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NHS England Checklist of Supporting Information for Annual Appraisal of GPs

Doctor’s name / Doctor’s GMC number
Appraiser’s name / Appraiser’s GMC number
Date of Appraisal / Birthday/appraisal month
Revalidation date / Doctor’s Area team or
other designated body
Date form received (office use) / (office use) Appraisal Lead comments. Revalidation ready?
Basic Supporting information required for appraisal / Seen / Comments
Quality Improvement Activity relating to the doctor’s individual practice. (Examples of quality improvement activities include: clinical audit or data collection and review, review of clinical outcomes, case review of discussions, analysis of notes from consecutive consultations and evaluation of health policy or management practice)
This will be shown under Section 8, if using the MAG form / Audit / data collection and review
SEA
Case review
Other activity
Significant Event / Serious Untoward Incident – (if named in any serious incident relating to the doctor’s individual practice this must be discussed at appraisal (Write none if none disclosed)
This will be shown under Section 9, if using the MAG form
Log or diary of educational activities throughout including reflections, with estimated number of CPD Credits / No. of Credits
Review of any complaints-all formal complaints must be discussed, reviewed and learning and actions identified (Write none if none disclosed)
Colleague Survey - results and reflections seen and discussed / One every 5 years / If not done this year when last done ?
Patient Survey - results and reflections seen and discussed / One every 5 years / If not done this year when last done ?
Probity Statement signed on MAG form / Every year
Health Statement signed on MAG Form / Every year
MAG/Output Statements / Agree / Disagree
Statement 1 An appraisal has taken place that reflects the whole of the doctor's scope of work and addresses the principles and values set out in the Good Medical Practice.
Statement 2 Appropriate supporting information has been presented in accordance with the Good Medical Practice Framework for appraisal and revalidation and this reflects the nature and scope of the doctor's work.
Statement 3 A review that demonstrates progress against last year's personal development plan has taken place.
Statement 4 An agreement has been reached with the doctor about a new personal development plan and any associated actions for the coming year
Statement 5 No information has been presented or discussed in the appraisal that raises a concern about the doctor's fitness to practice
Scope of practice / Activity / Seen / Comments
Review of all roles undertaken as a doctor The appraiser must identify any roles NOT reviewed
Add any additional roles in the ‘other’ columns / Trainer
Appraiser
U/G teaching
GPwSI
OOH
CCG
Sports
Other
Other
Other
Mandatory or other training required by the organisation but not a GMC Revalidation requirement
Done in last year / Included in PDP
*Certificate of CPR training / 18 months
* Evidence of child-safeguarding training / Every year
* Please note that CPR and Safe-guarding are NHS England /Area Team training requirements , not GMC Revalidation Requirements, and should NOT be taken account of in the 5 ‘sign off’ statements on the MAG form, but gaps in training should be addressed on the next year’s PDP
Exceptional Circumstances / Details
Breaks from work eg Maternity leave, sick leave, sabbatical etc / Specify duration and dates
Works less than 1 session per week in clinical GP/OOH work
Under performance review eg with Area team, GMC or NCAS
Other exceptional circumstances –please specify
Comments –requesting that form is read in detail by clinical lead / reasons for disagreement with Output statements / other message to the lead

The appraiser must agree or disagree with the following statements when the appraisal has been completed

Agree / Comments
This appraisal has raised no issues that need following up by the appraisal lead and/or Responsible Officer / Y/N
This appraisal has raised issues that need following up by the appraisal lead and/or the Responsible Officer / Y/N
I confirm that I am aware of no conflict of interest with this doctor that could influence the process of this appraisal / Y/N