West Midlands Workforce Deanery

NHS Health Education West Midlands Postgraduate Dental Team

Appraisal Document

for

Dental Nurses

Receptionists

Practice Managers

(2014)

Section 1, 2 and 3 should be completed by the appraisee before the appraisal discussion and given or sent to the appraiser at least 10 working days prior to the appraisal. (In section 3 there is an option for completing either the full version or the summary version

Section4will be completed by the appraisee and appraiser after the appraisal discussion

1: PERSONAL DETAILS

Name
Address and telephone number of location of your main clinical activity.
Professional Qualifications: UK or elsewhere, with dates.
GDC Registration: Registration number and date of first full registration (where applicable).
Date of commencement of activity in main location.
Other current posts Please list any other current appointments with (1) starting dates (2) average time spent on them
Previous posts in the last five years, with dates
Other relevant personal details Please give any other brief information you wish that helps to describe you e.g. membership of professional groups or societies

2: CURRENT WORK ACTIVITIES

Please summarise the clinical or non clinical activities you undertake in the practice
Give brief details of clinical or non clinical activity outside of the practice

3: PREPARATION FOR APPRAISAL

Work Activities – clinical and non clinical
What do you consider are the main achievements of your clinical and/or non clinical activity?
What do you think are your current development needs for the future? (This is in preparation for agreeing a PDP).
List below any documents you submit as evidence to support the above.

FULL VERSION

Put patients' interests first
(Links with GDC Standards for the Dental Team (1)and the requirements of the Practice)
How have you demonstrated that you put patients’ interests first? What do you think are your strengths and weaknesses in this area? (See guidance notes for suggested evidence/documentation).
What improvements could be made? What would you like to do better? What do you think are your current development needs in this area? (This is in preparation for agreeing a PDP).
List below any documents you submit as evidence to support the above.
Communicate effectively with patients
(Links with GDC Standards for the Dental Team (2)and the requirements of the Practice)
How have you demonstrated effective communication with patients, with reference to equality and diversity and providing effective information? What do you think are your strengths and weaknesses in this area? (See guidance notes for suggested evidence/documentation).
What improvements could be made? What would you like to do better? What do you think are your current development needs in this area? (This is in preparation for agreeing a PDP).
List below any documents you submit as evidence to support the above.
Obtain valid consent
(Links with GDC Standards for the Dental Team (3) and the requirementsof the Practice )
What do you do to obtain valid consent from patients?What do you think are your strengths and weaknesses in this area? (See guidance notes for suggested evidence/documentation).
What improvements could be made? What would you like to do better? What do you think are your current development needs in this area? (This is in preparation for agreeing a PDP).
List below any documents you submit as evidence to support the above.
Maintain and protect patients’ information
(Links with GDC Standards for the Dental Team (4) and the requirements of the Practice )
What do you do to maintain and protect patients’ information? What do you think are your strengths and weaknesses in this area? (See guidance notes for suggested evidence/documentation).
What improvements could be made? What would you like to do better? What do you think are your current development needs in this area? (This is in preparation for agreeing a PDP).
List below any documents you submit as evidence to support the above.
Have a clear and effective complaints procedure
(Links with GDC Standards for the Dental Team (5) and the requirements of the Practice)
What have you done to ensure that the Practice’s complaints procedure is understood by patients and applied effectively?What do you think are your strengths and weaknesses in this area?
What improvements could be made? What would you like to do better? What do you think are your current development needs? (This is in preparation for agreeing a PDP).
List below any documents you submit as evidence to support the above.
Work with colleagues in a way that is in patients’ best interests
(Links with GDC Standards for the Dental Team (6) and the requirements of the Practice)
How have you demonstrated that you work with colleagues in a way that is in patients’ best interests? What do you think are your strengths and weaknesses in this area? (See guidance notes for suggested evidence/documentation).
What improvements could be made? What would you like to do better? What do you think are your current development needs? (This is in preparation for agreeing a PDP).
List below any documents you submit as evidence to support the above.
Maintain, develop and work within your professional knowledge and skills
(Links with GDC Standards for the Dental Team (7) and the requirements of the Practice)
What are you doing currently to maintain and develop your professional knowledge and skills? How have you demonstrated that you are working within your professional knowledge and skills? What do you think are your strengths and weaknesses in this area?
What would you like to do more of? What would you like to do better? What do you think are your current development needs? (This is in preparation for agreeing a PDP).
List below any documents you submit as evidence to support the above.
Raise concerns if patients are at risk
(Links with GDC Standards for the Dental Team (8) and the requirements of the Practice)
What have you done to raise concerns if you felt a patient was at risk and what was the outcome?What do you think are your strengths and weaknesses in this area?
What improvements could be made? What would you like to do better? What do you think are your current development needs? (This is in preparation for agreeing a PDP).
List below any documents you submit as evidence to support the above.
Make sure your personal behaviour maintains patients’ confidence in you and the dental profession
(Links with GDC Standards for the Dental Team (9) and the requirements of the Practice)
How does your personal behaviour maintain patients’ confidence in you and the dental profession?What do you think are your strengths and weaknesses in this area?
What improvements could be made? What would you like to do better? What do you think are your current development needs? (This is in preparation for agreeing a PDP).
List below any documents you submit as evidence to support the above.

SUMMARY VERSION

It is important to read the GDC document ‘Standards for the Dental Team’ in order to complete the next section, even if you are not a GDC registrant these standards should apply to those of the Practice also

STANDARDS FOR THE DENTAL TEAM:

Put patients’ interests first
Communicate effectively with patients
Obtain valid consent
Maintain and protect patients’ information
Have a clear and effective complaints procedure
Work with colleagues in a way that is in patients’ best interests
Maintain, develop and work within your professional knowledge and skills
Raise concerns if patients are at risk
Make sure your personal behaviour maintains patients’ confidence in you and the dental profession

What have you done to demonstrate the above Standards for the Dental Team? What do you consider are your main strengths and weaknesses in relation to the Standards?
What improvements could be made? What would you like to do better? What do you think are your current development needs in these areas? (This is in preparation for agreeing a PDP).
List below any documents you submit as evidence to support the above.
Probity and health statement
(Links with GDC Standards for Dental Professionals 6 )
Please read and respond to the following:
Probity (Dental Nurses only)
“I declare that I accept the professional obligations placed on me by the GDCStandards for the Dental Team”.
O Please tick here to confirm
If you feel that you are unable to make this statement for whatever reason, please explain why below.
In relation to suspensions, restrictions on practice or being subject to an investigation of any kind since my last appraisal”
O I have nothing to declare”
O I have something to declare”
Health (all staff)
Do you have any health condition which would be relevant to care of patients or any other duties you perform in your role?
O Yes
O No
If you have answered yes please specify the steps you have taken to minimise any associated risk.

GDC Recommended Verifiable CPD Requirements

(GDC Registrants only)

Medical Emergencies (and basic life support) (10 hours in a 5 year period)

Basic life support attendance certificate/ date:
Other medical emergency training (if applicable):

Disinfection and Decontamination (5 hours in a 5 year period)

Decontamination training certificate/date:
Radiography and Radiation Protection (5 hours in a 5 year period)
(Dental Technicians/Clinical Dental Technicians may substitute this with materials and equipment)
Training certificate/ date:
Other CPD Activity (All staff)
Legal and Ethical Issues
(Consent, confidentiality, employment law, health and safety)
Complaints Handling
Safeguarding Children and Vulnerable Adults
Oral Cancer: improving early detection(clinical staff)
CPD Declaration to the GDC
(GDC Registrants only)
Date of last declaration:
Number of CPD hours declared:
Evidence Document Checklist
Evidence / Evidence Seen
Overview of objectives and development needs during the year
How well have you achieved the goals agreed last year? Where did you not succeed, can you describe the reasons?
Overview of objectives and development needs for the coming year
Please summarise what you think are your main objectives and development needs for the coming year.
Sign off
We confirm that the above information is an accurate record of the documentation provided by the appraisee and used in the appraisal process, and of the appraisee’s position with regard to development in the course of the past year and current development needs.
Appraisee Name:
Signature:
GDC Number:
(if applicable)
Appraiser Name:
Signature:
GDC Number:
(if applicable)
Date:

4. RECORD OF APPRAISAL (to be completed by appraiser/appraisee)

This record should be retained by the appraiser and a copy given to the appraisee for discussion at the next appraisal.

APPRAISAL OF OBJECTIVES FOR PAST YEAR (if applicable)

Objective / Progress Achieved / Factors Preventing Achievement / Actions Agreed and by When / Revised Objectives to be taken Forward
1.
2.
3.
4.
5.

OBJECTIVES AGREED FOR THE COMING YEAR:

This plan should be updated whenever there has been a change – either when a goal is achieved or modified or where a new need is identified

Agreed Objective / Agreed action to be taken and resources required / Target Date / Objective Achieved
1.
2.
3.
4.
5.

PERSONAL DEVELOPMENT PLAN

This plan should be updated whenever there has been a change – either when a goal is achieved or modified or where a new need is identified.

What development needs have I?
(explain the need) / How will I address them(explain how youwill take action, and what resources you will need? / Target Date(date agreed with appraiser for achieving the development goal) / Outcome(how will the
Practice change as a
result of the development
activity) / Completed(agreement
with appraiser that
development need
has been met)
1.
2.
3.
4.

Sign off
We agree that the above is an accurate summary of the appraisal discussion and agreed action, and of the agreed personal development plan.
Appraisee Name:
Signature:
GDC Number:
(if applicable)
Appraiser Name:
Signature:
GDC Number:
(if applicable)
Date: