GP appraisal in Wales

A system of annual appraisal for all general medical practitioners in Wales was introduced on 1st April 2003. The appraisal criteria are defined by the General Medical Council in Good Medical Practice and further elaborated by the Royal College of General Practitioners and the General Practitioners' Committee in their joint publication Good Medical Practice for General Practitioners.

The Department of Postgraduate Medical Education for General Practice will manage the appraisal system in Wales through a central Appraisal Office. Standard documentation will be employed and a consistent approach to declared procedures adopted.

The appraisal process will:

• Emphasise a positive and developmental approach
• Be sensitive to the doctor's working environment
• Be fair and effective
• Be well informed
• Be undertaken in a professional manner

Support for doctors involved in appraisal will be offered by local CPD co-ordinators. The Departmental web site will provide a range of appropriate educational resources.

Definition

Appraisal may be defined as a formative, systematic and regular review of past achievements with constructive planning of future progress.

Appraisal is not a single event - it is not a one-off meeting carried out to fulfill regulations and then forgotten – but a continual process and an integral part of a learning culture. Participation in appraisal should be a positive and supportive experience.

Opportunities

Involvement in appraisal will provide doctors with a number of opportunities:

• To participate in structured, accredited continuing professional development
• To receive acknowledgment of achievement and support for further development
• To reassure patients that their doctor is committed to improving quality of care
• To demonstrate a commitment to the health agenda in Wales and to local healthcare initiatives
• To comment upon constraints within the system
• To prepare for revalidation

The link between appraisal and revalidation

While appraisal and revalidation will be largely based on the same sources of information, the objectives of the two processes are distinct and complementary.

Appraisal is concerned with the doctor’s professional development within his or her working environment.

Revalidation involves an assessment against a standard of fitness to practise, in line with the basic framework of the GMC's guidance Good Medical Practice. It will allow a doctor's licence to practise to be renewed.

For the purpose of economy of effort and to avoid unnecessary duplication, the content of appraisal will be based on the core responsibilities identified in Good Medical Practice:

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

These responsibilities define structure to the appraisal folder. The GMC publication A Licence to Practice and Revalidation indicates that, generally, the data collected for the purposes of appraisal should satisfy the requirements of revalidation.

The appraisal folder

All doctors must prepare an appraisal folder - a structured record of achievement with supportive documentation. The standard appraisal folder will be used for Principals and Freelance GPs, and the content should reflect the role and responsibilities of each doctor.

The folder is available on the Departmental website and may be downloaded or completed online as required.

The folder consists of three distinct sections.

The FIRST section forms the preface to the folder and comprises Form 1 and Form 2

Form 1

The doctor is required to complete a current curriculum vita using the template provided.

This information will be stored on a secure, confidential, online database. Access to this data will be restricted to that doctor and to senior members of the Appraisal Office. The doctor will be responsible for maintaining the integrity of the data, which may be accessed for subsequent appraisals. The information will enable the department to keep the doctor informed of appraisal developments.

Form 2

The doctor is requested to provide a brief and factual description of his or her current medical activities. A proforma identifies the required information.

The SECOND section of the appraisal folder - Form 3 - comprises the documentation on which the appraisal discussion and subsequent revalidation judgments will be based.

The areas identified in Good Medical Practice form the framework of the written record.

It is anticipated that over a 5-year period, the doctor will have accumulated sufficient material to satisfy the requirements of revalidation. The separate areas should be clearly discernable in the appraisal folder.

Form 3A Good clinical care

This area includes

• Maintenance of core clinical competencies
• Doctor – patient communication
• Premises
• Patient access to services
• Integrity of medical records
• Use of equipment
• Appropriate use of investigations
• Prescribing
• Structured approaches for the management of chronic diseases
• Emergency care

Form 3B Maintaining good medical practice

This area includes:

• Keeping up to date
• Personal and practice development planning
• Audit
• Significant event analysis
• Awareness of local and national health related initiatives
• Compliance with health & safety at work regulations and employment matters.

Form 3C Relationships with patients

This area includes:

• Provision of information about offered services
• Patients’ consent to treatment
• Confidentiality issues
• Discrimination and prejudice against patients
• Complaints and formal enquiries.

Form 3D Working with colleagues

This area includes:

• Communication within the practice
• Teamwork and staff development
• Defined roles and responsibilities
• Referrals.

Form 3E Teaching and training, appraising and assessing

This area emphasises the importance of honesty and objectivity in appraisal and assessment of colleagues. Those involved in teaching have an obligation to maintain and develop their skills.

Form 3F Probity and Health

Issues of probity include:

• Accuracy of published information about services
• Honesty in writing reports and signing documents
• Integrity of research
• Financial and commercial dealings
• Conflicts of interest

Doctors are requested to consider whether or not aspects of their own health influence their ability to care for others.

Form 3G

An opportunity is provided for the doctor to share his or her insights – to reflect on the achievements of the appraisal period, to consider present developmental needs and to identify constraints to progress.

Completion of necessary paperwork prior to the appraisal discussion is an essential prerequisite for constructive dialogue between the doctor and appraisal facilitator.

Description of activities should be succinct and accurate. There is no need for exhaustive detail though necessary supportive documentation should be included. The appraisal discussion will provide an opportunity for explanation and fuller account.

The THIRD section of the folder comprises Forms 4 and 5.

These forms will be compiled by the appraisal facilitator – and subsequently agreed with the doctor – on satisfactory completion of the appraisal discussion. Both parties are required to sign these documents. Signed copies of both forms should be retained by the doctor and included in the appraisal folder.

Form 4

This document provides an accurate summary of both the appraisal submission and issues identified in discussion. An outline of the doctor’s learning and developmental strategy over the subsequent twelve months will be included. The doctor and the appraisal facilitator will each retain a copy of Form 4.

Form 5

Form 5 is a declaration that the annual appraisal has been satisfactorily completed. The appraisal facilitator will send a copy of the signed document, to the central Appraisal Office.

The doctor may be assured that the submission and content of the appraisal discussion will be treated as confidential. The appraiser will send the second copies to the relevant Appraisal Co-ordinator, who will undertake a learning needs analysis and forward the data to the GP Appraisal Unit.

All records will be held on a secure basis and access complies fully with the requirements of The Data Protection Act.

The appraisal process

Participation in appraisal will encourage doctors:

• To develop a structured approach to continuing professional development
• To plan practice initiatives
• To demonstrate achievements.

Preparation

Before embarking on the appraisal exercise, general practitioners:

• Must be fully aware of the appraisal process and system as it operates in Wales
• Should read the documents Good Medical Practice and Good Medical Practice for General Practitioners.
• Should access the Departmental website and explore the sections on Appraisal and CPD
• Should select their preferred appraiser from the Departmental directory. As long as the appraiser is available he or she will contact the doctor to make provisional arrangements for the appraisal discussion

Planning

At the start of the appraisal year, the doctor should identify both personal learning needs and developmental needs of the practice. These needs will inform that doctor’s appraisal strategy over the ensuing twelve months.

The doctor may consider it worthwhile sharing these goals with practice colleagues since collaborative approaches might be adopted. The doctor should clarify his or her responsibilities in such ventures and describe his or her contribution in the written account.

The identified needs form the basis of a Personal Development Plan. The doctor may wish to involve the support of the local CPD co-ordinator at this stage. Details of CPD Co-ordinators are available here

Development

Episodes of learning and development - arranged as part of a Personal Development Plan or through opportunistic activity - should be regularly recorded and stored in the appraisal folder. In this way, information will be gathered throughout the year.

The doctor may choose to work with colleagues, as part of a small group. Group members would share information and offer one another support and guidance. Participation in such activity should be recorded in the appraisal folder.

Three months before the end of the appraisal period, the nominated GP appraiser will contact the doctor and provisional arrangements made for the appraisal discussion.

The doctor should now review the initial learning strategy and complete any unfinished tasks.

One month before the end of the appraisal period, the GP appraiser will confirm the discussion arrangements. The date, time and venue will be agreed.

The doctor should properly organise the documentation.

Form 3G should be completed and enclosed in the folder which must be sent to the appraisor, no later than two weeks before the date of the planned discussion.

The appraisal discussion

The discussion should be held in a private, quiet, comfortable environment. It should begin promptly, remain free from interruption and be expected to last up to 3 hours.

Preparation by both parties is essential for an effective discussion.

The doctor may wish to bring along a legitimate agenda of properly considered issues and use the opportunity to display relevant material that had been omitted from the original folder.

The appraiser will have considered the submitted appraisal folder and may have identified matters that need further clarification. The appraiser may request further documentation be made available.

It is anticipated that the discussion process will be a constructive dialogue and highly supportive of the doctor.

Towards the end of the discussion, the doctor will agree the basis of the following year’s Development Plan.

Post discussion activity

Within ten days of the discussion, the doctor will receive two copies of both Form 4 – the appraisal summary – and Form 5 – the declaration of completion. The appraiser will have signed all copies. The doctor should countersign these documents and include one copy of each in the appraisal folder. The other copies should be returned to the appraiser.

Appraisal was neither designed nor intended to be an instrument for actively detecting and dealing with underperformance. However, in the unlikely event that a serious matter of conduct, health or performance is discovered, the appraiser has an obligation to fulfill his or her own professional responsibilities and appropriate action will be undertaken. Full details of this procedure will be available on the Departmental website.

The appraisal system in Wales

The Director of Postgraduate Medical Education for General Practice will hold overall responsibility for GP appraisal in Wales.

The GP Appraisal Unit, a designated office within the central office structure, will administer the system.

A senior member of the Adviser team will be given particular responsibility for managing the system and for ensuring that satisfactory standards are maintained. The responsible adviser will lead a team of appraisal co-ordinators. Contact details are available on the Departmental website.

Each appraisal co-ordinator will be an active general practitioner of high professional standing with experience of appraisal processes and who will assume responsibility for managing GP appraisal activity within a defined geographical area. Formal training will be completed before the introduction of appraisal.

The appraisal co-ordinators will support those involved in the appraisal process, both doctors and appraisers, and liaise closely with local CPD co-ordinators. They will be actively involved in monitoring and evaluating the system.

Appraisers will be active general practitioners, of good professional standing, who possess the capacity, capability and local knowledge to facilitate effective peer appraisal.

If you are interested in becoming an appraiser you should access the Departmental website, contact the GP Appraisal Unit or discuss these opportunities with your local CPD Co-ordinator.

All appraisers will be appropriately trained. They will receive regular feedback on their performance and actively participate in a process of ongoing development.

Each doctor will be allowed to select his or her appraiser – subject to availability and agreement - from a Directory held by the Department. The Directory will be accessible on the Departmental web site.

It would be considered unacceptable for a doctor to choose a colleague with whom the doctor enjoys a close personal or professional relationship and it is recommended that, whenever possible, the doctor does not select the same appraiser for every appraisal

At the end of every appraisal period, The Department of Postgraduate Education for General Practice will publish an Annual Appraisal Report. Copies of this document will be sent to The Chief Medical Officer for Wales, Officers of Local Health Boards and all participating general practitioners.

The Medical Directors of Local Health Boards in Wales will be regularly informed of appraisal activity.

Appeal Procedure

Issues of persistent concern or unresolved conflict between the doctor and the appraisal facilitator should, in the first instance, be referred to the local Appraisal Co-ordinator.

If attempts at local resolution are unsuccessful and the doctor remains unsatisfied, the matter should be referred to the responsible adviser. Full details of the appeal procedure will be available on the Departmental website.

Quality Assurance

Confidential feedback will be requested from all participating doctors. Doctors will be able to describe their own experiences, identify problem areas and make suggestions for improvement.

A random sample, comprising approximately 5% of the total submissions, will be reviewed every year by the appraisal co-ordinators to confirm the appraisal summary is an accurate description of the folder contents. The documentation and decisions will remain unaltered.

Every year, all aspects of the appraisal system will be subject to external review and formal reporting.