At this time of year, our Resilient GP forum and others are full of stressed and annoyed GPs trying to ensure their appraisal documentation is up to date and ready for that dreaded few hours. Questions and rumours abound regarding what is actually required to pass, disaster stories of hours of work being rejected due to technical detail are shared and newly qualified GPs try to find out what the hell is expected of them for this process.
I have to go through that myself, but I have also been a GP appraiser for three years and have recently been considering whether to continue in that role. Why? After all, it is well paid, non-patient facing and doesn’t require indemnity fees, the veritable holy trinity of extra GP income these days.
But the reasons against it are multiple and as with so much in the NHS these days, it is a combination of NHS England mission creep, over-regulation and a feeling of an unfair disparity between different areas of the country.
This year, our NHS appraisal team merged with another and their appraisal rules were adopted. These were tougher than had been previously applied in our area and are apparently what will be applied all over England eventually.
The new rules for me to apply to be an appraiser include 50 CPD points and three PDP tasks just for being a GP, any other roles need extra. No impact can be claimed. All ‘extended practice’ roles (yes- no clearly defined than that) have to be appraised separately and uploaded. There has to be way more navel gazing – sorry – reflection. The PSQ has to include patients from all areas of their practice (always wondered, what do pathologists do?). Where do these rules come from? A combination of GMC, RCGP and NHSE. Each responsible officer uses their own interpretation of the rules. Is this robust and fair?
Some of these will be familiar to appraisers, a variation on some were to me, but these new ones are more onerous and significantly more prescriptive. They will not be familiar to others yet because of the ridiculous regional variation of the appraisal system in England. A GP in one area may still be able to choose their appraiser and have a relaxed chat over a cup of coffee whilst in another, GPs are assigned someone and are subject to a grilling about their practice over three hours. This disparity makes a mockery of a system that has been put in place to ensure patient safety. Are patients in one area of the country ‘safer’ than those in another because the appraisal system is more robust? I think not. Does appraisal ensure patient safety at all? Unlikely. As is so frequently uttered, Shipman would have undoubtedly sailed through.
Adding to the above, this year NHSE decided that doctor’s appraisals needed to be added to the same system as other NHS employees, something called RMS. So now we have to upload the entire appraisal to this system. This has been done without telling appraisees in many cases. I have told mine, has your appraiser told you? Another layer of bureaucracy of dubious necessity.
What would happen if all GPs resigned from appraiser roles? NHSE would do what they have threatened, bring in non-medical appraisers. That is enough to make me continue for now. I hope that I can provide a formative, supportive and useful hour or two for those I appraise. The hoops have to be jumped through, but it can still be pleasant. I have no time for aggressive, nit-picking pedantic appraisers, they make their colleagues lives miserable and do nothing to make the system any better.
Appraisal is here to stay for now. I am still part of it so that it continues to be a peer-led, formative and supportive process. When the balance tips to performance management, I am out of there.
Dr Stephanie de Giorgio is a GP in Kent and a co-founder of Resilient GP