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Should GP and staff appraisals be suspended until the pandemic ends? It’s a subject that is actively being discussed in GP circles following the national vaccine roll-out, which has put increased pressure on primary care staff and left some surgeries stretched. NHS England’s decision in March last year to suspend GP appraisals was a much needed and welcome decision to allow doctors to focus on clinical work and be deployed in the most appropriate way to support the COVID-19 emergency situation. With the NHS now battling a second wave fuelled by a number of mutant variants, many GPs believe that putting appraisals on hold is a necessary step.
In this exclusive Q&A, Alison Lowerson, Quality Compliance System’s GP Policy lead, first considers whether GPs should pause the appraisals process, and focuses on what future appraisal systems might look like in in a post-Covid regulatory landscape.
Q) The debate around appraisals has divided the GP community. Why do some GPs wish to put the process on pause?
A) “As a former practice manager, with 18 years’ experience, I can understand why some GPs would wish to pause the appraisal process. I can also see why practice staff might not been keen to be appraised. During the pandemic, some job roles have changed overnight. Many have found themselves covering for colleagues, who were shielding or self-isolating, which has dramatically added to their workload. For many working in the crucible of the pandemic, discussing personal development goals when so many patients are seriously ill, might seem somewhat inappropriate.”
Q) There are also those who want the appraisal process should carry on. Why?
A) “But some in Primary Care want appraisals to continue. They argue that the revised system introduced in the autumn, which is a pared back version of the original template, can make a positive difference. Most crucially, however, those, who advocate for appraisals to continue do so because they are concerned that without a formal appraisal process in place clinical safety standards could slide. They also worry that postponing the appraisal process for even a few months, might mean that practice staff could miss out on important medicine updates, or slip into silo working, and in doing so, lose sight of the collaborative working culture, which has long been a key strength of primary care. Moreover, with mental health issues taking a toll on GPs and their practice team during the pandemic more than at any other time, it could be argued that appraisals are more important than they have ever been. Appraisals, conducted in the right way, can also help GPs and Practice Managers to monitor and support the emotional wellbeing of their team.”
Q) What action should GP Practices, that have temporarily suspended the appraisal process, take to satisfy the regulator?
A) “Appraisals are also a requirement of the Health and Social Care Act 2008. Many, particularly appraisers, will be aware of Regulation 18, which states that all practice employees “must receive appropriate support, training and professional development, supervision and appraisal to carry out their duties”. Therefore, even if the appraisal process continues to be temporarily suspended, GPs and Practice Managers would still have to demonstrate that they were providing appropriate guidance and support to their employees. To comply with CQC requirements, they would also need to demonstrate that they had met the CQC’s key lines of enquiry in ensuring staff have the skills, knowledge and experience to deliver effective care and treatment.
But moving forward, even practices that have decided to put appraisals on hold should not entirely forget about them. It won’t be long before they need to re-instate the appraisal process in their practices and, when they do, they will need to hit the ground running. Many Practice Managers are using the time to plan for the future. But how? In my opinion, Practice Managers should be discussing with staff and Patient Participation Groups exactly what impact moving into a Post-Covid world is likely to have on the surgery and agree with staff the impact it may have on the appraisal process. What could they do differently to support staff and what changes could they make to policies and procedures? Are the correct communication protocols and reporting procedures in place? There are many more questions of course, and the primary objective for every practice, should be to put in place a robust appraisal process that meets CQC requirements, and most crucially, the needs of the team.”
Q) What QCS policies and procedures can GPs and Practice managers, who are continuing to appraise during the pandemic, utilise?
A) “At QCS, we have created the Development Appraisal and Policy Procedure, which provides managers conducting appraisals with all the tools they need to suitably prepare, strategically plan and deliver appraisals that meet CQC requirements. This policy is fundamental because in the fog of the pandemic, and at any other time for that matter, it is crucial that performance objectives, set by GPs and Practice Managers, are realistic and achievable. Appraisals must be written in accessible language and should clearly communicate the expected employee objective. Finally, an appraisal should not just focus on the employee, but also the people they work with. Most of all, an appraisal should communicate that they are not just a single cog in the machine, but a valued member of the wider team, all of whom are working towards agreed goals.
QCS has also produced the Meetings Policy and Procedure. This policy, which includes structured agenda templates, ensures effective communication continues to support staff as well as providing safe and effective patient services. However, I believe that supervision, which is part of the annual appraisal process, should be deeply embedded in the fabric of every GP practice. It needs to be part of fostering a culture of safety and learning. With this in mind, QCS has created a Supervision Policy and Procedure, which helps Practice Managers to ensure that arrangements are in place to provide a safe and confidential environment for staff to reflect on and discuss their work. It also provides the building blocks for Practice Managers to set up best practice organisational frameworks which demonstrate learning activities that have made a profound cultural difference to their surgeries.”
Q) What lessons have GP Practices learned from the Covid crisis and how are they using this knowledge to improve appraisal process?
A) “During the pandemic, an important step change for many GP practices has been to embed a culture of supervision within their practices. Some, of course, already have it in place. But when I refer to putting in place a positive supervision culture, I need to make a distinction between the professional culture that already exists – clinical supervision is a mandatory requirement – and a new collaborative model, which also includes non-clinical staff. In addition to being anchored to continuous improvement, it is designed to build psychological resilience and manage emotional wellbeing.”
Q) How would this new supervision paradigm work in practice?
A) “GPs and Practice Managers could start by introducing monthly round table meetings. The meetings, which could also be virtual, should include every member of staff, even those who are self-isolating or working from home. These so-called ‘What went well, what didn’t go well retrospectives’ are a great way to collect honest and constructive feedback from practice staff, and affect change. Of course, the meetings would also provide an opportunity for people within the surgery to reflect on the positives too because it is important that staff recognise the best practice. Sometimes, especially during a pandemic, when staff are fire-fighting, information can go awry. Reinforcing positive examples in a group-setting is great for team spirit, while logging these meetings every month, provides the CQC with evidence that the practice has established a safe, well-led and effective culture amongst staff.”
Q) In regard to adding a new dimension of supervision to the appraisals process, do you think there is anything that GPs can learn from NHSE initiatives?
A) “I think that GP Practices are exceptionally good at incorporating new thinking into their processes, policies and procedures. Although they have a duty of care to their staff and patients to do so, it is a requirement of the CQC. The CQC want to see that practices meet the ‘caring’ and ‘responsive’ KLOEs too.
But that said, I think the creation of PCNs and ICSs have also helped many GPs to embrace new ideas. GP practices, for example, provide mental health and support via NHSE initiatives. While many haven’t been able to do so during the pandemic, GP services also operate an open-door policy, where staff are encouraged to talk about the personal challenges they face. Of course not everyone wants to open up but managers are trained to observe and listen to staff. By taking this very person-centred approach, they can spot signs of burnout and nip it in the bud before it becomes a bigger problem. Many GP practices have also forged close links with mental health services, and can arrange counselling if they feel a staff member needs it. While adding an extra element of supervision into the evaluation process may seem arduous – especially when many GP practices have decided to put appraisals on hold – if it safeguards mental health and gives staff the confidence to report concerns, then it can only be a good thing.”
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