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Independents' Day

My annual angry appraisal blog

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December is upon us, and with it the annual indignity of my appraisal, as inexorable as a bout of recurrent herpes and about half as welcome. It seems like only yesterday I was writing an angry blog about appraisal, but here we are again. I know what you’re going to say: I should do little bits of my angry appraisal blog throughout the year, so it’s nearly complete when I come to need it, and in fairness I swear each year to do that next time, only to inevitably find myself staring down a deadline in the wee small hours, shoehorning vaguely-remembered bits and bobs into some semblance of order.

Appraisal is a scandalous squandering of the most precious resource in the NHS

While recent high-level research shows most GPs find appraisal worthless, some people say they enjoy it, and I suppose I can understand that. I certainly get a mild sense of elation when it’s over for another year, like that experienced on leaving an exam hall, or relievedly jettisoning a particularly tenacious poo. If nothing else, it’s a few hours’ respite from the daily grind of withholding my secret cure for the common cold from people who’ve explained how they really need to be better in time for Christmas.

But that doesn’t excuse the fact that appraisal is a scandalous squandering of the most precious resource in the NHS: GPs' time. Each appraisal represents six combined appraiser-appraisee hours away from direct patient contact; multiply by 40,000 GPs and suddenly one and a half million appointments are up in smoke. And that’s even before you consider the innumerable hours of scanning, linking, and general fretting spent in pointless preparation, let alone the phantom clinics that will remain forever unfilled after frustration with appraisal encourages many colleagues into early retirement.

In years gone by, I used to keep my head down, tick the boxes, and pretend to reflect through gritted teeth, like Mark Corrigan doing expressive dance. Unfortunately, to the powers that be, this kind of mute compliance appears identical to enthusiastic endorsement. So nowadays I give ‘em the bare minimum name-rank-and-serial-number 50 credits, use the white spaces to delineate why it’s a total waste of time, and harangue my unfortunate appraiser about how I wish everyone else who hates appraisal would do the same. 'If you feel so strongly about this, why don’t you write about it in your blog?’, he suggested this time, in what I now suspect was a jaded attempt to get me to leave. Well, I was going to anyway, but now that he’s told me to, I can put it in my PDP as well.

Two points down, 48 to go. See you next year. 

Dr Pete Deveson is a GP in Surrey. You can follow him on Twitter @PeteDeveson

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Readers' comments (33)

  • David Banner

    Re Dr B 11.15

    If the lecture was good enough then the salient points will be put into practice when I do my next surgery, not by reading my illegible notes 10 months later.
    And whilst the RCGP tried to simplify the process, it made not one jot of difference to the meaningless drivel I had to invent as "reflection" on my recent appraisal.

    So are those of us who loathe the current appraisal process correct or merely moaners as Dr B would suggest? Pulse, can we have a poll please?? Let the people decide.....

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  • Perhaps we should ask NICE to analyse the cost-benefit of appraisal/revalidation. It should be fairly simple.

    On one side we have cost to the NHS. A few hundred million. On the other side we have improved patient outcomes. At present, there is no outcome data, so we must assume outcome benefit to be zero.

    We divide several hundred million by zero and a figure emerges. The figure is infinity.

    If revalidation were a medical intervention of some sort, NICE would have to turn it down as it provides no discernible outcome benefit.

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  • I think you are all forgetting one thing. The profession was asked if it wanted to be quality assured with the use of formal tests such as an MCQ - this proposal was rejected.

    Prior to becoming an Appraiser four years ago, I was furious about spending 2 whole days of my summer holidays every year frantically uploading stuff and making up reflections, in time for a September Appraisal. I would have preferred a 5 yearly exam.

    Now, I spend my time helping people to get through this process as painlessly as possible. Clustering CPD into only 4-5 sections as you go along, writing 1-2 lines of what you got out of a learning events and filing in the gaps during the interview itself (which a lot of GPs still find very useful)

    Now, I would definitely prefer this process over a 5 year exam because I realise the basic minimum is enough. You don't get a gold star for writing a novel and, quite frankly, no-one wishes to read it.

    Yes - it's a farce. Yes - we are being treated like children. Yes - it seems like a mountain of you are near retirement and have never had to use an eportfolio in your training.

    But it's an absolute travesty that GPs are not continuing to work in their senior years because of this. They must be supported to make it the process as easy and simple as possible. The college guidance last March did help as it specifically states you do not need volumes of reflection and one line for 8 hours of CPD is enough.

    But as Appraisers we have a responsibility to ensure we are not making the workforce crisis worse by being even remotely hawkish. I do the job because I love meeting different GPs as well as enjoying the coaching aspects of it. I have no desire to be a policeman and I'm sure many of my colleagues feel the same.

    No doubt, I will be shot down by the anon posters as being part of the problem. But I can live with that.

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  • David Banner

    Re Shaba 11.13

    Superb post, as always. If all Appraisers had your refreshingly positive attitude the whole process might have some value.
    Sadly we all know Appraisers who seem to relish the didactic and confrontational approach. I had a Mexican Stand Off with one Appraiser who repeatedly rejected my reflections and PDP as "not SMART enough", the CCG had to intervene on my behalf, and the whole experience was gruelling, stressful and soul destroying.
    I only hope that the lighter touch appraisal the RCGP have suggested is adhered to, and that all Appraisers in future are as supportive and constructive as you obviously are.

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  • Spuds

    Can you claim points for time spent on Pulse "reflecting" on how crap the Appraisal system is? In fact I claim impact points for showing the pro-appraisal loons the error of their ways.

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  • Spuds

    BTW Shaba, there is a word for someone who sees Appraisal as a waste of time and who also acknowledges the fact that it is causing good GPs to leave, and demoralising those who remain, and yet chooses to become an Appraiser.

    That word is "hypocrite".

    You don't want to be a policeman? Then stop doing it.

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  • I retired 3 years early as I could not face another appraisal or another malicious gestapo-like CQC visit, along with all the other problems that face our profession. I have never been happier since leaving the unnecessary stress of dealing with the non-medical rubbish afflicting our lives and feeling that despite giving 110% all you get is constant negativity in the press and from regulators. I feel that driving experienced doctors from their jobs is a great sadness, and I fear for the younger GPs who will get their their pensions sucked away in a near criminal attempt to make them work till their mid to late 60s, or leave early and get a pittance

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  • Like Hugh Priestly I retired early for much the same reasons, but getting my name removed voluntarily from the GMC register took months of being demanded to prove myself innocent of anything...

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  • Last year I reflected that I was spending too much time reflecting.
    This year I intend to reflect that I have benefited from spending less time reflecting. Sorted!
    On reflection, my main issue is not the reflecting , but being required to write an essay about it!

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  • doctordog.

    If it could be proven as useful and not imposed upon us, then maybe it would be better received.
    It is all about presentation over content and a colossal waste of time.

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