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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If appraisals are meant to pick up struggling doctors or weed out under-performing, out-of-date GPs, then I don’t think it is fit for purpose.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)

  • The complete failure of our alleged union to oppose this farce is a disgrace.

    The enthusiasm of the RCGP tells us that Evidence is still a concept yet to arrive in Euston Road.

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  • It is a farcical process to neither improve the professional practice nor beneficial to patient care.
    But a stupid process to the point of indescribable waste of time.

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  • Look at the bright side guys. The paperwork is dead easy these days with clarity or fourteen fish and it’s a good opportunity to have a long chat with a mentor who is at least a little bit wise and experienced. If you don’t respect your appraiser ask for a change. And is recording some CPd such a bad idea?

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  • Horizontally Opposed,

    You rather miss the point, seek out good practice & share it.

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  • Appraisal was a major factor in me quitting general practice in 3 months time at 54. I spent months sorting out the patient questionnaire last time, scoring good results but the hassle of it all was ridiculous. Agree every three years would not be so bad. No coincidence I am quitting exactly a year after my last appraisal so I don't have to do another one. The red tape pusher at the Ccg insisted I fill in my form to be taken off the performers list at the anniversary of my last appraisal ( plus a grace period of a few weeks) so that will be such a hassle to get back onto again that's a loss of another gp who otherwise would have probably continued doing a couple of days a week. Only one emotion was ever evoked by appraisal. Anger.

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  • I forgot to say, for that extra 3 weeks work beyond appraisal renewal date I of course had to submit another form and get it signed off by the central paper pusher department.

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  • the odds are stacked against full time work. Appraisal is easy if you work 2 days a week. The real grafters have no time for it. Most local appraisers are GP hobbyists who barely work. Think the whole thing needs simplifying and appraisers should be working a minimum of eg 6/7 sessions at experienced partner level.

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  • I've had good appraisers and bad. Once actually had to put in a formal complaint about one which was upheld (an nerve racking process that took months). So glad no longer to have to worry about appraisal since I have retired. Not sure it should go altogether, but agree with Samir that it is one more task in an already overcrowded life and not likely to help with GP recruitment and retention. David Banner maybe has it right, that a simpler, much less demanding format is probably about what is needed.

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