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At the heart of general practice since 1960

Appraisals vital for self-regulation

GPs must embrace the appraisal process as the best chance of avoiding top-down control, argues Dr David Fuller

GPs must embrace the appraisal process as the best chance of avoiding top-down control, argues Dr David Fuller

It's that time of year again. The dreaded appraisal. Why do I feel so stressed about my professional competence?

Appraisals were introduced to allay public concern about the lack of regulation of the medical profession. Following the Shipman atrocities, the GMC sought to establish whether doctors were indeed fit to practise and up to date on their knowledge.

It would no longer rely on the ‘management by exception' approach that had been in place since 1858. The emphasis was to shift from the initial qualification to something approximating a career of continual assessment.

Most GPs have had four appraisals since their introduction in 2003. Have they helped anyone? Are they an appropriate method of regulation?

Looking at a local survey of appraisees may help in the search for an answer.

I surveyed 42 GPs in the Malvern area of south Worcestershire, sending them questionnaires asking their opinion about whether they felt appraisals were useful. The survey was anonymous and, unlike the current ‘appraisee feedback questionnaire', required a free-thinking reply. Twenty-two GPs responded.

Twelve, or 55%, thought appraisals were pointless and a waste of time, with claims that they were too frequent, repetitive, of little educational value and caused difficulties getting a locum. These GPs said appraisals required hours of preparation, little of which could be assessed in the two or three hours allocated to the appraisal interview.

But another 10 GPs, or 45% of respondents, felt rather differently. These GPs did think their appraisals had been useful, because they allowed them to speak confidentially and glean helpful tips from a fellow GP. They could discuss difficulties at work and reflect on their role.

The appraisal encouraged postgraduate education, whether it be attending meetings or reading journals. These GPs saw the appraiser as a helpful advocate, and the appraisal as a supportive procedure.

Promoting development

Although more than half of GPs questioned in this small survey had doubts about the value of appraisals, a substantial minority appear to have accepted and assimilated them. GPs initially viewed them with some trepidation and suspicion but I believe they are promoting personal and professional development.

General practice is an individual, and often isolating, specialty that has benefited from the reassurance offered by an appraiser. Although appraisals are not designed to detect the ‘problem GP', they can provide the opportunity for counselling and advice. A non-compliant GP could fail to fulfil the requirements for the proposed revalidation with serious consequences for themselves and their practice.

Appraisals can also provide an important opportunity for GPs to express their opinion and, depending on their appraiser, experience professional empathy.

The appraisal, unlike the QOF visit, enables GPs to demonstrate their skills in the less quantifiable aspects of the job. Appraisals can catalyse general practice and stimulate analysis and audit.

Appraisals will evolve into and include a five-yearly revalidation. The proposed five- year relicensure cycle seems cumbersome and will be difficult to administer. But the information currently collated by appraisers can, if appropriately analysed, make an important contribution to the revalidation process.

Appraisals encourage self-discipline and personal responsibility and help to preserve professional expertise and pride. They are increasingly successful and are our best chance of avoiding the need for inefficient, top-down, centralised control.

Dr David Fuller is a GP in Malvern and organises educational meetings as part of his role as chair of the Malvern GP Association

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