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GP bureaucracy cut could see appraisals reduced to 30-minute exercise


GP bureaucracy


A new process ‘currently being evaluated’ would see GP appraisals lasting 30 minutes to cut unnecessary bureaucracy, the Department of Health and Social Care (DHSC) has announced.

The Government today published the response to its much-awaited bureaucracy consultation, including eight priority areas for action.

It follows a call for healthcare staff to submit examples of unnecessary bureaucracy, which received more than 600 responses identifying 1,000 examples, the DHSC said.

One priority area is that ‘GPs will have more time to focus on clinical work and improving patient care’, while others include ‘streamlined’ medical appraisals and ‘proportionate and intelligent’ regulation, the DHSC said.

Changes relating to its review into specific GP bureaucracy ‘will begin to be made by the end of the year’, it added.

This includes a ‘reform’ of the fit note, including ‘alternative arrangements’ for issuing the notes such as digital solutions and extending the certification to a ‘wider group of healthcare professionals’.

In 2016, a Department for Work and Pensions consultation explored the extension of fit note certification from GPs to other healthcare professionals, but this was never implemented.

It followed a vote by GPs at the BMA’s LMCs Conference that fit notes were a waste of clinical time that could otherwise be better spent.

The DHSC said that its new bureaucracy strategy will ‘lock in’ positive changes brought about by the pandemic so that GPs can ‘spend less time on paperwork and more time with their patients’.

Its consultation response said: ‘DHSC and NHSE/I have been conducting a joint review of bureaucracy in general practice. Changes will begin to be made by the end of the year and DHSC will continue to work across government and with the NHS to implement the solutions that emerge.

‘The actions will aim to boost job satisfaction, retention and role attractiveness and grow the number of doctors and primary care professionals working in general practice and Primary Care Networks.’

It added: ‘Medical appraisals must be streamlined so doctors can use the process for professional development, rather than “ticking boxes”.’

NHS England, the Academy of Medical Royal Colleges, the GMC and the BMA introduced a new streamlined appraisal process from October which takes ‘about 30 minutes to prepare’ and boasts a ‘significant reduction in supporting evidence’, the report said.

It added: ‘The Academy of Medical Royal Colleges is evaluating the effectiveness of the 2020 Appraisal model in the forthcoming 12-month appraisal cycle with NHSE/I and the responsible officers in England. 

‘If the evaluation concludes that more supporting information is required for revalidation purposes, serious consideration must be given to whether organisations take on more of that burden than previously, rather than simply to pass it back to the doctor.’

The report also said that the DHSC will also work with the GMC to ‘simplify’ the international registration process, relaxing the need for GPs from outside the UK to submit up to 1,000 pages of evidence by making the process more ‘adaptable’.

And NHSX expects all areas will have ‘basic minimum’ shared care records between trusts and GP practices by September 2021, the report said.

Speaking today at the NHS Confederation’s NHS Reset Conference, health secretary Matt Hancock said: ‘Of course, rules and regulations have their place. They can be the cornerstone of safe and high-quality care. 

‘But when left unchecked, rules and regulations can outgrow their original purpose – and they can stifle innovation and damage morale.’

He added: ‘You might be thinking: “Matt, I’ve heard this all before.” And on that you may well be right; and one of things we have done is gone back over the reports in this area of bureaucracy busting for the past 10 years to find recommendations that haven’t been put into action and instead put them into action where we can.

‘I’m determined that we seize this moment and build on the very best of what we have seen over these past nine months.’

In October, the health secretary praised GPs’ hard work ‘away from the public eye’ and reiterated pledges to cut bureaucracy for practices.

It followed RCGP comments that a 28% decline in bureaucracy over the pandemic had made general practice ‘a doable job’ again and BMA warnings that GPs would not be able to cope with a second wave without another pause to routine CQC inspections and QOF reporting.

In July, the BMA and RCGP joined a Government working group on ‘renewal and recovery’ in general practice, set up to feed into the bureaucracy review promised in the 2020/21 GP contract.

But although the health secretary promised that NHS bureaucracy would ‘not be coming back’ in July, the CQC restarted in-person GP practice inspections last month.

READERS' COMMENTS [17]

Dermot Ryan 24 November, 2020 3:01 pm

They simply cannot admit that the whole thing has been a disastrous mistake.
At least it is being tuned down. The next thing that needs to go is the fascists at CQC.
Maybe this COVID has something to have been thankful for

Kevlar Cardie 24 November, 2020 3:09 pm

30 minutes is still an eternity when it feels like one’s nads are being alligator clipped to a car battery, for no reason.

William McKee 24 November, 2020 3:18 pm

Like PHE, CQC needs to go as well.

Vinci Ho 24 November, 2020 3:20 pm

Let’s call this ‘politically correct 30 minutes’ ( instead of zero, hence no appraisal at all )

Michael Mullineux 24 November, 2020 3:48 pm

I have subjected myself to 18 years of appraisals since their inception without a single useful epiphany/reflection/outcome/learning point/enhancement. They have been and remain utterly tepid and vapid. Like most of us, I did not end up in this profession through laziness, torpor and disinterest in maintaining my clinical skills. Complete and utter waste of many hours of time, but many boxes have been successfully ticked over the years. But the reality is that NHSE=HMG=Bureaucracy and the likelihood of it reducing any time soon is vanishingly tiny.

Vinci Ho 24 November, 2020 4:13 pm

I just go with the logical argument:

Cutting the appraisal from the normal 2-3 hours to 30 minutes , is actually so-called cutting ‘unnecessary bureaucracy’ . So what does that tell you about the original nature of this appraisal exercise otherwise?
This is not just a kind of U-turn but a humiliation of DHSH/NHSE , evidently suggesting what they have been advocating through these years is f***ing cr*p.
DHSH should put a gun on its own head and pull the trigger to save a bit honour for itself.

Slobbering Spaniel 24 November, 2020 4:47 pm

The appraisal itself has always been less of a problem than time preparing for it and the wordy justification and documentation of study logs, audits, case reviews, SAE discussion, complaints analysis, 360 feedback , PLP production etc etc.

stephen Walton 24 November, 2020 5:04 pm

Please scrap appraisal preparation completely. This is purely a tick box rubbish exercise. — Realistically who ever makes notes about which articles you read all the time? Going to PGE lectures and seminars died years ago. The internet is here and this is how we self-educate. We don’t need to write notes about it….. Half hour of counselling fine, but no prep, Please!!

michael miller 24 November, 2020 6:28 pm

You still have to travel to see your appraiser which may be some distance in the countryside or involve a traffic jam in the cities. you still need to book time off (a session if your salaried). scrap it completely

Jamil Ismaili 24 November, 2020 6:50 pm

Talking of reducing unnecessarily time spent why are we still spending time every day signing prescriptions, the vast majority of which are printed off practice systems that have up to several layers already of inbuilt prescribing safety measures. Those if necessary could be adapted if needed to fit an agreed standard.
I can see a case for retaining additional measures say for controlled drugs but for the rest of signing this achieves no real purpose but the false sense of security that you might guarantee catching something overlooked from a pile of 100’s even 1000’s of scripts in the middle of a packed day

terry sullivan 24 November, 2020 10:23 pm

and nhse has to go–what does dfh actually do–apart from consume billions?

Decorum Est 25 November, 2020 12:22 am

Agree with all above, it’s just a load of bollicks.

John Graham Munro 25 November, 2020 12:47 am

Covid will eventually bury appraisals

Paul Burgess 25 November, 2020 10:29 am

Agree with Michael M
-and also with stephen W -except the ‘half hour counselling’ -why? -by a fellow GP that you don’t choose? -paid??
Pay me to take take the AKT -then give me confidential results including analysis of where I am weak and need to objectively focus some learning. But if the AKT is crap then why is it a condition of becomg a GP??

Dave Haddock 25 November, 2020 12:23 pm

Too many people on the gravy train to just end the whole pointless farce?

Ashley Krotosky 25 November, 2020 5:12 pm

Smoke and mirrors: the appraisal experience with any half decent appraiser is not at all unpleasant. It’s the hours (and hours) of putting the package together which is what kills -whether accumulated piecemeal or with a major splurge prior to deadline.

And before some comedian starts asking “how do we know whether we are reducing the burden? I know let’s all start measuring it,” NO, NO and thrice NO!

Wendy Kitching 27 November, 2020 10:19 am

I too have been doing appraisals since their inception. At first it was a massive amount of work – now I just copy and paste my responses from the previous year with just minor tweaks- no one seems to notice or mind . After all my personality, work interests , work ethics , clinical skills etc are unlikely to dramatically change are they ?
And yes I do think they are mostly a waste of time – I get far more out of day to day discussions with and support from my partners