A framework for the process for undertaking GP Appraisals in Waltham Forest

Primary Care Trust 2005/06

  1. Background

The National GP Appraisal Scheme was launched in March 2002. The aim of the process is to enable doctors to receive regular feedback on past performance and continuing progress and to identify education and development needs. With effect from 2004/05, all GPs on a PCT’s Primary Care Performer’s list will need to be appraised, including non-principals.

  1. Appraisers

It is expected that approximately 190 GPs will be undertaking appraisals across the

PCT in 2005/06. The position of appraiser is subject to interview.

Dr G. Ivbijaro will be overseeing the whole process as GP Clinical Governance lead and Dr T. John will be the Chair of the Appraisal Support Group.

The allocation of appraisers will be subject to the criteria outlined below.

  1. General principals for matching Appraiser and Appraisee

As a general principle, GPs will be randomly allocated to Appraisers.

However the following criteria would apply:

  • No individual can appraise someone, who will in turn be appraising them
  • Appraiser and Appraisee should not be within the same partnership
  • Appraiser and Appraisee should not be related to each other
  • There should not be a conflict of interest between Appraiser and Appraisee

Appraisers will have the opportunity to examine the list of GPs that they are to appraise in order to identify any conflicts of interest. Appraisees will also have the opportunity to declare a conflict of interest with regard to the Appraiser that they have been allocated to (See process for refusals below).

  1. Process for refusals

When a GP is allocated an Appraiser, they have the right to refuse. They are required to put this in writing, but they are not obliged to give a reason for this. This GP is then allocated another Appraiser. If they wish to refuse a second time, they can do so, but they need to put this in writing and this time they are required to state the reason. The Chief Executive of the PCT will then allocate them an Appraiser, but this time the decision is final and they are not allowed to refuse.

  1. Contract between the Appraisers and the PCT

Each Appraiser will need to sign a contract between themselves and the PCT in order to formalise the arrangement and ensure that they are clear about their responsibilities.

  1. Venue

Each Appraisal would take place in the Appraisee’s surgery, either in their consulting room or a designated quiet room. It is essential that protected time is set aside for this. The Appraisee needs to ensure that the phone is diverted and that there are no interruptions. If it is not possible for the appraisal to take place in the surgery, then the Appraisee should put this in writing and a suitable alternative venue should be found.

  1. Administration and Co-ordination of process

An Appraisal Co-ordinator has been employed to work around the co-ordination of the GP appraisal process. It is the Appraisal Co-ordinator’s role to send out appraisal forms and documentation. The Co-ordinator will write to each GP informing them of their appraiser, asking them to confirm the date of the appraisal when arranged and remind them to complete and return the necessary paperwork after the appraisal.

The PCT will inform the Appraisal Co-ordinator when GPs leave or join the GP list. The Co-ordinator will then take the necessary action to remove or incorporate the GP into the process. New GPs should be in post for at least three months before having an appraisal.

  1. How will the appraisal system work?

A table giving details of appraisees allocated to each Appraiser (using the criteria outlined above) will be drawn up by the Appraisal Co-ordinator. All appraisals will take place between 1 October 2005 and 30th March 2006. This table will then be circulated to each Appraiser and they then have a week in which to respond, stating if there are any GPs that they feel it would be inappropriate for them to appraise. This table will then be circulated to all GPs on the Primary Care Performers List in the PCT, together with an appraisal pack.

If the GP has concerns around the Appraiser allocated to them, they should follow the process around refusals outlined in Section 4.

An appraisal pack is sent to all GPs. The appraisal pack contains the documentation necessary for a GP’s annual appraisal. There are five forms, which are all standardised forms produced by the Department of Health. This standardised documentation should ensure that information from a variety of NHS employers will be recorded and expressed consistently.

The first four forms are to be completed by each GP before appraisal. These are as follows:

  1. Basic details
  2. Current medical activities
  3. Material for appraisal (The GP is required to submit documents in support of Form 3 and these will need to be assembled)
  4. Modified APPLE Self Assessment Tool / Peer Assessment Form for Clinical Governance for Waltham Forest PCT

The Appraisee should contact their Allocated Appraiser and arrange a mutually convenient date for appraisal. Each GP is then required to complete the first three pre-appraisal forms. These should be sent to the Appraiser together with copies of previous Form 4s and PDP form, at least two weeks prior to the date of the appraisal in order to allow adequate time for preparation for the discussion. These forms allow the GP and Appraiser to gather information and reflect beforehand on achievements and challenges over the past twelve months, service, practice and other objectives and personal and practice development needs and how these might be met. The PCT is expecting a very robust approach to the evidence to be provided for GP appraisal. Preparation for the appraisal should be completed during protected time that has been specifically set aside.

Form 4 is the formal summary of the appraisal and should be completed during and immediately after the discussion. This is the responsibility of the Appraiser but it needs to be agreed and signed by both GPs. The detail of the appraisal discussion will be confidential to the participants, but the overview should include a synopsis of the previous year’s achievements and summary of the appraisal discussion with agreed action and a personal development plan. A copy of the formal summary of the appraisal should then be submitted in confidence to the Appraisal Co-ordinator. The appraisal process is not complete until all the forms have been filled out. Only the Clinical Governance lead will have access to this. All records will be held on a secure basis in locked filing cabinets held at the Medical Education Centre and access and use must comply fully with the requirements of the Data Protection Act. All records are the property of the PCT and this information cannot be disclosed without the PCT’s consent.

Form 5 may be used to make a more detailed and confidential record of the appraisal discussion, but it is optional.

The appraiser and GP should make arrangements at least once more during the course of the year for about 30 minutes in order to review progress in relation to the actions and Personal Development Plan. This could be arranged and resolved via a telephone call rather than an actual meeting.

An outline flowchart of how the appraisal process will work is attached at Appendix A.

  1. Revalidation

Your portfolio will be the evidence that the PCT will be using to support your application to the GMC for revalidation. One of the expectations from the GMC is that the GP Clinical Governance Lead or his agent, must confirm to the GMC that they have no concerns or worries. Therefore, if you have completed Form 5, you must inform the GP Clinical Governance Lead, although they will not have access to this form.

Both the Appraiser and Appraisee should complete the declaration form enclosed in the pack (Form 5B).

Because the evidence for revalidation needs to be robust and transparent you are expected this year to use the modified APPLE Self Assessment Tool/Peer Assessment Form for Clinical Governance for Waltham Forest PCT.

You will need to submit your Form 4, PDP form, APPLE form, Appraisal Declaration Form and feedback questionnaire within 2 weeks of your appraisal.

  1. Concerns arising during an appraisal

An individual GP’s concerns around his or her own appraisal should be raised in the first instance with the Appraiser. If concerns remain, the GP should then discuss them with the PCT Clinical Governance Lead, who should in the first instance try to find an informal resolution to the problem through discussion and mediation, involving others as appropriate.

In the exceptional circumstances that concerns cannot be resolved in this way, the PCT Clinical Governance Lead might convene an appropriately constituted panel, chaired by a Board Member, to consider the matter further.

  1. Feedback

This year, you will be expected to fill out a feedback questionnaire on your appraisal, which will be sent to you with your notification of appraisal date. Your Appraiser will also be completing a feedback form on your appraisal. This form will be sent to your Appraiser, prior to your appraisal. You should not discuss these forms with each other. This is to guarantee that all appraisals carried out within the PCT are in line with recommendations from RCGP and the London Deanery. Routine feedback will be sent to individual Appraiser and Appraisee after the process.

  1. Payment

Payments for appraisals are as follows:

The Appraiser will receive a payment of £525 per GP appraisal. There is an expectation that this will cover attending meetings with other Appraisers and those administering the scheme to discuss learning for quality assurance purposes etc.

Payment will be made to each GP Appraiser once each appraisal has taken place and the post-appraisal forms including the feedback questionnaire and declaration form have been submitted to the Appraisal Co-ordinator. The GP should retain copies of these forms for themselves.

For GMS GP appraisees, payment for costs associated with having a GP appraisal are included within the global sum. For PMS GP appraisees, as from 2005/06, the appraisal funding for PMS practices will be paid within their monthly PMS baseline payments.

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