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At the heart of general practice since 1960

Review of the year

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I have been friends with another GP in my area for 25 years. He is a kind and generous person with a supportive wife and two grown-up children. 

He has been a partner in the same practice for 30 years. He is, and has always been, extremely popular with both patients, colleagues, and other local GPs. He always keeps up-to-date with clinical research, and makes remarkably detailed notes on his patients’ health. He has also worked as an appraiser, although like many experienced appraisers he recently retired from the role, as he felt his work in this area was no longer as meaningful and supportive as it had been. My meeting with him was partially social, but also partially out of concern. I knew he was having a hard time of it.

We began to talk and I listened out for him to admit his biggest underlying worry.

Was it keeping motivated during long working days, with impossible demand from a deprived patient population? Was it frustration with CQC registration or partnership changes? Or was it practice finances and cash flow?

None of those: he was in fact, worried about his upcoming appraisal, and revalidation.

He was seriously anxious, and had been ruminating on the event for the past six months.

He had already spend hours compiling documents for the folder, adding text and reflections to the electronic appraisal form, all the while wondering who his next appraiser would be, what he or she would be like, what approach he or she would take with his performance. 

Preparation for revalidation can exceed forty hours but worrying about it can occupy doctors for months, filling hundreds of days and nights with fear.

I have heard appraisals described as a cosy fireside chat with a colleague, but for many GPs – especially the hard-working perfectionists and worriers common in our profession – it’s just a weight on their minds. The anticipation has made more than a few doctors fear of being ‘found out’ as not good enough, or being a fraud.

At the LMC we support and advise many GPs for whom revalidation and appraisal act like a sword hanging from the ceiling by a thread.  

But, like Damocles, many good doctors are not willing to stay under this sword for much longer. 

The LMC Insider is chief executive of an LMC in England. He is also a practising GP

Readers' comments (5)

  • Too true....

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  • Russell Thorpe

    sounds symptomatic of a deeper problem to me.

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  • So sorry to read about your friend. I was also an appraiser, from the time it first started until 3 years ago. I stopped as soon as the new model bean-counting came in. I find that my own appraisal has deteriorated from being a supportive positive exercise to something mechanical and much more cautious; there are some pieces of evidence that I would hesitate to bring to my appraisal, and inevitably these are the most valuable (painful) learning experiences.

    The one point that helps me keep my sanity is the conviction that my practice standards are definitely around the mean, not at the bottom 5%.

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  • Vinci Ho

    Resigned from the job of appraiser 2 years ago. As I said before , stop doing it when you no longer believe in what you say and do( in this case , to my appraisees). There is some money one should never earn if one feels the meaning , the ethos and the principles are all lost and betrayed . We became the secret police ........

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  • Agree very odd that such a competent doctor should be ruminating over a simple revalidation.
    These are not unduly stressful.
    Just gathering stuff throughout the year and getting into the habit of doing it.
    Sounds like depression to me.

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