What do doctors really think about the relevance and impact of GP appraisal 3 years on? A survey of Scottish GPs

Abstract

The aim of appraisal is to provide an opportunity for individuals to reflect on their work to facilitate learning and development. Appraisal for GPs has been a contractual requirement since 2004 in Scotland, and is seen as an integral part of revalidation. AimTo investigate the outcomes of GP appraisal in terms of whether it has prompted change in medical practice, education and learning, career development, attitudes to health and probity, how GPs organise their work, and their perception of the overall value of the process. Design of studyA cross-sectional postal questionnaire. SettingGP performers in Scotland who had undertaken appraisal. MethodThe questionnaire was based on the seven principles outlined in Good Medical Practice, a literature review, and previous local research. The survey was conducted on a strictly anonymous basis with a random, representative sample of GPs. ResultsFifty-three per cent (671/1278) responded. Forty-seven per cent (308/661) thought that appraisal had altered their educational activity, 33% (217/660) reported undertaking further education or training as a result of appraisal, and 13% (89/660) felt that appraisal had influenced their career development. Opinion was evenly split on the overall value of appraisal. ConclusionAppraisal can have a significant impact on all aspects of a GP's professional life, and those who value the process report continuing benefit in how they manage their education and professional development. However, many perceive limited or no benefit. The renewed emphasis on appraisal requires examination of these findings and discussion of how appraisal can become more relevant.

Continuous professional development for GPs: experience from Denmark

“…A reflective and supportive appraisal system could form part of the answer on how to help Danish GPs to a clearer understanding of their individual learning needs, and thereby enhance the effect of the subsequent CPD activities 18 19. Such an appraisal also seems to enhance personal responsibility, if performed by skilled colleagues 18 19…”

Verifying appraisal evidence using feedback from trained peers: views and experiences of Scottish GP appraisers

“…Appraisers have consistently voiced their discomfort at being given this task. 6,7 This external peer review system allows the judgements to be made prior to an appraisal with a built-in sampling process of 'quality control' ensuring fairness across the country, that is, a national standard. However, the feasibility of a national external peer review system to support appraisal is open to question.…”

“…Although appraisal has gained acceptance, [3][4][5] the benefits and impact are limited for many GPs. 6,7 When introduced, it was envisaged that the combined evidence from five appraisals would inform a proposed system of medical revalidation in the UK. 8 The recent white paper makes clear, however, that the existing appraisal model is inadequate for this purpose because it lacks robustness and objectivity.…”

Barriers and attitudes influencing non-engagement in a peer feedback model to inform evidence for GP appraisal

“…Conversely, others did not see the value or thought it limited, which reflects previous findings for external peer review through the Scottish GP appraisal system [4]. …”