Appraisal Pack 2018-19

Executive Directors

Name:
Job Title:
Department:
Appraiser Name:
Date of Appraisal:

Avoid the ‘tick box exercise’ method of conducting appraisals; see ‘Making the Appraisal Meeting Work – Avoiding the Tick Box Exercise’ leaflet available on the intranet

You can complete a short anonymous questionnaire regarding the quality of your appraisalwhich is available on the intranet;

*If you are a Registered Nurse/Midwife or SCPHN and your Revalidation is due this year you will also need to complete the Revalidation Documentation for Nurses and Midwives 2018 -2019.

Section 1: Personal Reflection on the last 12 months
The following questions and statements are to help you to prepare prior to your appraisal. Use these as a framework for your discussion during your appraisal; use the space below to make notes of matters you’d like to raise.
What do you consider to be your most important achievements of the past year?
What have been the most significant challenges for you in the last year?
What is the biggest obstacle at work that you are facing?
What action could be taken to improve your performance in your current position by you, your manager or systems/processes?
What contribution would you like to make in your current role? What are you really good at?
How could teamwork in your immediate team be improved? To what extent do you feel part of a team? How regularly do you meet with your team?
Section 2: Understanding your Role and Responsibilities
Job Description (refer to Appendix A at the end of this document):
Are there any changes or amendments to be made to your Job Description?
Are you clear about what you are responsible for?
What are you accountable for in your role?
Who are you accountable to? Do you know who your senior management team are?
Who are you accountable for?
What’s Your Line Management Structure?
Who do you discuss your workload with, who allocates you tasks, who do you have your appraisal conversation with?

Version One: April 2018

Section 3: Mandatory training and requirements of your role
Mandatory Training:
Are you aware of the mandatory training requirements of your role?
What is your mandatory training compliance %? If it is not 85% or above what is your plan to complete your training?
Infection Prevention and Control:
Infection Prevention and Control is everybody’s responsibility. All staff must promote effective infection prevention and control practice to help achieve the Trust vision, goals and priorities. Discuss how you do this in practice.
Safeguarding Children and Adults:
Safeguarding is everybody’s business and living a life free from harm is a fundamental right for children, young people and adults. Take some time during your appraisal to discuss the level of training you require and whether it is up to date. If your training has lapsed ensure you undertake the training within 2 weeks of this appraisal. Reflect on any safeguarding enquiries, issues or investigations you may have been involved in.
Duty of Candour:
All employees have a responsibility under the Duty of Candour; what is your understanding of this in relation to your role? For further information see the documents ‘Duty of Candour Introduction – NHS Litigation Authority’ and ‘NMC The Professional Duty of Candour’ available on the intranet;
Verification of Registration:
Please provide details below of your registration to any professional body that is related to your role, e.g. NMC, HCPC, CIPD, ACCA, CIMA.
Name of professional body:
Date of registration:
Date of renewal of registration / revalidation (if applicable):
Registration number/PIN:
If you are a Non-Medical Prescriber please complete the Annual Declaration to Practice form and discuss with your Appraiser
Section 4: Clinical Checklist & Revalidation Checklist
for completion by Registered Nurses/Midwives & SCPHN (Specialist Community Public Health Nurses) only:
Objective / Comments
Are you on target to achieve the required number of practice hours over 3 years (450 required over 3 years, 900 for dual qualified RN and Midwife)
Are you on target to achieve 12 – 15 hours of CPD (35 hours required over 3 years)
Are you on target to achieve 5 - 10 hours of participatory learning (20 hours required as part of your total 35 hours of CPD requirements, every 3 years)
Are you on target to achieve feedback on your practice
(Five pieces required over 3 years)
Have you been able to positively reflect on a CPD experience, or feedback on your practice (Five pieces required over 3 years)
Section 5: Health & Wellbeing
Are you aware of the support services and health and wellbeing activities available to you?
You can access support through the following ways;

Self-referral to Occupational Health
Counselling and advice through the Trust Employee Assistance Programme
Fast track referral to Physiotherapy
Advice from the Back Care Advisory Team

Please visit the intranet to view the Health & Wellbeing Zone;

To view the Rapid Access to Treatments and Rehabilitation Policy go to; under Clinical Policies.
Describe what would help improve your health and wellbeing at work, (for example, having the flu jab, making sure you have a lunch break):
What will you do about this? What help do you need?
Section 6: Harassment, Bullying & Abuse (HBA):
Anti-Bullying Advisors and Freedom to Speak Up Guardians
The organisation wishes all staff to be aware that there is support available if you are experiencing harassment, bullying or abuse.
Full information, practical advice, how to access support and the Bullying and Harassement Policy are available on the intranet:
You can also email; which is a confidential email address and we can put you in touch with someone to support you.
If you have a concern about risk, malpractice or wrongdoing you can contact the Trust’s Freedom to Speak Up Guardian, or one of the Freedom To Speak Up Advocates. Alternatively you can email:. Please refer to the Freedom To Speak Up: Raising Concerns (Whistleblowing) policy for the NHS on the Intranet for more information.

Section 7: Career Aspirations and Succession Planning
The focus of this section should be on your potential and aspirations for future career development, and for your manager to consider succession planning where you may be suitable for development into critical posts in the future.
Thinking about your current role, your life and your career are you…

Why have you chosen the option you have?
What do you like about the current job you do? What don’t you like and why?
What support do you need from your manager, the team or the organisation to fulfil your potential for the future
If you want to develop or are ready for more, how ready are you for a change?
☐ Now
☐ 1 Year
☐ 2 to 3 years

Section 8: Review of Objectives Over the Past Year
(make notes here to discuss at your appraisal)
Your Objectives from last year / Achieved?
Met successfully/ not met required standard / Comments
Include evidence to show why the objective has or has not been met
Overall summary – have all objectives been achieved?
(Note: if your objectives have not all been successfully achieved, your pay progression may be affected)
Section 9: Personal Development Plan from Last Year
Your Personal Development Plan (PDPfrom last year / Achieved?
Met successfully / not met required standard / Comments
Include evidence to show why the PDP activity has or has not been achieved

Section 10: Review of Behaviour
Give some examples of how you have demonstrated this behaviour
Fails to recognise the priorities and challenges of the local population, stakeholders or staff / In touch with the reality faced by local people and their families, stakeholders and staff
Either fails to understand or does not value the importance of involving key stakeholders in the running of the organisation / Ensures the views of stakeholders and staff contribute to the organisation’s vision, strategies, resulting business plan and initiatives
Displays limited insight into the reality faced by individuals or local populations or what would really make a difference to them / Interested in the experiences and needs of individuals; displaying genuine insight into how improvements across the system can enrich their lives and manage complexity of needs within the local health and social care system
Keeps things to themselves, has lots of ‘private’ conversations; reluctant to share information or views publically / Open and honest in their approach, avoids secrets and willing to share information appropriately with stakeholders and staff
Quick to blame or criticise others when things go wrong; may take an overly parental, judgemental approach, harassing or bullying performance management style / Calm, balanced and objective when problems are raised or failure is surfaced, encouraging others to seek solutions not conflict. Manages performance through supportive dialogue using a non-bullying performance management style
Overly harsh or negative when challenging others; has the capacity to personalise issues and create unnecessary conflict / Challenges in a constructive and supportive way which encourages others to focus on desired outcomes, progress and opportunities
Reluctant to share their own mistakes, vulnerabilities or short comings; puts minimal effort into their own learning and growth as a leader / Champions learning by displaying strong personal commitment to sharing their mistakes and investing in their own development
Appraisee: please sign here to confirm your commitment to abide by these effective behaviours yourself and to highlight any ineffective behaviour you observe in colleagues:
Section 10 continued;
Ineffective Behaviours / Effective Behaviours / Give some examples of how you have demonstrated this behaviour
Does little to initiate or capitalise on opportunities to bring key groups together; may rely on others to make these meetings work / Brings people together, binds them around common interests and focuses them on a compelling vision for the future
Displays little awareness of the latest developments on the local and national scene; relies on getting this information from others / Has their finger on the pulse nationally and locally; knows everything that’s going on and shares this knowledge with others
Responds defensively when challenged and can become entrenched, arguing their case for the sake of it / Responds in a calm and balanced manner when challenged and is comfortable to accept alternative perspectives
Approach to chairing or contributing to meetings can suppress energy levels or fail to recognise the level of contribution others make / Brings out the best in people during meetings, encourages contribution and reinforces a productive and dynamic approach. Acknowledges good work and rewards success
Perceived as low energy and glass half empty; does little to motivate or inspire others; does not promote healthy or supportive working practices / Displays energy and positivity even during difficult times; keeps others upbeat and motivated; promotes a healthy, supportive environment
Gets too involved in telling people how to run their services or is too far removed to understand how best to support people / Empowers people; gives them the freedom to act whilst remaining alert to key strategic issues or risks and provides support where it’s needed
Appraisee: please sign here to confirm your commitment to abide by these effective behaviours yourself and to highlight any ineffective behaviour you observe in colleagues:
Section 10: continued
Ineffective Behaviours / Effective Behaviours / Give some examples of how you have demonstrated this behaviour
Appears ambivalent or negative about the organisation’s ability to drive transformation of services across the local health and social care economy / Ambitious and optimistic about the organisation’s capability and potential to deliver even higher quality support and improved outcomes
Complicates things unnecessarily, allowing problems to seem bigger than they are and priorities to become clouded; micromanages. / Empowers others to take decisions, innovate and improve.
Focuses on the pace of change with little regard for risk management or gets overly bogged down with the problems rather than the solutions / Balances the need to operate at pace whilst remaining aware of the key risks and ensuring they are assessed and managed effectively
Quick to criticise new ideas or people who make mistakes, may expect everything to be run past them first / Encourages people to be creative, trusting their ideas and allowing them to innovate and try new things
Tries to catch people out / surprise them; may challenge in a way that causes unnecessary friction and tension / Tests people’s ideas and suggestions in a constructive way which stimulates useful discussion and evaluation
Appears unaware or disinterested in the time pressures faced by others and of the commitments they have to honour / Respectful of other people’s time and the need to ensure meetings and interruptions are kept to a minimum
Focuses primarily on reducing cost without giving sufficient consideration to quality and value for money / Focuses on value for money, quality and future benefits rather than purely cost reduction
Appraisee: please sign here to confirm your commitment to abide by these effective behaviours yourself and to highlight any ineffective behaviour you observe in colleagues:
Section 11: Your Objectives for 2018-19
Successfully meeting your objectives is directly linked to pay progression. This means that if it is identified at your appraisal that you have not successfully met all your objectives, you will remain at your existing A4C pay band point. It is therefore important to clearly understand and agree your objectives.
Objective
Make sure objectives are ‘SMART’; Specific, Measurable, Achievable, Realistic and Time-bound / Are there any resources or training needed for the individual to achieve the objective?
(Development should be added to the PDP) / When will the objective be reviewed/monitored? / When should the objective be complete/achieved? / What will be the measure of success?
Mandatory training compliance should be 80-100% for at least one month in the 6 months prior to the next appraisal date
Section 12: Your Personal Development Plan (PDP) for 2018 – 19
Discuss here what training, development and other activity you might need to do in order to be more effective in your role or further develop your career.
Ensure that you discuss any study leave that may be required.
Personal Development Plan activity
All Mandatory Training must be completed or booked prior to any other development being agreed and undertaken. / Why is this development activity being set?
Reference to individual/department/Trust objectives and plans. / When should this activity be achieved by? / When will this development be reviewed/monitored?

Section 13: Commentsand Declarations
Comments from Appraisee:
Comment of Appraiser
Both Appraisee and Appraiser to ensure compliance with the following;

I confirm that if I use an organisational fleet vehicle or my own car for organisational business (excluding driving to and from work) that I will provide my driving licence to my appraiser for completion of the driving licence checks form available on the intranet;

I confirm that if I have any declarations of interest to be registered I have completed the Register of Interests Declaration form which is included in at the back of this document.

My staff badge is readable and will not go out of date before 31.3.19.

If I am a budget holder, I have read and understood the Standing Financial Instructions (SFIs) available on the Intranet:

Appraisee Signature: / Date:
Appraiser Signature: / Date:
Comment of Chair:
Signature: / Date:
Appraisal Document returned to Appraisee within one month of appraisal: /
Appraiser emailed mailbox to confirm name of appraisee and date of appraisal: /

NB this form must be completed at the point that an interest is identified, or on an annual basis as part of the appraisal process for all band 7 or above staff. You are required to discuss the interest with your line manager, in order that they are aware of the matter and can take reasonable steps to mitigate any risks.

Name:
Department:
Job Title:
Declarations of interest (please ensure where you declare an interest that you provide full details. A free text box is available at the end of this form if required)
Partnership:
Directorship:
Shareholdings: / Company:
Shares held:
Private Practice: / Capacity:
Commercial Interests
(please state whether self or state relationship if personal or business relation) / Body:
Interest:
Interest in Other Public Bodies (e.g. school governor, local councillor)
Links to Other NHS:
Ownership of land or rental property (e.g. accommodation used by Trust)
Charitable/Voluntary
Outside or secondary Employment
(please specify)
Other Consultancy Work
(please specify)
Other (please specify)
GP: (for Board Members only)

Staff member making the declaration

I ………………………………………………..(name) declare that I do not have any interest/have the above interest which may need to be taken into consideration in relation to the Trusts policies or decisions (*please delete as required). I can confirm that where I have declared an interest I have discussed this with my line manager.

Signed …………………………………………………. Date ………………………

Staff members comments:-

Line manager of staff member making the declaration or other senior manager where appropriate

I ………………………………………………..(name) can confirm that I am the above mentioned staff members line manager (or where appropriate other senior manager) and that he/she has discussed this matter with me in full. I can confirm that I have taken necessary steps within the department to mitigate any risk associated with the declared interest.