Appraisal of NHS consultants has been running for two years, and most general practitioners will have their first appraisal this year. If done properly, the process should enhance personal development and learning, but links with revalidation have led to fears about it being used only for assessment. The challenge is to produce a valued appraisal system that ultimately improves patient careAppraisal should be a vibrant educational process. It is a means of preparing the ground for enhancing personal development and contributes to partnership between an individual and the employing organisation. Most importantly for health care, appraisal has been shown to be positively associated with patient care, with the association increasing with the quality of the appraisal.1 For doctors in the United Kingdom, appraisal is also going to be the main method of revalidation. 2 We therefore need to be clear what appraisal is, in order to maintain its integrity as an educational tool. This article sets out what appraisal entails for NHS doctors and its potential benefits. It also explores some issues that could adversely affect appraisal and practical steps that will allow it to flourish. What is appraisal?Appraisal is a structured process of facilitated self reflection. It allows individuals to review their professional activities comprehensively and to identify areas of real strength and need for development. Appraisal is a formalised means of helping a professional move through the learning cycle (fig 1). 3Reflection forms the link between experience and the generation of ideas, which results in altered behaviour.The existence of the NHS has facilitated the development of a standardised model of appraisal for all doctors. Although separate guidelines exist for consultants and general practitioners and some differences of approach (see bmj.com), the core process and intent is identical. [4][5][6] The essence of appraisal is a confidential conversation, supported by preparatory documentation based on the General Medical Council's guidance on good medical practice (box 1). 7 The appraisal conversation should be followed by a period of reflection, after which the appraiser gives feedback. An action plan is then agreed, which the appraisee can use to steer development and learning. Importantly, after anonymisation the development needs within the plan can also be collated and fed back to the organisation to inform local learning and planning of services (fig 2).A
This paper introduces the first stage of the NHS Revalidation Support Team's (RST) proposals to strengthen medical appraisal. It reports on four focus groups held at London Deanery in 2010, with the aim of gauging initial reactions from general practitioners (GPs). The four groups consisted of two groups of appraisers and two groups of appraisees. After presentation of the proposals to strengthen appraisal, participants were invited to make comparisons between existing appraisal, and the new proposals, Interestingly, the matter which attracted most discussion was a proposal to include an element of self-assessment by the appraisee prior to appraisal, and not, as might have been expected, the proposals for assessment of the appraisee's progress towards revalidation by the appraiser. Since these focus groups, the model of strengthened medical appraisal referred to in this paper has been the subject of testing in the pathfinder pilot, a large scale pilot involving 3000 doctors in various settings in England. The evaluation of the pathfinder pilot was published (July 2011). After further refinement of the appraisal process, including taking into account new GMC and Royal College publications and more testing and piloting, the final version of medical appraisal to support revalidation, known as the Medical Appraisal Guide (MAG) is due to be published in March 2012, in time to permit the expected commencement of revalidation in late 2012.
Appraisal for general practitioners (GPs) has been in place since 2002. We conducted a review of current literature on what benefits GPs perceived appraisal to offer. GPs recognised that appraisal offers the chance to reflect on their personal development, and promotes educational activity. Furthermore, there is a strong perception that appraisal encourages changes in clinical practice and offers additional benefits such as mentorship and motivational support for the doctor. The conclusion we draw is that GPs, and the patients that they treat, should continue to benefit from outputs of medical appraisal after the introduction of medical revalidation.
Effective appraisal is one of the key underpinning systems to allow the practical implementation of clinical governance. Between March and July 2002, over 800 GPs have attended the national GP “Training the Appraisers” Programme, funded by the Department of Health, and run by the NHS Clinical Governance Support Team (CGST) in partnership with Edgecumbe Consulting Ltd. The one day programme, which includes practical “real life” appraisal sessions for GPs, is well on the way to meeting its remit of training 900 GP appraisers (an average of three appraisers per PCT) in 2002. Once they have completed the course, trained appraisers can begin the process of conducting the first round of appraisals in their local primary care organisations. The GP Appraisal Programme recognises the potential of an effective system of appraisal to develop over time, so that patients can be confident that their family doctor is supported in taking regular, structured steps to ensure they are identifying and fulfilling their professional development needs and thereby enhancing the delivery of high quality care.
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