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Appraisers – just be nice, like me

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Appraisal. Makes your heart sink doesn’t it? Add in revalidation and it’s time for a glass of something stiff. I have to take some responsibility – I’m an appraiser, but I’m a nice one. Honest.

One of the reasons I became an appraiser was how dreadful some of my appraisals had been. Sounds a bit twisted, but there’s nothing worse than feeling the hours you put into all that paperwork, reflecting, logging entries and fighting with technology has been a total waste of time. Yes, there was a minimum level to be met and boxes to be ticked, but I wanted the appraisal itself to be about more than that. I wanted to talk about work, about balancing the demands of being a GP.

If you are one of those giving this process a bad name, do us all a favour. Stop it. 

I have to admit a major part of the motivation to appraise is that it offers a welcome chance to sit for a few hours and do something other than endlessly see patients and file results.

But at the same time I’ve tried hard to be an advocate for sensible appraisal – both for the list of evidence and the meeting itself. You want a quick functional appraisal because you’ve been doing the job 35 years and have a pile of work waiting? Fine. You’re newly qualified and want a chat about resources and the value of extra diplomas? Ok. You want to discuss juggling childcare and being a working mum? It’s your appraisal – not mine. As long as the boxes are ticked, it’s your choice.

Turns out not everyone favours this approach. I despair to read feedback from GPs whose appraiser, locality lead or responsible officer has decided the GMC criteria don’t go far enough. They want their doctors to do more. And the RCGP criteria? Not good enough either.

‘We want minimum amounts of reflection (high quality of course) for every entry. You say 50 credits? We say at least 80. We want PUNs, we want DENS. We want at least three interesting cases. We want evidence of teaching. We want a “practice development scenario” (we don’t know what that is either but put it in anyway). We want CPD credits allocated to specific things in a specific way, never mind your PDP or what you actually wanted to learn. If you have more than 10 credits on any one thing, we’ll ditch the rest. You wrote a textbook entitled “Everything you could ever want to know as a GP” full of up-to-date clinical guidance and all the examinations you could need to know, and taught an entire medical school their whole curriculum? That’ll be 10 credits. We want your Hep B status, CPR training, safeguarding training, cycling proficiency certificate and 25-metre swimming badge. We want your time, your last few positive emotions towards this job and we want no common sense applied. If you disagree? We’ll haul you in front of a panel and put your livelihood at risk. You’re welcome.’

This is not what appraisal is about. I thank my lucky stars I now have a good appraiser, a sensible appraisal lead and a responsible officer I’ve never had to meet. But if you are one of those giving this process a bad name, do us all a favour. Stop it. You’re to blame for GPs’ morale being in their boots just as much as the politicians. Back off.

Dr Zoe Norris is a GP in Hull

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Readers' comments (10)

  • the appraisal process is not supportive but remains an extra layer of inspection/ regulation/ bureaucracy. As a trainer I understand the value of reflection and Quality Improvement obviously, but such a prescriptive approach is ridiculous and adds extra stress for no added value !

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  • I hope one day a revalidation officer or appraiser gets sued by a GP for inappropriate deferral/ loss of work . Some revalidation officers are interpreting rules as they see fit and introducing layers of unnecessary complexity at a whim to the appraisal process and evidence requirements.some of them are power hungry and should be put in their place . The whole process has become so onerous and stressful, it is shocking the UK has become like this . I dont see how this will help patient care - having stressed out doctors spending increased amounts of time entering reflective garbage and organising pointless surveys!

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  • I wouldn't stand for any of the above. It's not remotely constructive and yet again if we don't stand up for ourselves then we have only ourselves to blame. Fortunately all my appraisers have been pragmatic and sensible.

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  • It is certainly better to be a nice appraiser than a power crazed draconian one.
    However, better still would be no appraisers. This utterly pointless and valueless process is only possible at all because some GPs agree to do it.

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  • 11:38 is right. I'm sure you mean well Zoe, if you don't do it someone else might be worse right?, but you are perpetuating the torture regime by collaborating.
    You forgot to mention appraisers demanding minimum 3 learning points documented and reflected upon for every hour CPD, and another 50hours for GPSi role
    What a soul-sapping demoralising and demeaning process

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  • Azeem Majeed

    Thanks Zoe. An excellent article.

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  • Listen to your inner voice. If it feels like a waste of time, it probably is. Absolutely pointless exercise in box-ticking created to give public an impression that doctors are being properly monitored and therefore are safe.

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  • Thanks for an excellent article. My heartsink patients are less stressful than the appraisal system.

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  • Chris Kenyon

    I completely agree with what you have said Zoe. Fortunately for me I have always had "nice" appraisers but I have had a very bad experience with a "responsible officer" from whom the appraiser had to protect me, so while much of it does feel pointless, I was glad to have the help of that appraiser. However, much of it makes you want to give up!

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  • Is it surprising that newly qualified doctors are opting out of General Practice and that most GPs either retire or die before they reach the age of 60 years?
    Who enjoys seeing patients every 10 minutes and always running late?
    Also the nhs should be run sepately from Government like the Bank of England to avoid unecessary interference?

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