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GPs buried under trusts' workload dump

Fear and loathing in the appraisal process

Dr Samir Dawlatly

It can be difficult to know where to start when analysing my loathing of the appraisal process. It is meant to provide evidence that we GPs are keeping up with multiple standards and guidelines, as well as reflect on things that go well, and things that don’t.

There is no way that I could fit all the things I have learned in a year into my appraisal, from the purely factual things like the cut-off for referral to the lipid clinic for suspected familial hypercholesterolaemia, to less quantifiable knowledge, dare I say wisdom, such as the way I discuss prognosis with a terminally ill patient, or assess suicide risk in a depressed patient I have never met before.

Once, in a pique of passive-aggressiveness, I tried to include everything I had done and learnt, including all my blogs, into my appraisal, amassing more that 120 hours of CPD. I felt very professionally developed. It was a daft kind of protest. Though I limit myself to the obligatory 50 hours, there is still the rush to finish the bastard in the few weeks before the appraisal, which always takes place in March. Lovely conundrum, appraisal or QOF (which also always seems to be a last-minute job)?

I would have hoped that all the stops should be pulled out, including appraisal, to remedy the GP crisis

If appraisals are meant to pick up struggling doctors or weed out under-performing, out-of-date GPs, then I don’t think it is fit for purpose. I am not a turkey voting for Christmas. There are plenty more ways for someone to point the finger at me. If it is meant to be an edifying process, then I have completely missed the point. I can’t help but wonder if it exists purely to prop up the micro-economy of one day learning courses and workshops that can be paid for, to top up your CPD.

One way of considering appraisals is to contemplate how a proposal for the current process would be received if it was being implemented, for the first time, this year. Would the profession agree to it, in the context of the crisis general practice is in, when the opportunity cost is up to 80,000 sessions per year?

Though it might be optimistic to consider that appraisers would see patients instead of appraising, for the 40,000 GPs, and falling, being appraised over half a million appointments are lost so they can attend their review.

When workload is a massive factor in retaining GPs, to then require them to reflect on their year’s learning can only make matters worse. Despite all that, I suspect, unfortunately, that it would be seen to be too radical a step to scrap appraisal. Though I would have hoped that all the stops should be pulled out, including appraisal, to remedy the GP crisis.

Dr Samir Dawlatly is a GP partner in Birmingham

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Readers' comments (18)

  • Done (painlessly) this morning-no surgery for me this morning.
    Weeks of sleepless nights getting my ducks in a row--for what??
    Utterly agree with Samir

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  • It is an utterly pointless process which robs patients of thousands of potential doctor consulting hours every year.
    Solution?
    Simple- we need GPS to stop being appraisers. The process is only possible because some GPs agree to take on these roles.
    So come on appraisers why do you agree to do the DOH's dirty work for them and put your colleagues through this pantomine every year?

    If you need to boost your income there is plenty of locum work out there, or do some undergraduate teaching-that is a worthwhile way to spend your time.

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  • Bring in a revalidation exam every 9 years like they have in the US. That way you’d be actually rigorously tested on the latest required knowledge and up to date treatment recommendations. Oh wait..we can’t have that as it would involve too much study and half the GPs would fail

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  • David Banner

    Between the Wild West of the 20th Century (when you could in theory go a whole career without any education) and the infuriatingly pointless annual colonoscopy we suffer today, there was a brief period of common sense appraisal in between.
    You would collect certificates from a few meetings and wave them at your appraiser, briefly discuss your future educational needs, then a longer chat/moan to see if you were coping with the job.
    There were no online torture chambers, no meaningless “reflections”, no long lists of probably unachievable goals, no week of madness uploading certificates and typing endless drivel that nobody will ever read.
    For the love of God, RCGP, please end the madness.

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  • |David Turner | GP|25 Jun 2019 6:20pm
    Solution? Simple- we need GPS to stop being appraisers.

    It goes far deeper David. You think if GPs stop doing appraisal the state won't find some other bunch of jokers/managers to do it? Regulation/licensure is POWER, and nobody relinquishes power easily, least of all the state. A deeper solution is needed - voting for a smaller state.

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  • I think it is OK. But FAR TOO OFTEN. But we should do it every three years, with a phone call with appraisers at 18 months. Now that everyone has been revalidated, it can slow down now. I think LMCs,GPC,Pulse should lobby for that change. RCGP even, but doubtful as part the medical education industry who have a vested interest

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  • I agree it is a pointless exercise .waste of valuable time for 2doctors who could be looking after people who need help.maybe have more frequent patient feedback and scrap appraisals.

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  • What's wrong with looking at the top & bottom 5% of prescribing, referrals & death certificates? There will be simple explanations for most outliers but both good & bad practice might be revealed.

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  • In summary ,to be a good GP,strive to be average.Uninspiring ,pointless and Sad.

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  • Appraisal is the biggest pile of excrement that we have to wade through every year. Educationalist, hubristic, self-aggrandising colleagues who collaborate with the establishment as appraisers have perpetuated this punishment. Nothing is ever good enough, their rhetoric is that you can always improve even if your portfolio is exemplary. There is never a 'well done old chap for surviving another year', just 'what can you do better next time'.'No complaints, you had better reflect on how difficult you must be making it for anyone to complain about you'. Non-GP appraisers are far more realistic and usually in awe of GP performance in impossible environment. It's the part-time portfolio GP's who openly admit that they can't cope with full-time practice themselves who are sometimes the most brutal persecutors. Dare to question the process and you will select yourself for extra scrutiny.

    Keep your head down Samir, 50 hours of the most mundane, middle-of-the-road, generic reflection garbage and you might survive a few more years

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