Appraisal for GPs

Appraisal In General Practice

Dr Andrew Mowat, Primary Care Tutor, Dr Andrew Mowat, Primary Care Tutor,

James Street Family Practice, LouthJames Street Family Practice, Louth

Appraisal

"a process by which clinicians can chart their continuing progress and identify their development needs"

(Department of Health 2001)

“a positive, developmental, employer-led, two-way, action-oriented process, primarily directed at quality improvement”

(ScHARR 2001)

Dr Andrew Mowat, Primary Care Tutor, Dr Andrew Mowat, Primary Care Tutor,

James Street Family Practice, LouthJames Street Family Practice, Louth

References

Supporting Doctors and Protecting Patients 1999

NHS Plan - Annual appraisal, condition of contract by 2001

GMC Revalidation Procedures ScHARR View of Appraisal SCHIN NHS Appraisal Toolkit

Dr Andrew Mowat, Primary Care Tutor, Dr Andrew Mowat, Primary Care Tutor,

James Street Family Practice, LouthJames Street Family Practice, Louth

Purpose of Appraisal

appraisal as performance assessment assessing, rating or scoring an individual's

current performance against predetermined standards

appraisal as performance development developing capability, promoting education and

personal development, and facilitating future achievement beyond current levels

ScHARR

Dr Andrew Mowat, Primary Care Tutor, Dr Andrew Mowat, Primary Care Tutor,

James Street Family Practice, LouthJames Street Family Practice, Louth

An Appraisal is …

an annual process for: Exploring role expectations, negotiating relative

priorities, and staffing, and aligning individual and organisational objectives at local level.

Reviewing progress towards achieving previously agreed objectives and agreeing future objectives.

Recognising, acknowledging and valuing achievements.

Exploring what is needed from the organisation to help and support the individual in making the best contribution that they can.

ScHARR 2001

Dr Andrew Mowat, Primary Care Tutor, Dr Andrew Mowat, Primary Care Tutor,

James Street Family Practice, LouthJames Street Family Practice, Louth

And also …

an annual process for: Identifying personal development needs and the

means of addressing them, and forming a personal development plan.

Helping the individual to produce information for any external accreditation procedure

Exceptionally - early identification of an individual struggling or performing poorly.

Securing overall improvement in performanceScHARR 2001

Distinctions

What’s the difference between

Appraisal and Revalidation?

Dr Andrew Mowat, Primary Care Tutor, Dr Andrew Mowat, Primary Care Tutor,

James Street Family Practice, LouthJames Street Family Practice, Louth

Appraisal is …

led by the organisation/employer and focused on the performance of the individual employee

a way of aligning organisational and individual objectives part of a wider systematic approach to performance

management and development within the organisation an annual process a process internal to the management organisation a local process, customised to suit local and individual

circumstances

Dr Andrew Mowat, Primary Care Tutor, Dr Andrew Mowat, Primary Care Tutor,

James Street Family Practice, LouthJames Street Family Practice, Louth

Appraisal is also …

a two way process, because it can encompass consideration of contextual,environmental or systemic factors inhibiting individual performance

primarily performance-developmental (or `formative', to use the medical education parlance)

action orientated, with agreed action commitments on both sides

as far as possible, a process with accepted, agreed outcomes confidential, with many outcomes shared narrowly

Dr Andrew Mowat, Primary Care Tutor, Dr Andrew Mowat, Primary Care Tutor,

James Street Family Practice, LouthJames Street Family Practice, Louth

Whereas, Revalidation is …

led by the professional regulatory body (in this case the GMC)

a way of checking that an individual doctor is fit to practice part of the individual lifelong requirement of being able to

practice as a doctor a quinquennial process a process external to the management organisation a national process which is standard for all doctors, whoever

employs them

Dr Andrew Mowat, Primary Care Tutor, Dr Andrew Mowat, Primary Care Tutor,

James Street Family Practice, LouthJames Street Family Practice, Louth

Revalidation is also …

a one way process an assessment process (‘Summative’) status oriented (i.e. confirming fitness to practice), with

required actions (if any)on one side only a process with imposed outcomes a matter of public record

Dr Andrew Mowat, Primary Care Tutor, Dr Andrew Mowat, Primary Care Tutor,

James Street Family Practice, LouthJames Street Family Practice, Louth

ScHARR schematic

Planning process Practice Visit Report process 6-month follow up

School of Health and Related Research, University of Sheffield

Dr Andrew Mowat, Primary Care Tutor, Dr Andrew Mowat, Primary Care Tutor,

James Street Family Practice, LouthJames Street Family Practice, Louth

ScHARR schematic

The Appraiser will need (minimum) Initial Training 1 hour preparation 1-2 hour appraisal time ½ hour writing up report ½ hour midyear review ½-1 hour travel each time

Dr Andrew Mowat, Primary Care Tutor, Dr Andrew Mowat, Primary Care Tutor,

James Street Family Practice, LouthJames Street Family Practice, Louth

Appraiser Training

Cascade system Initial programme Feb – Jun 02 Max 3 appraisers per PCT Trained appraisers then cascade training in

locality

Dr Andrew Mowat, Primary Care Tutor, Dr Andrew Mowat, Primary Care Tutor,

James Street Family Practice, LouthJames Street Family Practice, Louth

Continuing Training

Initial Training Continuing Training

2-3 days per year for:ongoing training in appraisalgeneral administration

e.g. preparation of overview reports

Dr Andrew Mowat, Primary Care Tutor, Dr Andrew Mowat, Primary Care Tutor,

James Street Family Practice, LouthJames Street Family Practice, Louth

The Appraisal

Initial Aims: to begin to establish the appraiser/appraisee relationship to ensure that GPs have personal development plans, or have begun

work on them to explore one or two other aspects of practice, agreed locally, for

which robust information is available to produce a basic action plan for the GP for the coming year to generate information for the revalidation folder to produce limited, sensible recommendations for action to be

supported by the HA/PCT or practice to develop GP/practice to explore how appraisal should develop in future

Dr Andrew Mowat, Primary Care Tutor, Dr Andrew Mowat, Primary Care Tutor,

James Street Family Practice, LouthJames Street Family Practice, Louth

Dr Andrew Mowat, Primary Care Tutor, Dr Andrew Mowat, Primary Care Tutor,

James Street Family Practice, LouthJames Street Family Practice, Louth

Prior to the visit …

achievements and challenges in the last twelve months (clinical and non-clinical), seen where relevant in the context of earlier appraisals

service, practice and (where relevant) wider objectives for the next year and beyond

in the light of objectives, personal (and perhaps practice [if appropriate to a discussion about the individual in context]) development needs

progress in collecting evidence for revalidation purposes share information before the meeting and agree a joint

agenda

Dr Andrew Mowat, Primary Care Tutor, Dr Andrew Mowat, Primary Care Tutor,

James Street Family Practice, LouthJames Street Family Practice, Louth

The Appraisal Discussion

Preparation Appraiser& Appraisee

Agreed Agenda beforehand Comfortable work setting

free from interruption protected time (at least 90 minutes)

Two-way discussion Work through agenda

agree points for action by each side

Dr Andrew Mowat, Primary Care Tutor, Dr Andrew Mowat, Primary Care Tutor,

James Street Family Practice, LouthJames Street Family Practice, Louth

Appraiser Techniques

Prepare for meeting including travel arrangements, directions etc

Confirm the agenda has been agreed Ask about achievements in previous period

celebrate success Problem-solving style Seek opportunity to learn yourself Finish on a positive note

Dr Andrew Mowat, Primary Care Tutor, Dr Andrew Mowat, Primary Care Tutor,

James Street Family Practice, LouthJames Street Family Practice, Louth

The Report

The appraiser and appraisee should agree a written overview of the appraisal which should minimally include:

a synopsis of achievement in the previous year objectives (an action plan) to be pursued by the appraisee over the

next year including milestones and review dates actions expected of the HA/PCT to address needs in the local

context or wider system the key elements of a personal development plan for the appraisee a standard summary of the appraisal as recommended by the GMC

for the individual's revalidation folder a declaration that the appraisal has been carried out properly

Dr Andrew Mowat, Primary Care Tutor, Dr Andrew Mowat, Primary Care Tutor,

James Street Family Practice, LouthJames Street Family Practice, Louth

Contentious issues

How confidential is the appraisal? Who “owns” the report? How is the feedback given? How is support given to those with identified

needs? Who supports the appraisers? What liability would the appraisers be assuming? Who reviews/appraises the appraisers?

Dr Andrew Mowat, Primary Care Tutor, Dr Andrew Mowat, Primary Care Tutor,

James Street Family Practice, LouthJames Street Family Practice, Louth

Costs

Initial setup Training Costs Backfill (Locum Costs)(1 whole day)

Appraiser time: @ £60 per hour (LMC suggestion) £300 per appraisal administrative support (confidentiality)

5 hours minimum work per appraisal: 41 principals, ?5-10 non-principals in locality

Dr Andrew Mowat, Primary Care Tutor, Dr Andrew Mowat, Primary Care Tutor,

James Street Family Practice, LouthJames Street Family Practice, Louth

Summary

Appraisal is different from Revalidation Allows identification of areas of success, and

future needs Sets an action plan to meet those needs,

involving the individual Is confidential to appraisee & appraiser Will need significant investment by ELPCT

Questions?