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Fears of spiralling workload under toughened appraisals scheme

By Gareth Iacobucci

A pilot study has revealed the huge bureaucratic burden involved in the toughened annual appraisals GPs will require for revalidation.

The evaluation, carried out in hospital doctors in the Mersey region by the Royal College of Physicians (RCP), was designed to test the feasibility of the GMC's enhanced appraisal framework, which is intended to form a key part of GP revalidation.

The pilot found doctors had grave concerns that enhanced appraisals are 'extremely time consuming', and their fears that carrying out the process every year 'would draw time away from direct clinical care and stifle innovation'.

Findings from the evaluation of secondary care doctors, supported by the Revalidation Support Team, were first revealed by Pulse in February, when we reported news of the ‘clear concerns' about the overly bureacratic nature of the system.

In the final report, doctors said the beefed-up process required excessive amounts of time, and suffered from a lack of administrative support, and ‘inaccurate, irrelevant or non-existent' supplementary data from trusts.

Participants reported ‘a clear increase in the amount of time required for the new process compared to previously', despite the selection of a pilot site where appraisal ‘was known to be well-developed'.

The latest study comes after Pulse revealed that the majority of GPs in RCGP-led primary care pilots faced problems with colleague and patient feedback, which, along with enhanced appraisals, will comprise a large bulk of GPs' revalidation portfolios.

A recent Pulse investigation showed that more than 90% of PCTs were already toughening up GP appraisal systems in an attempt to satisfy the requirements of revalidation.

The RCP said contracts and job plans must have built-in recognition of the time required for the process, and warned: ‘In those organisations where appraisal has been poorly conducted in the past the increased commitment is likely to be substantial.'

Respondents also warned that many doctors would merely treat the process in its current form as 'a bureaucractic exercise', and viewed the motivations as 'political rather than truly being about patient care'. Fears were also raised that responsible officers may be 'vindictive against individuals'.

Doctors reported ‘insufficient administrative support' available to successfully access supporting information, with the RCP arguing that IT systems available to doctors will need to be ‘much more robust and flexible than at present'.

Respondents were also ‘uncomfortable with the availability and reliability of data held by the Trusts' used to inform their appraisals, and expressed concerns over the objectivity of data, and over ‘unregulated MSF done by a consultant, rather than a validated external provider'.

The RCP urged that any information provided by trusts ‘should not be a part of revalidation until its reliability has been ensured'.

A survey carried out after the pilot found that almost a third of appraisees did not view the enhanced appraisal process as beneficial.

In addition, 67% of appraisees and 60% of appraisers said information gathering was not well supported by their Trust, and that data was ‘inaccurate, irrelevant or nonexistent'.

Although 76% of appraisers said they would be confident to make a judgement as to whether the appraisal was 'satisfactory' based on the evidence, almost a quarter warned that ‘supporting information was not sufficiently robust or contextualised' to make that judgement.

Just 40% of appraisees felt that there would be an improvement in patient care as a result of the enhanced appraisal process, although appraisers were more positive, with 70% believing there would be improvements.

Dr Ian Starke, RCP medical director for revalidation, said: ‘We were able to collect and fully represent the views of the pilot appraisers and appraisees from many specialties, gathering vital information about the positive and negative aspects, and perceptions of the proposed system.

‘The findings of this study have already been shared with those developing the next series of revalidation pilot studies, and this process will continue.'

Fears of spiralling workload under toughened appraisals scheme