Bradford VTS Online Resources:
APPRAISAL APPS & TOOLS
- FourteenFish appraisal tool
- Clarity appraisal tool
- GP Tools
- MyCPD learning tool
- MAG form (personally I dislike this form)
- GPappraisalsUK (a really super site)
- How to do your appraisal podcast
- RCGP pages on Appraisal
- RCGP: appraisal mythbusters
- RCGP pages on Revalidation
- RCGP Guide to supporting information for appraisal and revalidation 2018
- Almost 90% of GPs found their appraisal useful
- Quality Improvement Activity
- Learning from Complaints
- Looking After Ourselves
- Management & Leadership
- Teaching & Learning
- Significant Event Analysis
- Professional Development Plans (PDPs)
APPRAISAL BY REGION
What is Appraisal and Revalidation?
Appraisal is the annual process to ensuring you reflect on and meet your EDUCATIONAL and PASTORAL needs. NHS England defines medical appraisal as a process of facilitated self-review supported by information gathered from the FULL SCOPE of a doctor’s work. As part of the revalidation process, appraisals are key for doctors to demonstrate they are fit to practise, as well as being an opportunity to consider professional development needs. GP appraisals are undertaken annually at a meeting between a doctor and an individual (usually, but not invariably, a doctor) who is trained as an appraiser.
The purpose of appraisal
In the past, GPs collected numerous things for their appraisal. In fact, appraisal became a data gathering hefty task to prove that you, as a GP, was doing the right things. But this heavy last minute paper work collection process veered away from the ethos of appraisal – i.e. to genuinely help you. From 2020, the new ‘slimmed-down’ approach will place greater emphasis on your wellness and your individual growth. In Professor Powis’ words, the goal of a GP appraisal is ‘support, not paperwork’. So the new approach is about being ‘input-light’. The appraisal should not deteriorate into a box ticking exercise. Instead it should be a real force for positive change in your working and personal life.
- 90% of GPs report that their appraisal was useful for promoting quality improvement in their work
- 90% of GPs found their appraisal useful for improving patient care
- 90% report that their appraisal was useful for personal development
- 90% report that their appraisal was useful for professional development]
Your annual appraisal is a chance to take a step back, re-orientate yourself and recommit to what’s important to you – more important than ever with ongoing disruption to work this year.
How often is Appraisal and Revalidation? And what's involved?
- All doctors need to engage in Appraisal and Revalidation.
- GP appraisal every year and GP Revalidation every 5 years.
- Your Revalidation date is most likely to be 5 years from your CCT date (but check with your appraiser).
- So, remember – it is the appraisal BEFORE that 5th year date that you will need to make sure is fit for signing you off.
- There will be some essential requirements – like Child and Adult Protection training, PREVENT etc.
History of appraisals
The concept of appraisals, their value and purpose has been around for a long time within organisations and businesses. GP appraisal by one’s peers and clinical mentors were introduced in 2002 but in 2012 became a part of the process of revalidation. Initially a formative and supportive process, they now have the dual role of providing evidence required for revalidation as well.
A few tips for Newbies
- Carefully fill in the the “Agreed Action Plan” in the ESR form with your Trainer. Identify specific needs that are measurable that can then be transferred to you next year’s Appraisal’s personal developmental plan (PDP). Once signed off with your trainer, this form can be uploaded into next year’s appraisal portfolio.
- Also, if you’re a final year trainee reading this, remember that your GP Trainer will no longer be there to keep reminding you about things like they might have done with learning log entries. So, develop a personal system for collecting all this information throughout the year and then collate it all at least 6 weeks before your appraisal date. You will not be given second chances to postpone the date like what might have happened in GP Training. Also remember that your Appraisal Folder (whether electronic or paper, preferably former) will need to be submitted at least 2 weeks before the appraisal date to your GP Appraiser.
- Collect information throughout the year. And start early on! Appraisers are still finding that GPs are causing themselves unnecessary stress by leaving their reflective note-taking until a few weeks before the appraisal. Capturing reflections and learning is much harder to do when a learning event took place months ago and opportunities to do things differently may be lost
- Consider if there is an easier way to record information, perhaps using your phone or tablet.
- Use an app or web tool like Clarity or FourteenFish.
- FourteenFish and Clarity are great apps that serve as tools for keeping all your appraisal stuff together and seeing what is essential at a glance.
- Another great thing – if you do more work at a practice than another and if most of them are on FourteenFish, you can ask to join their FourteenFish e-group and share learning activities and notes.
- The GMC offers an app called MyCPD – but I don’t know how good it is for GPs. I think it is designed for any doctor and their appraisal, so may not be GP specific.
- Personally, I dislike the MAG form. It’s a bit archaic, backward and painful to fill in. Go for something modern that uses clever computer technology to make sure you are on track and can organise your data in a variety of graphical ways. FourteenFish and Clarity and great tools for doing this.
- If you undertake several roles as a GP, provide details of all of them. For example, GP trainer, TPD, Dermatology GPSI, ENT GPSI, Safeguarding lead, CCG work, Clinical lecturer, OOH work, A&E work etc.
- You will need to think about what evidence to collect for each of these roles. For example, if you work for an out of hours (OOH) provider, record feedback and appraisal discussions for your work in that role, year on year.
- If you work as a locum you must list, and provide details of, all the practices you have worked in over the previous year. This information needs to be supplied every year.
- Not all meetings or events need to be added to the appraisal portfolio
- Not all continued professional development (CPD) items need to have reflective notes
- Be selective for the ones where new learning has stimulated a change in practice.
- This will help to reduce the recording burden and make the preparation part of your appraisal less of a headache and stressful period. Actualy, submitting huge numbers of CPD credits is unhelpful and if you do this, it kind of shows an inability to organise and display key items.
- And remember, reflections can be concise. Focus you reflection on the impact of the learning on your practice rather than writing out a set of “lecture notes”. Perhaps use the “What? >>> So what? >>> Now what???” framework to guide you?
- Were they achieved? Were they helpful?
- Which ones weren’t achieved. Why? Do you want to carry them forwards?
- This is incredibly important. It’s usually 5 years from your CCT date, but check with your local GP appraisals team.
- Once you know it, plug it into your diary and add it to your Appraisal Toolkit.
- Make a note of the appraisal BEFORE this date – that is the appraisal you need to make sure all the evidence and mandatory requirements are in order. Things like patient and colleague surveys.
- You will not be given lots of second chances like you may have been given for Educational Supervision and ARCP. If all the necessary supporting information is not presented before the pre-revalidation appraisal, the revalidation will be deferred. Although this is not a disaster, the GMC does not allow repeated deferrals so it is best to be organised and avoid this situation entirely.
The 4 Areas of Appraisal
Appraisal is based on GMC core guidance “Good Medical Practice” (GMP), 2011. Evidence is organised into four domains which demonstrate essential professional values:
Maintain your professional performance
- Maintain knowledge of the law and other regulation relevant to your work
- Keep knowledge and skills about your current work up to date
- Participate in professional development and educational activities
- Take part in and respond constructively to the outcome of systematic quality improvement activities (e.g. audit), appraisals, and performance reviews.
Apply knowledge and experience to practice
- Recognise and work within the limits of your competence
- If you work in research, follow appropriate national research governance guidelines
- If you are a teacher/trainer, apply the skills, attitudes, and practice of a competent teacher/trainer
- If you are a manager, work effectively as a manager
- Support patients in caring for themselves
- If you are in a clinical role:
- adequately assess the patient’s conditions
- provide or arrange advice, investigations, or treatment where necessary
- prescribe drugs or treatment, including repeat prescriptions, safely and appropriately
- provide effective treatments based on the best available evidence
- take steps to alleviate pain and distress whether or not a cure may be possible
- consult colleagues, or refer patients to colleagues, when this is in the patient’s best interests
Ensure that all documentation (including clinical records) formally recording your work is clear, accurate, and legible
Contribute to and comply with systems to protect patients
- Take part in systems of quality assurance and quality improvement
- Comply with risk management and clinical governance procedures
- Cooperate with legitimate requests for information from organisations monitoring public health
- Provide information for confidential inquiries, significant event reporting
- Make sure that all staff for whose performance you are responsible, including locums and students, are properly supervised
- Report suspected adverse reactions
- Ensure arrangements are made for the continuing care of the patient where necessary
- Ensure systems are in place for colleagues to raise concerns about risks to patients.
Respond to risks to safety
- Report risks in the healthcare environment to your employing or contracting bodies
- Safeguard and protect the health and well-being of vulnerable people, including children and the elderly and those with learning disabilities
- Take action where there is evidence that a colleague’s conduct, performance, or health may be putting patients at risk
- Respond promptly to risks posed by patients
- Follow infection control procedures and regulations.
Protect patients and colleagues from any risk posed by your health
- Make arrangements for accessing independent medical advice when necessary
- Be immunised against common serious communicable diseases where vaccines are available
- Listen to patients and respect their views about their health
- Give patients the information they need in order to make decisions about their care in a way they can understand
- Respond to patients’ questions
- Keep patients informed about the progress of their care
- Explain to patients when something has gone wrong
- Treat those close to the patient considerately
- Communicate effectively with colleagues within and outside the team
- Encourage colleagues to contribute to discussions and to communicate effectively with each other
- Pass on information to colleagues involved in, or taking over, your patients’ care
Work constructively with colleagues and delegate effectively
- Treat colleagues fairly and with respect
- Support colleagues who have problems with their performance, conduct, or health
- Act as a positive role model for colleagues
- Ensure colleagues to whom you delegate have appropriate qualifications and experience
- Provide effective leadership as appropriate to their role
Establish and maintain partnerships with patients
- Encourage patients to take an interest in their health and to take action to improve and maintain it
- Be satisfied that you have consent or other valid authority before you undertake any examination or investigation, provide treatment, or involve patients in teaching or research
Show respect for patients
- Implement and comply with systems to protect patient confidentiality
- Be polite, considerate, and honest and respect patients’ dignity and privacy
- Treat each patient fairly and as an individual
- If you undertake research, respect the rights of patients participating in the research
Treat patients and colleagues fairly and without discrimination
- Be honest and objective when appraising or assessing colleagues and when writing references
- Respond promptly and fully to complaints
- Provide care on the basis of the patient’s needs and the likely effect of treatment
Act with honesty and integrity
- Ensure you have adequate indemnity or insurance cover for your practice
- Be honest in financial and commercial dealings
- Ensure any published information about your services is factual and verifiable
- Be honest in any formal statement or report, whether written or oral, making clear the limits of your knowledge or competence
- Inform patients about any fees and charges before starting treatment
- If you undertake research, obtain appropriate ethical approval, and honestly report results.
So, each doctor must build a portfolio showing evidence for each of these four areas. The types of evidence you collect will be from your
- Continuing professional development (CPD): courses, meetings, journals, web-based learning and the Patient’s Unmet Needs (PUNs)/Doctor’s Educational Needs (DENs) system
- Quality improvement activity (QIA): audit, case reviews, evaluation of policies or review of clinical outcomes.
- Significant events – remember, they don’t have to be catastrophic events!
- Feedback from colleagues, patients and a review of compliments and complaints.
The 5 Appraisal Inputs
You have to provide evidence for 5 areas of your work in your appraisal. Together, these 5 areas help to provide a rounded picture of whether you are reflecting on AND meeting your EDUCATIONAL and PASTORAL needs based on the FULL SCOPE of your work. Full scope of your work” means the appraisal has to provide evidence for these 5 area in all the jobs you do. So, if your a GP, a trainer and a dermatology GPSI, then you have to provide items 2, 3, 4 and 5 for each of these three areas of your work.
- Personal information: name, contact details, GMC number.
- Scope and nature of work: the work you do in your capacity as a doctor, including NHS and non-NHS work.
- Supporting information: evidence of CPD, quality improvement, reflection on teaching/ management activities; comlaints, compliments, feedback from patients or colleagues.
- Review of previous personal development plan: what was achieved and if some items were not completed, the reasons for this.
- Achievements, challenges and aspirations: including the main developmental needs for the coming year.
What sorts of things should I document/collect?
Remember what we said earlier. Dont leave everything until the last minute. Collect information throughout the year. And start early on! Many GPs are causing themselves unnecessary stress by leaving their reflective note-taking until a few weeks before the appraisal. Capturing reflections and learning is much harder to do when a learning event took place months ago and opportunities to do things differently may be lost. Consider if there is an easier way to record information, perhaps using your phone or tablet. Use an app or web tool like Clarity or FourteenFish.
- Remember, NEVER INCLUDE INFORMATION THAT MIGHT IDENTIFY A PATIENT OR A FELLOW COLLEAGUE AT THE PRACTICE
- Also remember, appraisal is not just about showing that you attending courses and things. It’s to show WHAT HAS CHANGED IN YOUR PRACTICE FOR THE BETTER as a result of such activity.
- PUNS and DENs from day-to-day clinical surgeries
- If you use something like GP notebook or CKS, log in when looking up stuff. They have trackers that you can then print off. But it is also good to have a few entries which you write about a bit more fully like you currently do with Learning Log Entries.
- Any case reviews?
- Include significant events, prescribing meetings, referrals meetings, clinical topics, mortality meetingss, palliative care meetings, safeguarding meetings (adults & children)
- Away days
- What did you learn? How has it changed your practice?
- Protocols – did you help develop or update any?
- QoF – Anything you lead on? Why? What was the result?
- Learning from Complaints
- Learning from your Multi-Source Feedback from your work colleagues
- Learning from the Patient Satisfaction Questionnaire
Widen your learning
Medical knowledge is changing at a phenomenal rate and there are always new skills a doctor can learn so that he or she can adapt themselves to a forever changing society. So, think about how you plan to update your knowledge, learn new skills and get some pastoral support.
KNOWLEDGE & SKILLS
- Evening courses, seminars, lectures and workshops.
- Many are free. Many are hosted by your local CCG. Contact them and find out where you can get an up to date programme of educational events.
- If you are staying in your training area, ask your GP Trainer and TPDs – they’ll have some idea.
- How about creating a Whats App group or something similar with some of your colleagues?
- Former peer GP Trainees
- A What’s App group of your practice doctors
- Discuss clinical knowledge (remember to respect patient confidentiality)
- GP Clinical Knowledge Update Courses
- Go on advertised workshops e.g. communication skills course for handling conflict
- Usually have to pay for these
- But they’re often amazing at skilling you up
- Great for clinical knowledge refresher for particular areas eg BMA learning, FourteenFish emodules, RCGP eLearning
- But there are also emodules for lots of other non-clinical things like Health & Safety, Fire Training, Child Protection, Adult Protection, PREVENT training – see eLearning for Health (eLFH).
- Evening meetings with colleagues for support and fun
- Stay in touch – with GP Trainer and TPDs
- What’s app group of GP trainee friends
- The doctors in the practice where you work
Never post anything confidential on social forums. You are responsible for what you post. Keep things totally anonymous; protect the patient. Remember, a patient can be identified without their name, address and date of birth. For instance, if I wrote “Can someone help me with a young lady in Bradford who has this rare genetic disorder called Diddly-Squat syndrome” – I will be breaking confidentiality as someone on the net will probably know who you are talking about! The rarity in this case makes it an identifying feature, especially if say there are only 4 cases in the UK. Stay away from posting on permanent social platforms. Instead, use colleagues you know or groups that you belong to or chat groups which are closed off from the public and are totally private and confidential (and where the chat can be deleted afterwards)
Reflection & Impact - the 2 key things
The GMC and RCGP stress the importance of reflection within your appraisal documentation. You need to demonstrate that you have thought about what you have learned and what you need to do differently as a result. Where practice has changed as a result of learning, this should be documented (impact to practice). A confusing system where credits could be doubled if impact was demonstrated was scrapped in 2016 but documenting impact to practice is still crucial. The RCGP states that there is no longer any need to scan certificates of attendance as proof of learning. Thoughtful reflection documented on the toolkit is much more worthwhile evidence that learning has taken place.
GPs often have difficulty understanding what they are supposed to write in the “reflections” section. In simple terms, it is writing down the take-home messages from a learning event, ie “What have I learned today that is going to change my practice?”
When writing up your reflection, consider the following 4 things…
- Learning: What did I learn that I didn’t know before; particularly, what did I learn which will change my practice?
- Reaction to that learning: What do I feel about what I learned? (Was it helpful, thought-provoking, reassuring …?)
- Change as a result of that reaction: What do I need to do differently as a result of what I have learned?
- Results/Impact as a result of that change: What has changed as a result of what I learned? (This part of the reflection may need to be completed subsequently. The rest is more useful if completed soon after the learning event.)
The "What? > So What? > Now What?" reflective framework
There are many approaches to reflection. The What? So what? Now what? framework is one example of a simple way to structure reflections, whether it be of a single event or of a period of time. It could include personal experience, interaction or observation of others and formal/informal learning events. Key elements in this framework that might be helpful to consider:
- Focuses on thoughts at the time of an experience. It explores thought processes when a particular action or decision was taken and how those may have impacted on actions and feelings.
- ’What was I thinking when I took the actions or made the decision that I did’
- So what?
- Involves considering the significance of what happened as well as the values and feelings at the time of and prompted by the experience, and why these may influence future learning or actions.
- How did I feel at the time of and after the experience, why was it important?’
- Now what?
- Looks at the processes and opportunities that can help learning from the experience and identifying future actions, reflection on those actions, and how to use these to develop further.
- What can I learn from or do differently next time’
The 6 markers of a succesful PDP record
Use these to help define the components of each of your PDPs in your appraisal record. Remember, identify PDPs that are relevant to the scope of work that you will be doing.
What learning need have you identified for your development plan? How did you identify this need?
What activities, practical or educational, will you undertake? What resources will you need?
How urgent is this need? When do you expect to achieve your goal?
How will you know that you have achieved your goal? What evidence will you need?
How will your practice change as a result of this activity? What, if any, further learning need have you identified?
Agreement from your appraiser at the next appraisal that you have satisfactorily met this need.
What sorts of things might my appraiser ask?
- What are you good at and not good at? How has this changed from last year?
- What is your practice good at and not so good at (QoF wise)? How has this changed from last year?
- How has a particular learning event changed the way you practice or the way you provide care for your patients? This question will be repeatedly asked about learning activities, courses, PUNS, DENS, PDP items, and prescribing/referral meetings.
- Any audits or other Quality Improvement Activity you have engaged in? Why was the need? What was the outcome?
- How does the practice learn together? How do you disseminate learning to each other?
- PDPs – have you achieved them? How has it led to changes in the care you provide for patients? Any that have been unachieved? Why?
- Patient feedback & complaints – how did this affect you? Lessons learnt? What now?
- Let’s have a look at your MSF. What are the emerging themes about you? Anything you’d like to work on?
- Let’s have a look at your PSQ. What are the emerging themes about you? Anything you’d like to work on?
- What are your developmental needs for the coming year? What shall we put in the PDP? And discussions we have had that might help with formulating a PDP for next year?
- Let’s take a step back and make sure these PDPS cover the whole scope of your work and are S.M.A.R.T.
- Plug your revalidation date into your diary.
Hot Tips for making your appraisal prep dead easy...
If you have any more top tips, email me: [email protected]
- Choose an electronic system for holding your information
- FourteenFish and Clarity are big runners. But there are others. Personally, I don’t like the MAG form – I find it clunky and antiquated and I believe e-tools like FourteenFish make using their appraisal system quite a joy to use.
- Don’t leave it til the last minute. Plug in 4 appraisal tidy dates a year – 3 months apart.
- Most GPs I know collect all their data for the appraisal through the year and dump it into a physical or electronic folder of some sort. But the headache comes when 2 weeks before their appraisal, they then have to sort out this mounds of information that they have collated.
- So instead, I have found an easier system. Plug into your diary (I use Outlook Calendar) four times when you will dedicate 2 hours of that day to sorting out your appraisal folder data – organising it and making it more meaningful.
- For example, I have my Appraisal every September. Therefore, I have scheduled in my diary the following dates for “Tidying My Appraisal System” – 12 Feb, 12th May, 12th August, 12th Nov.
- Form a collaborative group and share your learning
- Get the group you work with often – for example all the docs at your surgery – to start working collaboratively and share meeting notes on things you have been to together. For example, Basic Life Support, Adult Protection and Child Protection meetings, Learning from Mortality meetings, Significant Events, Prescribing and so on.
- So, when someone writes up notes say in a meeting at your surgery, ask them to anonymise and then email around the meeting notes. Then upload it to your appraisal e-system and ammend it to your own personal reflections and tweaks.
- Review your PDP regularly and see whether you are on track.
- A good way to do this is to simply review it at the same time you have plugged into your diary the 4 appraisal tidy dates.
5 questions to help you
- What do I want to get out of my appraisal?
Is it a knowledge area you want to improve on? A better work-life balance? A new skills? A new interest that you’ve been meaning to do for ages? What would really help me at this particular period of time?
- What are my strengths? For instance, what have I done well? What was really good for me this year?
In appraisal, it is easy to be self-critical and focus on our gaps rather than seeing everything in balance by looking at the other positive side of the coin too. There’s lots of reasons for doing this. It makes you feel good. This then motivates you. This may then signpost towards something you want to do in the future. Morale in GP is often low, and it is important to remind ourselves of the truth – that we all have strengths that we need to celebrate rather than skim over.
- What’s my personal well-being like? For instance, am I in a good place? Am I struggling? Am I burning out? Am I depressed?
Use your appraisal as a chance to identify and break destructive cycles, like checking emails when you first wake up, and think about where you might be able to build in more boundaries and protected space for your own health.
- What contributes to my work-related stress?
Define exactly all the recurring things that irritate and frustrate you. Keep a list throughout your daily working life. I send an email to myself every time something narks me off that is likely to recur again and again. I keep them all in an email folder I call “narksme”.
- What’s the smallest thing I could do now, bit by bit, to change one of those things that cause me work-related stress?
Think practically and incrementally. Working on even the smallest things can make a lot of impact – and you know it. Go through you narks list and see what you would like to work on. Find small steps and just work from there. Do things a little bit at a time – every week or so, rather than concentrating all within a week. You’ll be more positive about the process and you’ll feel great when you make changes that work. Taking more manageable steps forward also helps you manage stress – you’re making progress, but without adding heaps more to your plate.
And finally, remember to listen to your appraiser rather than react defensively towards them. They are in the same boat as you – a working GP – and they know how stressful it is. They are trained to support you, not whip you! Don’t dismiss your appraiser’s input. Often, they’ll ask you questions to get you thinking, or to help you view a problem from a different angle. Considering that 97% of GPs are happy with the skills of their appraiser, it’s likely that they will help you uncover helpful ways to manage your work and take time for yourself and your own path.
GP Locums & Appraisal
All doctors need to engage in Appraisal and Revalidation. The same applies to GP Locums. GP appraisal every year and GP Revalidation every 5 years. Your Revalidation date is most likely to be 5 years from your CCT date (but check with your appraiser). So, remember – it is the appraisal BEFORE that 5th year date that you will need to make sure is fit for signing you off. There will be some essential requirements – like Child and Adult Protection training, PREVENT etc.
- It’s easier for GPs in more permanent roles (Salarieds & Partners) to show things like Quality Improvement Activity. But how do you show this when you’re a locum moving from practice practice. There are in fact plenty of ways in which you can collect and build a portfolio of evidence for your Appraisal.
- Please try and belong to a locum group or locum chambers – network and ask locum colleagues how they do it.
- There is some great advice on the NASGP site – Click AppraisalAid.
- And finally, FourteenFish is a great app and tool for keeping all your appraisal stuff together and seeing what is essential at a glance. Another great thing – if you do more work at a practice than another and if most of them are on FourteenFish, you can ask to join their FourteenFish e-group and share learning activities and notes.
- Practical Tips for Appraisal for Locum and Sessional GPs (Wessex)
- BMA Appraisal Tips for Sessional GPs