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Independents' Day

Just what we need for GP appraisals - more red tape

Dr Stephanie de Giorgio

At this time of year, our Resilient GP forum and others are full of stressed and annoyed GPs trying to ensure their appraisal documentation is up to date and ready for that dreaded few hours. Questions and rumours abound regarding what is actually required to pass, disaster stories of hours of work being rejected due to technical detail are shared and newly qualified GPs try to find out what the hell is expected of them for this process.

I have to go through that myself, but I have also been a GP appraiser for three years and have recently been considering whether to continue in that role. Why? After all, it is well paid, non-patient facing and doesn’t require indemnity fees, the veritable holy trinity of extra GP income these days.

But the reasons against it are multiple and as with so much in the NHS these days, it is a combination of NHS England mission creep, over-regulation and a feeling of an unfair disparity between different areas of the country.

This year, our NHS appraisal team merged with another and their appraisal rules were adopted. These were tougher than had been previously applied in our area and are apparently what will be applied all over England eventually.

The new rules for me to apply to be an appraiser include 50 CPD points and three PDP tasks just for being a GP, any other roles need extra. No impact can be claimed. All ‘extended practice’ roles (yes- no clearly defined than that) have to be appraised separately and uploaded. There has to be way more navel gazing - sorry - reflection. The PSQ has to include patients from all areas of their practice (always wondered, what do pathologists do?). Where do these rules come from? A combination of GMC, RCGP and NHSE. Each responsible officer uses their own interpretation of the rules. Is this robust and fair?

Some of these will be familiar to appraisers, a variation on some were to me, but these new ones are more onerous and significantly more prescriptive. They will not be familiar to others yet because of the ridiculous regional variation of the appraisal system in England. A GP in one area may still be able to choose their appraiser and have a relaxed chat over a cup of coffee whilst in another, GPs are assigned someone and are subject to a grilling about their practice over three hours. This disparity makes a mockery of a system that has been put in place to ensure patient safety. Are patients in one area of the country ‘safer’ than those in another because the appraisal system is more robust? I think not. Does appraisal ensure patient safety at all? Unlikely. As is so frequently uttered, Shipman would have undoubtedly sailed through.

Adding to the above, this year NHSE decided that doctor’s appraisals needed to be added to the same system as other NHS employees, something called RMS. So now we have to upload the entire appraisal to this system. This has been done without telling appraisees in many cases. I have told mine, has your appraiser told you? Another layer of bureaucracy of dubious necessity.

What would happen if all GPs resigned from appraiser roles? NHSE would do what they have threatened, bring in non-medical appraisers. That is enough to make me continue for now. I hope that I can provide a formative, supportive and useful hour or two for those I appraise. The hoops have to be jumped through, but it can still be pleasant. I have no time for aggressive, nit-picking pedantic appraisers, they make their colleagues lives miserable and do nothing to make the system any better.

Appraisal is here to stay for now. I am still part of it so that it continues to be a peer-led, formative and supportive process. When the balance tips to performance management, I am out of there.

Dr Stephanie de Giorgio is a GP in Kent and a co-founder of Resilient GP


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Readers' comments (28)

  • Drachula

    Oh hell. Mine in 10 days. I thought all boxes were ticked for revalidation, but if not then I really am off. I've been thinking about it for years, and I can envisage 6m at home and 6m living and working abroad.
    Well done NHSE, RCGP, GMC

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  • If all GP's refused to engage in appraisal would they all loose their license?

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  • I was an appraiser for 7 years; initially loved it then resented the increased boxticking and creeping element of performance mananagement. Gave it up with no regrets. My own last appraisal was a disaster with the two of us completely disagreeing over quite major outcomes and PDP objectives(whose benefit was it intended for, I kept on asking myself? Certainly not the patients, not mine but hers and the DoH it seemed)I think the whole profession should use them as one element of a bargaining strategy when it comes to this government. We should all refuse to cooperate with officialdom and none of us submit them to any RO; but we should continue to do them amongst ourselves voluntarily. We would be engaging in appraisal, but preserving our professionalism which is being eroded all the time. The GMC couldn't refuse everyone's recertification!!!

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  • There is an implicit assumption that regulation is inherently good; which is false. Nor is it inherently bad. But it does have to show a return on investment, or a cost benefit.
    Q - What is the Number Needed to Harm (NNH) for appraisal?
    Right Touch Regulation is worth reading - from the Professional Standard Authority. Regulation is now a £multi-million business.

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  • Excellent article. Sadly, I feel the same Stephanie. I have been an Appraiser for over two years now and I'm giddy with all these changes. It's fast becoming as prescriptive as the trainee eportfolio. It's squeezing out any space for supportive coaching - I think many of us will be off if this continues.

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  • Fortunately I have had the "cup of coffee" appraisal from a colleague I have known and trusted for over 20 years. I have been allocated the same appraiser for the next 2 years by which time I will have ceased practising. I wouldn't go on if I had a box-ticking jobsworth appraiser but I feel sorry for those who are trapped in this ridiculous useless system.

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  • Appraisal and revalidation = complete waste to time with no gain for anyone. Needs to be scrapped. Yet to hear one doctor who has actually benefited from it. COI- appraiser and GP trainer. As for the eportfolio......

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  • This assumes there were a lot of dangerous doctors before appraisal and revalidation? The countries where there is none of this time wasting box ticking nonsense has worse health outcomes (you can google it...we are the worst in outcomes). The only thing english doctors have become amazing at with revlidation and the appraisal system is......BOX TICKING. Well done folks. keep it up. great use of NHS money being spent. we have plenty to go around and this is truly worthwhile.

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  • Britain no longer produces real world class physicians. It produces box tickers.

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