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The importance of housekeeping

Dr Richard Cook

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As I sit here writing, I have a glorious view out of my kitchen window. You may be imagining rolling fields and the glint of the sea in the distance. Unfortunately not.

All I can see is a soggy seven-man tent that I have just finished putting up in the garden to dry out after a family excursion to Wales. I wasn’t part of the family excursion, but my holiday arrangements and work/life balance are a discussion for another day.

If you have ever returned from a camping trip with a sopping tent you will know the score – you study the weather forecast furiously with the aim of getting the tent up for a few hours to dry out enough so that you can forget about it and tuck it away until next time (another year, in our case).

It’s a bit like managing appraisals, except that at least the tent provides some enjoyment.

Without the patients – the human connections – our job is nothing

You could call it housekeeping, if you like, which seamlessly brings me on to the topic of my own appraisal and ‘career aspirations’. I have written before about appraisal and my views remain unaltered. I have had quite a few discussions this year with colleagues, allied health professionals and family about the career of medicine, what it means and what I want from life.

Amazingly I have not included this in my appraisal folder or claimed any CPD points, largely because I couldn’t be bothered, but also because I can’t really see how it is the business of the ‘responsible officer’.

Housekeeping is important, though. I am no educationalist myself, but we have all heard of Neighbour. His Inner Consultation remains a must-read for any GP, and should in my view be essential reading for all medics. I believe his housekeeping checkpoint can apply not just to our next patient, but also to our next surgery, next week’s diary and so on. It is more important than ever to look after ourselves and colleagues, given the pressure we face each day.

So on to career aspirations and my proposed PDP. ‘My main aim is to spend more of my time this year concentrating on writing protocols, attending non-productive meetings, chasing up secondary care and browsing twitter,’ is what I wanted to write. But that would have left me with nothing to aim for next year, so I had a rethink.

Why do we do our job? Human connections – at least, that’s the reason for me. Having discussed and chewed this over, I keep coming back to it. Without the patients, and the connections, the job is nothing. Those GPs who shy away from this are missing the point, in my view, of why we are here.

Unfortunately, there is no recognition in the appraisal for housekeeping, maintaining sanity and keeping going through means outside the sphere of medicine – it is not a holistic process. My proposed PDP cannot include my wish to cycle over the highest road in Europe next month, or to travel to the Pantanal to photograph Jaguars. Yet these are the activities that will keep me working, and also more able to connect with patients.

I’m a fifty something potential statistic. NHS England needs to wake up before we hang ourselves out to dry like the tent.

Dr Richard Cook is a GP in west Sussex

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Readers' comments (9)

  • Totally agree. What buisness is it of RO?

    Appraisal sucks to the core. Wastage of time and resources.

    Managing human resources and admin issues to please CQC is ridiculous

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  • 'Appraisal'
    You couldn't make it up
    Yes you could
    Maybe but you shouldn't
    Yeah alright

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  • Inalways include things that are non medicine related in the appraisal. Actually tend to be interesting and do generally relate back to the day job.

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  • David Banner

    Poor old Sisyphus. Condemned to forever push a boulder up a hill for no purpose other than to have it roll back down, then start the whole pointless laborious task all over again.

    The worst aspect of appraisal is the way it ruins your whole year. Once it’s done there is enormous relief, tempered by the thought that it’s coming around again soon.
    You promise that this year you will keep everything logged as you go along, as you always promise, but as usual it never happens. Then at Easter or Summer Holidays there is that nagging feeling that it’s coming soon, always planting a dark cloud on your horizon. Then with a month to go comes the blind panic, looking for Mickey Mouse online fluff, any old lecture, inventing some tripe about last year’s PDP.
    And then there is the week locked away from family trying to upload certificates and writing utterly meaningless twaddle “reflections” on a meeting you barely remember, inventing PDPs that will require the least work, then submitting the whole pile of rubbish to an appraiser who probably looks at barely any of it.
    And then the whole sorry, meaningless,infuriating, infantilising, evidence-free, colossal waste of time starts all over again.
    We are all Dr Sisyphus.

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    @David Banner...
    its enough to make you HULK out..
    (Cue change music
    pupil changes .. ripping shirt
    ripping boots).. (70,s Hulk)

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    GMC Has made appraisal compulsory
    They should have to fund it
    (from our funding of them )

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    The whole point of appraisal
    1. NHS England as a corporate entity has to police the workforce or at least be seen to be doing so.. if anything so as to protect itself should there be an adverse case
    2. GMC loves anything which makes it easier for them to strike off doctors
    Dont engage with apopraisal.. you are automatically a bad doctor
    as per the ethos of guilty till proven innocent
    Engage with appraisal and the whole ethos is to collate information which can potentially later be used against you..

    It should be a supportive meeting where the appraiser has a whole host of resources like
    educational content
    able to arrange shadowing GPWSI'S or other specialists etc
    target to individual growth requirements

    Dream On

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  • I'm one of the few GPs left who seem to enjoy my job - possibly because I do not have to work. But there are three things that will make me retire

    1. Appraisal
    2. Revalidation
    3. CQC

    That anyone can subscribe to such evidence free processes and hold their heads up high is beyond me. Actually I'm wrong. There is evidence available about the CQC - all of it indicates that it is time-consuming, intrusive and has no impact upon the quality of patient care.

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  • David Banner
    Kudos! You have summarised my life story!

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