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PCTs pile appraisal pressure on GPs



By Gareth Iacobucci

Exclusive: NHS managers are ramping up the pressure on GPs ahead of revalidation by significantly toughening their appraisal processes, Pulse can reveal.

Our investigation shows more than 90% of trusts across the country admit to toughening up GP appraisal systems in an attempt to satisfy the requirements of revalidation, which is set to be rolled out across the UK from next year.

Despite the huge cost pressures facing the NHS, trusts are increasing their spend on appraisal by tens of thousands of pounds in a desperate attempt to bring systems up to scratch.

The RCGP said action on appraisal was needed but should not be ‘punitive’, while some GPs complained about the more formal ‘box-ticking’ approach trusts were taking.

The survey of 108 PCTs in England, where appraisal systems have lagged behind elsewhere in the UK, found 98 said they were toughening their appraisal process this year.

Many are using the self-assessment tool developed by the NHS revalidation support team to help improve their patchy appraisal systems, as well as employing more GP appraisers, giving them more robust training and imposing tighter and more regular assessment of their performance.

Trusts also revealed the significant extra resources they are prepared to commit to ensure their appraisal systems are in line with the requirements for revalidation.

NHS Wiltshire said it was increasing its appraisal budget from £305,586 in 2009/10 to £384,503 this year, and NHS Knowsley said it was ‘recruiting an additional 10 GP appraisers’, and would review their contracts after 18 months as part of a ‘rigorous’ recruitment process.

Some GPs in Essex are unhappy at the methods being used to collect data, with local company Education and Quality in Practice writing directly to practices requesting all appraisal paperwork be redirected to them, after being commissioned by the PCT to take on the work.

Elsewhere, trusts have begun recruiting responsible officers to oversee the process and implementing multisource feedback as a routine part of appraisal, with GPs expected to deliver feedback to colleagues.

These include NHS Barnsley, which said it had ‘implemented 360° multisource feedback available to all GPs’, as well as appointing a new assistant medical director with responsibility for CPD and appraisal.

Dr Fiona Cornish, a GP appraiser in Cambridge, said: ‘We have a checklist and if the appraiser doesn’t fill in everything, it gets bounced back. Some feel now the appraiser has a more policing and tick-box role.’

Dr Claire Lockwood, a GP in Basildon, Essex, said: ‘With each appraisal there are more boxes to tick. It’s like being back at school.’

How revalidation has developed

April 2009 • GPs encouraged to start collecting evidence voluntarily for CPD portfolio

November 2009 • Introduction of license to practise

September 2010 • Requirement to appoint responsible officers comes into force

Late 2011 • First early-adopter sites begin revalidation

Source: GMC, February 2010

Dr Fiona Cornish: appraisers now have more of a policing, box-ticking role Dr Fiona Cornish: appraisers now have more of a policing, box-ticking role