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Review of the year

I have been friends with another GP in my area for 25 years. He is a kind and generous person with a supportive wife and two grown-up children. 

He has been a partner in the same practice for 30 years. He is, and has always been, extremely popular with both patients, colleagues, and other local GPs. He always keeps up-to-date with clinical research, and makes remarkably detailed notes on his patients’ health. He has also worked as an appraiser, although like many experienced appraisers he recently retired from the role, as he felt his work in this area was no longer as meaningful and supportive as it had been. My meeting with him was partially social, but also partially out of concern. I knew he was having a hard time of it.

We began to talk and I listened out for him to admit his biggest underlying worry.

Was it keeping motivated during long working days, with impossible demand from a deprived patient population? Was it frustration with CQC registration or partnership changes? Or was it practice finances and cash flow?

None of those: he was in fact, worried about his upcoming appraisal, and revalidation.

He was seriously anxious, and had been ruminating on the event for the past six months.

He had already spend hours compiling documents for the folder, adding text and reflections to the electronic appraisal form, all the while wondering who his next appraiser would be, what he or she would be like, what approach he or she would take with his performance. 

Preparation for revalidation can exceed forty hours but worrying about it can occupy doctors for months, filling hundreds of days and nights with fear.

I have heard appraisals described as a cosy fireside chat with a colleague, but for many GPs – especially the hard-working perfectionists and worriers common in our profession – it’s just a weight on their minds. The anticipation has made more than a few doctors fear of being ‘found out’ as not good enough, or being a fraud.

At the LMC we support and advise many GPs for whom revalidation and appraisal act like a sword hanging from the ceiling by a thread.  

But, like Damocles, many good doctors are not willing to stay under this sword for much longer. 

The LMC Insider is chief executive of an LMC in England. He is also a practising GP