I have been appraised, I have revalidated, I have played the game since the introduction of annual appraisals ten years ago. And now I am forced to reflect.
But is forced reflection on forced learning the best we can do as a profession driven by evidence-based practice?
The system is a sham
What have I learned from my annual BLS update? Ummm, that it’s very important and I should update each year.
How has it changed my practice? Well, I know not to start another three-hour learning session in a severely decaffeinated state.
And then there is my professional development plan when I’m faced with the questions of: ’Surely you must have some learning objectives? No, two is not enough, must be three or four,’ together with ‘have you achieved last year’s? What do you mean your ideas changed? You came across something more interesting and relevant?’ with the inevitable following words: ‘Tough mate coz it don’t count.’
But as long as the hours spent on perfecting CPR in the last five years equals 15 and the hours spent learning how to recognise depression in the last five years is equivalent to 0, I get a tick and a pass. Next!
But who actually reads this guff? Obviously our poor appraisers have signed up to it, and most of course go through the same routine themselves each year and are aware of the rules of engagement (don’t start me on the whole practice manager appraisal thing) .Then presumably there are those NHS England responsible officers, medical directors and deputies who have sold their souls to the establishment, ending their careers ticking boxes and doing good on behalf of Her Majesty. I hope they derive some personal satisfaction from their role.
But other than them, most believe the system needs an overhaul. I am aware that recent RCGP guidelines are supposed to lighten the load. But have you read them? Clearly it’s a small fry, little or no impact, to keep the masses quiet.
In essence the system is a sham, it doesn’t achieve what it set out to and hasn’t since its inception. Has patient safety improved? Does anyone have figures on how many physicians have been sanctioned by the GMC as a result of the appraisal process? What is the cost benefit of this? How many physicians have left the NHS as a result of the appraisal process? Those wanting to leave general practice are told to just work one more year or do some locuming when they retire full-time practice. But no one wants to keep up with all the appraisal shenanigans that go with it.
Most of my learning is not recorded and I suspect that applies to many of us. It consists of conversations with colleagues, reading between patients, browsing journals and reading medical blogs. I learnt more in an impromptu tutorial from a cardiology colleague as I sucked his wheel on an Alpine cycle ride than I have in many highly organised meetings.
Why is it not recorded when you can use any number of apps and website trackers? Because most of us of course can’t be bothered with the banality of recording everyday events, don’t have the time or are just too busy trying to see patients and actually enjoy life rather than slide inexorably towards an overly appraised, highly reflective early retirement. We have had enough of justifying our existence behind a facade of safety and learning, falsely reassuring our paymasters and the public whom we do our best to serve.
What could make appraising better? Scrap it? Adapt it? Change happens slowly in these circles so don’t hold your breath for the next ten years.
Personally I have found my patient feedback survey has been the most interesting aspect of the whole process. The comments were revealing as a large numbers of patients said what they liked about their doctor was that ‘he listened’.
My advice would be to value doctors. Nurture them. Manage them holistically. Find a way. They are a dying breed and we won’t truly miss them and primary care until they are gone. Our doctors and patients deserve better.
Is anybody out there listening?
Richard Cook is a GP partner in Hurstpierpoint, West Sussex