Skip to main content

How Appraisals Optimise Doctor Regulation

Published on: 12 Aug 2022
Category:

Doctors Regulation Appraisals

Every licensed physician practicing in the UK must participate in the NHS appraisal process not only to maintain their license but also to ensure their skills and knowledge are up to date, and to reflect on their achievements and identify any learning points that may help them improve their practice. 

Appraisals are not designed to discover potential issues relating to poor practice, nor are they the appropriate time to report concerns about other doctors, as there are separate processes designed for both of these issues. Instead, appraisals focus on supporting, encouraging and stimulating doctors to help them withstand the pressure of their work, and to help them improve their practice.

 

What is an appraisal?

Appraisal is an annual, formative process focused on the doctor’s personal and professional reflection, and appropriate documentation of this reflection. It is not a pass or fail assessment, but rather an opportunity for the physician to reflect on their performance The appraisal process consists of 3 stages:

  1. Inputs to appraisal

  • Doctor’s scope of practice: all organisations and locations, private or NHS-based, where the doctor works or has worked as a licensed medical professional since their last appraisal, and the nature of their practice

  • Any other relevant supporting information, such as last year’ s Personal Development Plan (PDP), documentation of Continued Professional Development (CPD), etc

  1. Confidential appraisal discussion

  • A confidential meeting with a senior colleague trained as an appraiser   

  • Discussion about any issues arising from last year’s appraisal

  • The doctor’s reflection and review of the past year of practice

  • Review of their last year’s PDP and formulation of a new PDP

  • Review of the past year’s achievements, challenges and learning points for the future

  1. Outputs of appraisal

  • New PDP objectives

  • Summary of the discussion

  • Appraiser’s statements

 

Although completing yearly appraisals is required to obtain a revalidation recommendation and thus maintain your license to practice, revalidation should not be the main objective of medical appraisal. Instead, the appraisals are centred around reflective practice and continued personal and professional development in all aspects of the doctor’s scope of work.

 

How to complete an appraisal

All appraisals should be completed using a GMC-approved toolkit. These currently include the MAG (medical appraisal guide) form and online toolkits Clarity and FourteenFish. The MAG is a free to use, interactive PDF form that needs to be downloaded and requires Adobe Reader XI or above to work. Clarity and FourteenFish are both online appraisal toolkits, where the appraisal forms are completed on their respective websites.

Most physicians are assigned an appraiser by their employer or another organisation (designated body) they are associated with, or they can choose a suitable person approved by the GMC. Those who are not associated with a designated body and do not have a suitable person can find an independent appraiser. 

All appraisers need to meet all conditions set by the GMC in order to qualify as appraisers, and doctors are advised to check whether their appraiser does in fact meet them, especially when they are looking for an independent appraiser. The list of conditions is available on the GMC website.

During their appraisal, doctors should be aiming to reflect on their practice and discuss the improvements they have made, or any learning points they have encountered, within the four domains described by the Good Medical Practice Framework for Appraisal and Revalidation. The four domains are as follows:

  • Knowledge, skills and performance

  • Safety and quality

  • Communication, partnership, and teamwork

  • Maintaining trust

To prepare for appraisal, doctors should begin to reflect on what changes they have implemented to their practice to better meet the principles and values of those four domains, and document those changes and the effect they had on their work.

Ahead of the appraisal process, doctors also need to submit the following supporting information:

  • Continuing professional development (CPD)

  • Quality improvement activities (QIA)

  • Significant events

  • Feedback from patients to whom they provide medical services

  • Feedback from colleagues

  • Review of compliments and complaints

  • Review of achievements, challenges and aspirations

  • Probity and Health declarations

  • Previous appraisal record

  • Scope of work

  • Reflection on your practice, ensuring patient confidentiality

Continuing professional development and quality improvement activities are important aspects of every doctor’s practice as they ensure that their knowledge and skills are up to date, that any gaps in knowledge are addressed, and that their practice is continuously improving and adapting to the patients’ needs, and the society’s expectations for how doctors should work.

The spectrum of CPD activities is broad, and includes personal, opportunistic, and experimental learning. Both informal and formal learning activities are considered CPD activities. Because the spectrum is so broad, almost any activity where doctors spend time learning something new and relevant to their practice and applying this knowledge in their work can be included as CPD. 

However, during appraisal, it is best to summarise only the most significant CPD activities to avoid sacrificing quality for quantity.

Quality improvement activities are those in which doctors focus on reviewing their practice, or aspects of their practice, assessing the efficacy of their methods and determining areas of improvement within their work. An example of such activity would be clinical audits, local audits, case reviews and discussions, or learning event analyses. 

Every doctor needs to provide evidence of participating in relevant audits in their appraisal, and any other QIAs that they have completed since their last appraisal, to prove that they are doing their best to provide high quality care to their patients. In appraisal, doctors will reflect on their QIAs and how they have improved their practice.

During appraisal, doctors will also need to review their Professional Development Plan objectives from last year and whether they have completed them. Usually, new PDP objectives will also be laid out during appraisal, unless last year’s PDP have been determined to require more than a year to complete, or the doctor’s circumstances have changed, not allowing them to complete their PDP.

 

GP appraisal

GPs also undergo annual appraisal, like all other specialties. The appraisal process for GPs does not differ greatly from that for other specialties. Sessional GPs may have several portfolios as they may undertake multiple roles during different sessions, as opposed to locum GPs whose contracts are usually for 24-hour care. Therefore, sessional GPs will need to think about how to best reflect on their practice and demonstrate fitness to practice in all their different roles, while remaining concise.

Additionally, locum GPs will need to find their own appropriate appraisers as they are often not linked to a designated body which can assign them an appraiser.

 

GMC medical revalidation

Medical revalidation is a process in which doctors demonstrate their fitness to practice and that their practice is up to date. In order to be revalidated, doctors still need to fully engage with the medical appraisal process and provide sufficient evidence that they are reflecting on, and continuously improving their practice. 

Revalidation decisions are based largely on the outcomes of medical appraisals. The revalidation process occurs roughly every 5 years, or every 5 appraisal cycles, although the GMC now allows approved missed appraisals without the need for “catch-up appraisals “. 

A revalidation decision is made by a responsible officer, an individual appointed by each doctor’s designated body responsible for helping the doctor with revalidation. If a doctor does not have a designated body or a suitable person, it is possible to get revalidated directly through the GMC.

The responsible officer receives the doctor’s portfolio and the outcomes of each of the appraisal cycles since their last revalidation, reviews this information and makes a recommendation to the GMC about the doctor’s fitness to practice. This decides whether a doctor will be revalidated right away, and their license is renewed, or whether a revalidation decision will be deferred to allow more time to engage with appraisal and meet the GMC requirements for supporting information. 

 

NHS Revalidation Management System (RMS)

The RMS is a system which contains the personal details of doctors who have undergone appraisal. These details include information about education and employment history, criminal charges and convictions, and other information relevant to their appraisal. 

It also holds information that facilitates payments to appraisers. This service is primarily intended to be used by responsible officers and administrative staff, but it may also be accessible to medical directors and regulatory bodies for purposes of medical revalidation.

 

Appraisal tips and resources

Tips:

  • Quality over quantity: when preparing supporting information, it is best to focus on documenting the most important and relevant details. The information should be comprehensive and cover the full scope of practice, with an appropriate level of detail to facilitate appraisal. 

  • Make a good impression: dressing smartly, being punctual, bringing all the required documents, and asking for feedback at the end of appraisal all contribute to making a good impression on the appraiser.

  • Reflect, but also demonstrate: show how reflection has led to developing new skills and improving your practice.

  • Include the negatives as well as the positives: discuss any areas of improvement and lessons learned from the mistakes made during your practice. Discuss how you approach complaints from patients and how you use them to improve your practice.

 

References:

  1. The Royal College of General Practitioners (RCGP). Mythbusters appraisal and revalidation. Available from: https://www.rcgp.org.uk/training-exams/practice/revalidation/mythbusters-appraisal-and-revalidation.aspx (accessed Jul 2021)

  2. The RCGP. Guide to supporting information for appraisal and revalidation. Available from: https://www.rcgp.org.uk/training-exams/practice/revalidation/guide-to-supporting-information-for-appraisal-and-revalidation.aspx (accessed Jul 2021)

  3. The British Medical Association. Medical appraisals. Available from: https://www.bma.org.uk/advice-and-support/career-progression/appraisals/medical-appraisals (accessed Jul 2021)

  4. NHS England Yorkshire and the Humber Medical Appraisal. Choosing an appraisal toolkit. Available from: https://portal.yhcs.org.uk/web/gp-appraisal/choosing-an-appraisal-toolkit (accessed Jul 2021) 

  5. General Medical Council (GMC). Finding an appraiser. Available from: https://www.gmc-uk.org/registration-and-licensing/managing-your-registration/revalidation/appraisals-and-annual-returns-for-doctors-without-a-responsible-officer-or-suitable-person/finding-an-appraiser (accessed Jul 2021)

  6. GMC. Guidance on supporting information for appraisal and revalidation. Available from: https://www.gmc-uk.org/registration-and-licensing/managing-your-registration/revalidation/guidance-on-supporting-information-for-appraisal-and-revalidation (accessed Jul 2021)

  7. GMC. Continuing professional development: guidance for all doctors. [pdf]. Published Jun 2012. Available from: https://www.gmc-uk.org/-/media/documents/cpd-guidance-for-all-doctors-0316_pdf-56438625.pdf (accessed Jul 2021)

  8. GMC. Your supporting information- quality improvement activity. Available from: https://www.gmc-uk.org/registration-and-licensing/managing-your-registration/revalidation/guidance-on-supporting-information-for-appraisal-and-revalidation/your-supporting-information---quality-improvement-activity (accessed Jul 2021)

  9. Cumisky A. GP Online. Preparing for appraisal as a GP locum. Published 23 Jan 2017. Available from: https://www.gponline.com/preparing-appraisal-gp-locum/article/1420781 (accessed Jul 2021)

  10.  The RCGP. Revalidation. Available from: https://www.rcgp.org.uk/training-exams/practice/revalidation.aspx (accessed Jul 2021)

  11. Davies M. GP Online. Getting the most out of your appraisal. Published 4 October 2017. Available from: https://www.gponline.com/getting-appraisal/article/1428820 (accessed Jul 2021)