goals for the coming year?

The completed template can be uploaded to the GP’s preferred website without any supporting documentation. This information is already part of the usual websites GPs use for appraisal (for example, Clarity and Fourteenfish). The GP will need to sign off probity, confidentiality, and health declarations in the toolkit, and confirm the accuracy of the supporting information.

As before, the information should be submitted 2 weeks in advance so that the appraiser can read it before the meeting.

Completion of the last year’s PDP objectives may have been difficult for many GPs since the pandemic began. A change in work patterns, and thus learning priorities, means that personal objectives may have changed from last year’s PDP to meet current needs. The Medical Appraisal Guide 2020 states: ‘It would normally be expected that the objectives laid out in the personal development plan are completed by the time agreed but it should be remembered that circumstances and priorities may have changed (for example a doctor’s job may have changed).5

2. Be ready to adapt to virtual GP appraisals

GP appraisals will need to be virtual, not face to face, for the foreseeable future. NHS England does not specify which platform should be used, only that it must be secure and mutually acceptable to both the GP and the appraiser. Telephone calls are not to be used and the discussion should not be recorded. The timing of the appraisal must also be mutually suitable and preferably not at weekends or in the evenings.

It is particularly important that GPs feel safe describing their recent experiences and are able to explore any concerns and other ideas. All appraisers start discussions with a confidentiality declaration but GPs should feel empowered to clarify the statement if there is a particular issue they would like to air. ‘Confidentiality is not absolute … This would clearly be the case should patient safety issues be identified.6

3. Know where to access support

During the meeting, the GP’s needs may become more apparent and the appraiser may wish to signpost the GP to national resources; an updated list has been produced by the Academy of Medical Royal Colleges (AOMRC) called Medical Appraisal 2020: support for doctors.7 In many cases there is also local mentoring, or other helpful resources, and appraisers should be aware of these as a result of the training they have received in order to offer the Appraisal 2020 service.

Postponing appraisals

If GPs are well enough to work, they should have an appraisal. During the pandemic, several GPs have become unwell and have been unable to work. Provided they have worked in the previous 12 months it would be a good idea for them to have a supportive appraisal focused on their wellbeing. Other GPs may be resistant to the idea of an appraisal even in its ‘light preparation’ format; if they feel unable to meet an appraiser now, that will be considered sympathetically.

Each designated body will have a different way of helping GPs in this situation but, in general, support can be offered first and a postponement offered until feelings of stress and other problems improve. However, it is worth noting that the appraisal discussion is focused around the wellbeing of the GP, so those who are most stressed are likely to be the ones who will benefit the most from an appraisal meeting.

4. Find new ways of seeking feedback for revalidation

The new format for appraisal will guide GPs to supply all the necessary information for revalidation; however, the GMC has moved the revalidation date of all GPs forward by 1 year. GPs who have already supplied all the necessary information will still be revalidated this year; however, those who need more time to complete feedback surveys, for example, will be able to submit these in the next year’s appraisal.

Paper surveys for patient feedback were previously thought to be a good method of gathering patient views because in many GP practices there are a few patients who do not use the internet. With the move to see fewer patients face to face it is likely that email surveys will become the norm in the future. The GMC and AOMRC are considering the best ways to seek patient feedback and are expected to publish new guidance on this soon.

The six supporting types of information for revalidation have not changed8 and can still be submitted in the usual way under the new format.

What does the future hold for GP appraisal?

At present it is not clear when the COVID-19 pandemic will end so the changes to GP appraisal may well continue, but this is an early phase of attempting different methods for appraisals. It may evolve into a new system as we continue to learn how to help our colleagues more effectively, while still adhering to GMC guidance.

References

  1. British Medical Association. COVID-19: analysing the impact of coronavirus on doctors. BMA, 2020. Available at: www.bma.org.uk/advice-and-support/covid-19/what-the-bma-is-doing/covid-19-analysing-the-impact-of-coronavirus-on-doctors
  2. Academy of Medical Royal Colleges. Appraisal & revalidation during COVID-19. www.aomrc.org.uk/revalidation-cpd/appraisal-revalidation-during-covid-19/ (accessed 22 September 2020).
  3. Academy of Medical Royal Colleges. Medical appraisal template 2020—professional appraisal in the context of the coronavirus pandemic. Available at: www.aomrc.org.uk/wp-content/uploads/2020/09/2020_Appraisal_template_040920.docx (download).
  4. General Medical Council. Continuing professional development: guidance for all doctors. GMC, 2012. Available at: www.gmc-uk.org/-/media/documents/cpd-guidance-for-all-doctors-0316_pdf-56438625.pdf
  5. Academy of Medical Royal Colleges. Medical Appraisal Guide 2020—a guide for professional medical appraisals in the context of the COVID-19 pandemic.  AOMRC, 2020. Available at: www.aomrc.org.uk/wp-content/uploads/2020/09/Medical_appraisal_guide_covid19_0820.pdf
  6. NHS England. Medical Appraisal Guide. NHSE, 2013 (updated 2014). Available at: www.england.nhs.uk/revalidation/wp-content/uploads/sites/10/2014/02/rst-medical-app-guide-2013.pdf
  7. NHS England. Medical appraisal 2020: support and advice for doctors. Academy of Medical Royal Colleges, 2020. Available at: www.aomrc.org.uk/wp-content/uploads/2020/09/Medical_appraisal_2020-support_for_doctors_0920.docx (download).
  8. General Medical Council. Guidance on supporting information for appraisal and revalidation. GMC, 2018. Available at: www.gmc-uk.org/-/media/documents/rt—supporting-information-for-appraisal-and-revalidation—dc5485_pdf-55024594.pdf?la=en&hash=1CA018A10A29AEEA7CDE433E0B901B97DFE96402