Contents of GP Personal Appraisal File

Introduction

Section A:All About Appraisal
  1. What is appraisal?
  2. Revalidation and comparison with appraisal
  3. The process and responsibilities

Section B: Newcastle Appraisal System

  1. Aims and objectives of the local scheme
  2. Specification of GP Appraisers
  3. How to identify your appraiser
  4. Support available for appraisal
  5. Confidentiality
  6. Accountability and responsibility for the scheme
  7. Monitoring the system
  8. A Learning Organisation
  9. How to raise a concern or make a complaint
Section C: Undertaking Appraisal
  1. Preparing for appraisal
  2. The appraisal interview
  3. Developing a personal development plan
  4. Follow up
  5. The NHS Appraisal Toolkit
  6. Methods of Reflection
Section D: Completing the Appraisal Documentation
Section E: Personal Appraisal Documentation
  1. Form 1
  2. Form 2
  3. Form 3
  4. Form 4
  5. Form 5

Section F: Resources
Introduction

In Supporting Doctors, Protecting Patients (1999) the Chief Medical Officer proposed that all doctors employed in or under contract to the NHS should be required to take part in regular appraisal. The NHS Plan confirmed that participation in annual appraisal would be a condition of contract from 2001. The Department of Health expects PCTs to ensure implementation of GP appraisal from April 2002.

Negotiations with the BMA General Practitioners’ Committee have resulted in agreement to proposals with the proviso that GP time to undertake appraisal is fully funded and protected. There is an onus on both PCTs and GPs to deliver - support for GP appraisal will be a mandatory function for PCTs and participation in appraisal will also be a GP contractual requirement.

A small Implementation Group is overseeing the introduction of GP appraisal in Newcastle. Overleaf details of members of this group are provided. Members can be contacted directly if you have any queries or concerns.

This Personal Appraisal File has been produced by the PCT in partnership with the LMC. It is based on work initiated by Debbie Freake and further developed by Laura Bond, Professional Development Manager at South Tyneside PCT. It is intended to help GPs understand the nature of the appraisal process, how the local system works. It aims to give as much guidance as possible, both to facilitate satisfactory completion of appraisal and to ensure that practitioners can derive maximum benefit from the appraisal process. We would strongly recommend that practitioners read the file and very much hope that you will find it useful.

Dr Debbie FreakeDr Relton Cummings

Medical DirectorChair

Newcastle PCTNewcastle & North Tyneside

Local Medical Committee

GP Appraisal Implementation Group Membership

NameDebbie Freake

Title Medical Director

Work addressNewcastle Primary Care Trust

Benfield Road

Walkergate

Newcastle upon Tyne

NE6 4PF

Tel No(0191) 219 6055

Fax No(0191) 219

E-mail

NameRelton Cummings

Title LMC representative

Work address17 Osborne Road

Jesmond

Newcastle upon Tyne

NE2 2AH

Tel No(0191) 281 4588

Fax No(0191) 212 0379

E-mail address

NameProf Tim Van Zwanenberg

Title Professor of Post Graduate General Practice

Work addressFaculty of Health, Social Work and Education

Coach Lane Campus

Newcastle upon Tyne

NE7 7XA

Tel No(0191) 222 8926

Fax No

E-mail addressvanZwanenburgTimA87004COLLINGWOOD

NameAlison Smith

Title PCT PEC member

Work addressWesterhope Medical Group

377 Stamfordham Road

Westerhope

Newcastle upon Tyne

NE5 2LH

Tel No(0191) 243 7000

Fax No(0191) 243 7006

E-mail address

SmithAlisonA86025WesterhopeMEDNE52LH@

nant-ha.northy.nhs.uk

NameJohn Bookless

Title Postgraduate Tutor

Work addressThrockley Primary Care Centre

Tillmouth Park Road

Throckley

Newcastle upon Tyne

NE159PA

Tel No(0191) 210 6700

Fax No(0191) 210 6702

E-mail addressBooklessJohnTHROCKLEYSURGERYNE159AA

@nant-ha.northy.nhs.uk

NameVal Wadge

Title

Work address48 Osborne Road

Jesmond

Newcastle upon Tyne

NE2 2AL

Tel No(0191) 281 4060

Fax No(0191) 281 0231

E-mail address

NameDawn Solomon

Title Primary Care Support Manager

Work addressNewcastle Primary Care Trust

Benfield Road

Walkergate

Newcastle upon Tyne

NE6 4PF

Tel No(0191) 219 6037

Fax No(0191) 219 6066

E-mail

Section A: All About AppraisalAbout appraisalSection A1

What can appraisal do for me?

  • It is an opportunity to explore priorities amongst competing demands
  • It provides a vehicle to influence resources and policy
  • It provides access to objective advice on practice issues
  • It is a source of personal and professional support
  • It is a means to improve professional practice and satisfaction

Many GPs have expressed misgivings with regard to appraisals. In part because of the additional pressure on already scare time. But, also because it has often been viewed in the context of poor performance and ‘policing’ of the profession. A key objective for our local scheme is to ensure that GPs can derive maximal benefit from its introduction and view appraisal as a positive improvement to their working lives.

What can appraisal do for the profession?

A successful approach to appraisal can help the GMC discharge its responsibilities to set professional standards and regulate the profession. Equally the British Medical Association (BMA) has a strong interest in the reputation of doctors and a commitment to quality. In addition, the Royal College of General Practitioners (RCGP) pioneers quality development.

What can appraisal do for the public?

  • Improving quality of care received
  • Improving confidence in doctors in the wake of negative attention

What can appraisal do for the NHS?

As contract holders for GPs the PCT will wish to ensure that GPs are not only competent to practice but appropriately resourced, supported and developed to meet agreed expectations of them.

What is appraisal?

Although appraisal is a long established concept there has been a positive shift from one of performance assessment to performance development.

Appraisal is a formative and developmental process. It is a positive process, to:

  • give individuals feedback on past performance
  • chart and acknowledge continuing progress
  • identify development and learning needs

The content of GP appraisal is based on the GMC’s core headings set out in Good Medical Practice (a copy of this guidance is provided in the Resources Section (Section F):

  1. Good clinical care
  2. Maintaining good medical practice
  3. Relationships with patients
  4. Working with colleagues
  5. Teaching and training
  6. Probity
  7. Health

Sections about research and management activities, and other professional roles, are also included in the NHS appraisal documentation.

The Department of Health commissioned the School of Health and Related Research (ScHARR) at the University of Sheffield to undertake detailed work on appraisal for GPs in 2000. ScHARR defined appraisal as ‘ a positive, developmental, employer led, two way, action orientated process, primarily directed at quality improvement’.

ScHARR view appraisal as an opportunity for:

  • Exploring role expectations, negotiating relative priorities, and setting and aligning individual and organisational objectives at a local level
  • Reviewing progress towards achieving previously agreed objectives and agreeing future objectives
  • Recognising and valuing achievement
  • Exploring what is needed from the organisation to help and support the individual in making the best contribution they can
  • Identifying personal development needs and the means of addressing them, and forming a personal development plan (PDP)
  • Helping the individual to produce information for any external accreditation purposes (e.g. revalidation)
  • Exceptionally (because there should be other mechanisms), early identification of any individuals struggling or poorly performing
  • Securing continued overall improvement in performance

NB: The appraisal discussion will be limited to the information you choose to include either on the form or during the meeting.

Section A2

How is appraisal linked to revalidation?

Revalidation is a different concept to appraisal. Appraisal is designed to facilitate personal continuous improvement year on year throughout the working life of a doctor. It is intended to be of direct benefit to the individual appraised, and an aid to achieving personal objectives.

Revalidation is a five yearly process run by the General Medical Council. It is designed to ensure a basic minimum standard that can be expected by the public of doctors. It aims to ensure the competence of all doctors and can sanction removal from the General Medical Register or registration subject to certain conditions being met (for example, remedial training).

Appraisal will provide a regular, structured system for recording progress towards revalidation and identifying development needs (as part of PDPs) which will support individual GPs in achieving revalidation.

While appraisal and revalidation will be based largely or wholly on the same sources of information, and appraisal summaries will inform revalidation, the objectives of the two processes are distinct and complementary. Revalidation involves an assessment against a standard of fitness to practice in line with the seven headings of the GMC’s guidance ‘Good Medical Practice’. It will allow a doctor’s licence to practice to be renewed. Appraisals are concerned with the doctor’s professional development within his or her working environment and the needs of the organisation in which the doctor works.

Despite these differences, appraisal and revalidation should be linked for the sake of economy of effort, with the GMC’s Good Medical Practice as common ground. Despite the fact that appraisal and revalidation are distinct processes, the benefit of appropriate information sharing is considerable. The arrangements for the introduction of appraisal for GPs will integrate appropriately with those for revalidation.

This means that for revalidation purposes satisfactory completion of Form 4 plus supporting documentation over a five-year period will meet the purposes required for revalidation.

Precise revalidation guidance for doctors is still under development. This guidance will be circulated to you as soon as it becomes available. Revalidation will not commence until at least two years after the legislation has been approved (expected December 2002). Thus, it is likely that the first doctors will be revalidated from 2005.

The table overleaf identifies some of the key differences between revalidation and appraisal:-

Appraisal and Revalidation: The Differences

Appraisal

/

Revalidation

Led by individual practitioners and the PCT, and focused on the development of the individual practitioner / Led by the GMC
A way of aligning organisational (PCT and practice) and individual objectives / A way of checking that an individual doctor is fit to practice
Part of the wider systematic approach to performance management and development in the PCT / Part of the individual lifelong requirement of being able to practice as a doctor
An annual process / A quinquennial process
A process internal to the PCT / A process external to the PCT
A local process, customised to suit individual and local circumstances / A national process which is standard for all doctors, whoever employs/contracts them
A two-way process, it considers contextual, environmental and systematic factors / A one-way process
Primarily developmental (or formative) process / An assessment (or summative) process
As far as possible, a process with accepted, agreed outcomes / A process with imposed outcomes
Confidential, with many outcomes shared narrowly / A matter of public record

Adapted from Appraisal for GPs, ScHARR, University of Sheffield, 2001

1

Section A3

Process and Responsibilities

Generally a GP is expected to undergo appraisal with an approved GP appraiser on an annual basis. Time spent by the appraisee in preparing for and undertaking the appraisal interview is reimbursed through provision of locum costs through the PCT. It has been agreed with the LMC that this is likely to be equivalent to 2 ‘sessions’ of GP time.

The tables overleaf detail the appraisal process:-

1

Outline of process and responsibilities

Appraisee responsibilities / Before / During / Appraiser responsibilities / Before / During
Collection of information / Continuously collect appropriate information and data for your appraisal file (more information is provided in Section C) / 
Arranging the appraisal meeting / Contact your appraiser to arrange the appraisal meeting (perhaps 2 months prior to the meeting)
Agree a convenient time and suitable venue /  / Notify Medical Director’s office at the PCT of the arrangements / 
Producing the appraisal documentation / Produce the appraisal documents preferably using your PC. Photocopy the appraisal forms and supporting documentation, retaining the originals in your appraisal file (more information is provided in Section C) / 
Appraisee responsibilities / Before / During / Appraiser responsibilities / Before / During
Sharing the appraisal documentation / Following completion of the appraisal forms 1-3 (details about each form are given below) send them to your appraiser, along with supporting documentation, 3 weeks prior to the appraisal meeting /  / Review the documentation prior to the appraisal meeting (details about each form are given below) / 
Form 1
Basic Details / Complete entire form
Discuss information on form /  /  / Review information on form
Discuss information on form /  / 
Form 2
Current Medical Activities / Complete entire form – providing a brief and factual description of the work you do in the practice and in other posts
Review and discuss information /  /  / Review information on form
Discuss information on form /  / 
Appraisee responsibilities / Before / During / Appraiser responsibilities / Before / During
Form 3
Material for Appraisal / Complete the entire form and collect supporting documentary evidence (more information to assist you in completing this form is provided in Section 8
Discuss information on form
Sign off the form /  / 
 / Review information on form
Discuss information on form
Sign off the form /  / 

Draft a PDP / Whilst completing Form 3 think about your development needs and draft you PDP for the coming year / 
Appraisee responsibilities / During / After / Appraiser responsibilities / During / After
Form 4
Summary of Appraisal Discussion with Agreed Action and Personal Development Plan (PDP) / Consider items for inclusion on PDP ensuring all objectives are SMART objectives
S – Specific
M – Measurable
A – Achievable
R – Relevant
T – Timebound
Completion of the PDP is the responsibility of the appraisee / 
 /  / Completion of the Summary Statement (Form 4) is the responsibility of the appraiser /  / 
Form 5
Detailed confidential account of appraisal interview / Completion of this form is optional.
Appraisee responsibilities / During / After / Appraiser responsibilities / During / After
Signing off the summary documentation / Agree and sign off the summary documentation (Form 4) and the PDP within 2 weeks of the appraisal meeting – forward in confidence to the PCT Medical Director– using the Consent Form acknowledge whether this information may be shared with the Primary Care Support Manager to assist with education and training planning /  / Agree and sign off the summary documentation (Form 4) and the PDP within 2 weeks of the appraisal meeting / 
Mid-year review discussion/meeting / Contact your appraiser for a mid-year review of progress towards agreed objectives, no longer than 6-7 months after your appraisal meeting /  / Discuss with the appraisee (telephone or face-to-face) their progress towards agreed objectives / 

1

Section B: Newcastle Appraisal SystemSection B: 4

Aim and objectives of the local scheme

Aim

To improve the working lives of doctors in Newcastle, ensuring GPs derive maximal benefit from the introduction of annual appraisal, by helping them consolidate and improve on good performance.

Objectives

To provide GPs with:

  • access to objective feedback and guidance on practice issues
  • a source of personal and professional support
  • an opportunity to explore priorities amongst competing demands
  • an opportunity to identify the need for adequate resources to enable service objectives to be met
  • an opportunity to improve professional practice and satisfaction

Section B: 5

Specification for GP Appraisers

In Newcastle we have encouraged as many GPs to train as appraisers as possible. The PCT and LMC believe that this enables the GP community to have ‘ownership’ of the appraisal process, rather than it being seen as something imposed from outside.

We believe that this is a demanding, but also worthwhile role that will be respected by the GP profession and by PCTs. We would particularly encourage those who have been or are currently actively involved in undergraduate or postgraduate teaching/training of doctors, nurses or other professions.

The success of appraisal will be directly related to the skill of the appraiser. It is considered important by both the LMC and PCT that GPs feel confident in those who appraise other GPs. GP training and everyday work and experience places us in a good position to become first-rate appraisers who use excellent communication skills.

However, our GPs skills alone are not sufficient to become successful GP appraisers. All potential appraisers will be given tailored and accredited training on GP appraisal, and GPs will have a choice of appraiser.

All appraisers will:-

  • Be a practicing GP (or recently retired/resigned)
  • Be committed to the concept of appraisal
  • Be respected by his/her peers and PCT colleagues
  • Have good or even exceptional interpersonal skills
  • Be fully trained in GP appraisal
  • Be familiar with the local system and relevant documentation
  • Have an adequate knowledge of the appraisee’s practice circumstances
  • Be aware of what resources are available locally and nationally to support practitioners and practices, and how to access these, and of how to ensure that organisational action points can be picked up by the PCT

The PCT will be responsible (in collaboration with the LMC) for ensuring suitability of appraiser in terms of capability, capacity, and professional and organisational credibility. We will endeavour to ensure that appraisers are drawn from different age/sex/ethnic groups with experience across a range of general practice settings. The anticipated large pool of Newcastle appraisers will help us achieve this and maximise choice for local GPs.

Section B: 6

How to identify your appraiser

There are a number of different ways in which appraisal systems might be operated and different ways of identification of appropriate appraisers. We would like GPs to have as wide a choice of both system and appraiser as possible in order that GPs can feel confident in the appraisal process.

We have asked all GPs and practices to consider and choose one of 3 options for their own appraisal: -

  1. In-House Appraisal: One or more GPs in a group practice are trained as appraisers. They apprise the other GPs within the practice. They may in turn be appraised by another trained GP within the practice or may choose to undertake their own appraisal external to the practice.
  1. Reciprocal Arrangements with one or more practices: as an example, GPs in Practice A would be appraised by a trained appraiser in practice B, and vice versa. The arrangement might include more than 2 practices.

GPs in practices who have discussed and agreed on either Option 1 or 2, should be aware at an early stage of their intended appraiser. Appraisees and appraisers should make contact as soon as possible to confirm arrangements and consider possible interview dates.