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Fear and loathing in the appraisal process



It can be difficult to know where to start when analysing my loathing of the appraisal process. It is meant to provide evidence that we GPs are keeping up with multiple standards and guidelines, as well as reflect on things that go well, and things that don’t.

There is no way that I could fit all the things I have learned in a year into my appraisal, from the purely factual things like the cut-off for referral to the lipid clinic for suspected familial hypercholesterolaemia, to less quantifiable knowledge, dare I say wisdom, such as the way I discuss prognosis with a terminally ill patient, or assess suicide risk in a depressed patient I have never met before.

Once, in a pique of passive-aggressiveness, I tried to include everything I had done and learnt, including all my blogs, into my appraisal, amassing more that 120 hours of CPD. I felt very professionally developed. It was a daft kind of protest. Though I limit myself to the obligatory 50 hours, there is still the rush to finish the bastard in the few weeks before the appraisal, which always takes place in March. Lovely conundrum, appraisal or QOF (which also always seems to be a last-minute job)?

I would have hoped that all the stops should be pulled out, including appraisal, to remedy the GP crisis

If appraisals are meant to pick up struggling doctors or weed out under-performing, out-of-date GPs, then I don’t think it is fit for purpose. I am not a turkey voting for Christmas. There are plenty more ways for someone to point the finger at me. If it is meant to be an edifying process, then I have completely missed the point. I can’t help but wonder if it exists purely to prop up the micro-economy of one day learning courses and workshops that can be paid for, to top up your CPD.

One way of considering appraisals is to contemplate how a proposal for the current process would be received if it was being implemented, for the first time, this year. Would the profession agree to it, in the context of the crisis general practice is in, when the opportunity cost is up to 80,000 sessions per year?

Though it might be optimistic to consider that appraisers would see patients instead of appraising, for the 40,000 GPs, and falling, being appraised over half a million appointments are lost so they can attend their review.

When workload is a massive factor in retaining GPs, to then require them to reflect on their year’s learning can only make matters worse. Despite all that, I suspect, unfortunately, that it would be seen to be too radical a step to scrap appraisal. Though I would have hoped that all the stops should be pulled out, including appraisal, to remedy the GP crisis.

Dr Samir Dawlatly is a GP partner in Birmingham