GP Appraisal – A summary of National Guidance

1. Summary

National Guidance on GP Appraisal was published on 1 March 2002. The Chief Medical Officer, Sir Liam Donaldson has advocated that appraisal will be "a positive and supportive developmental process", giving GPs an opportunity to consider their work and possibly identify any training needs. Primary Care Trust (PCT) Functions Regulations will be altered to include appraisal as a mandatory function and there will be a requirement for both the PCT and general practitioners to deliver. Department of Health (DH) research suggests the average time commitment for a GP being appraised will be between 4.5 and 6.5 hours, which includes 2 to 4 hours of preparation. It is expected that the process should take place during normal working hours.

Sir Liam Donaldson goes on to state:

"Introducing such a major programme will of course be a learning process for everyone involved. The first year will be one of building up experience and expertise, both for PCTs and individual doctors. Local circumstances will determine the speed at which implementation will be introduced but the expectation is that all general practitioner principals and the Personal Medical Services equivalents will have been appraised by March 2003."

Guidance on the GP appraisal scheme has been published along with five standardised forms developed by the DH to assist the process. Documentation is available at: www.doh.gov.uk/gpappraisal

2. The Scheme

2.1. Aims of Appraisal

"The primary aim of appraisal is to help GPs consolidate and improve on good performance, aiming towards excellence".

Within the aims of appraisal, it specified that adequate resources will need to be identified to ensure that any service objective identified through the process can be met. There is also a suggestion the process of appraisal could be used to meet the requirements of GMC revalidation, and appraisal will be set against the seven headings of the GMC’s Good Medical Practice. However, the link between appraisal and revalidation has not yet been established in detail by the GMC.

2.2. Process

Time to be set aside during normal working hours. It is anticipated that appraisal will take between 4.5 and 6.5 hours. In line with Good Medical Practice the core headings will be:

	Good clinical care
	Maintaining good medical practice
	Relationships with patients
	Working with colleagues
	Teaching and training
	Probity
	Health

2.3. Documentation

Standardised forms have been produced. Every GP being appraised will need to prepare an appraisal folder. This will include documentation, information, data and evidence to facilitate the appraisal process.

The majority of documentation will be available from existing sources, and can be supplied by PCTs, as it is already collected as part of the regular monitoring currently undertaken by the Trusts.

2.4. Preparation

GPs are to be informed at least two months in advance that they are to be appraised. It is suggested that the GP and the appraiser might reflect on:

	Achievements and challenges in the last 12 months
	Service, practice and wider objectives for the future
	Personal development needs

Information and paperwork to be used during appraisal must be shared at least two weeks in advance by both the appraiser and appraisee.

2.5. The Appraiser

The appraiser must be another GP with an understanding of the working conditions of the appraisee. They are to be appropriately trained to carry out appraisal, although what this entails is not specified.

If it becomes apparent that the proposed appraiser and appraisee are incompatible, then the PCT Chief Executive will be responsible for nominating an alternative. This seems to suggest that GPs are unable to choose their appraiser.

2.6. Peer Review

Any specialist aspects of a GP’s clinical performance will need to be assessed by peers with the appropriate knowledge. Peer review will need to be timetabled in advance of appraisal. If during appraisal a more detailed examination of an aspect of the appraisee’s work is identified, again internal or external peer support can be sought. This should take place within one month of the appraisal interview with a follow-up meeting between the appraiser/appraisee arranged to complete the process.

2.7. Appeals Process

A local process needs to be agreed, which fits the national model. This should address any concerns or complaints the appraisee might have about the fairness of the scheme, the appraiser or outcomes of the appraisal interview. The GP will have the right to seek representation, and this might be through the LMC.

2.8. Outcomes of Appraisal

The process should conclude with the development of an action plan, which will include a personal development plan (PDP). The action plan will also identify the potential practice resource needs and clinical governance issues.

Details of the interview discussions will be confidential, although the appraiser and appraisee are to agree a written overview of the appraisal, which will identify:

	the achievements of the previous year,
	objectives for the next year,
	the PDP,
	actions expected of the PCT,
	a summary to be included in the revalidation folder,
	a joint declaration that the process has been carried out correctly.

The summary statement will be countersigned, and a copy will be sent in confidence to the PCT senior clinician/clinical governance lead and Chief Executive. It remains unclear where the complete notes of the appraisal interview and follow-up work will be held. Where problems or needs have been identified, these should be sent to the Chief Executive for action. This should include any serious concerns about performance, which could then be referred to the locally agreed support process.

The appraiser and appraisee will need to meet at some point during the course of the year to review progress. This session should take approximately 30 minutes and might be a telephone call rather than an actual meeting.

2.9. Roles and Responsibilities of NHS Management

Responsibility for appraisal rests with the PCT. "The Chief Executive will be personally accountable to the PCT Board for ensuring that all GPs are appraised and any follow up actions taken."

The PCT must:

	ensure appraisal covers all doctors working in general practice and "…commands the confidence of the profession and their representatives locally (i.e. the LMC and usual professional channels)."
	ensure all doctors undergo appraisal
	identify, appoint and train appraisers
	performance manage appraisers
	develop an appeals process
	ensure that "action is taken as far as possible" to address the individual development needs of GPs or service improvements
	identify appropriate financial provision to support appraisal. "This should include a funded policy on the provision of locum cover."

3. Roles of the LMC

Bedfordshire & Hertfordshire LMC would like to be able to commend the local system, as appraisal is a process which is supported by the profession. In order to do so we need:

	to agree the process with all stakeholders
	to work with educationalists in assisting GPs to develop their Personal Development Plans
	to provide ongoing support to GPs when completing their appraisal forms
	to provide support to GPs if seeking reconsideration of the process through the appeals mechanism
	to agree the suitability of potential appraisers
	to ensure support and mentoring arrangements for appraisers
	to monitor the actual time required for appraisal
	to be content the funding provision is sufficient. Dr J Chisholm in his letter to the Profession advises: "In response to our concerns, the Department has confirmed that the terms of service change means that GPs will only be required to participate in appraisal when and if properly resourced schemes are in place." It has been suggested that for an average PCT, funding the process will cost £150,000.

If the funding is not adequate for a proper system then the LMC will not be in a position to recommend participation.

Elizabeth Riches
Director of PCT Liaison, March 2002