Every five years, a GP needs to demonstrate good practice and performance by collecting a portfolio of evidence in several areas, including CPD, a clinical audit, one significant event per year and feedback by colleagues and patients as part of the annual appraisal process.
Since revalidation was introduced in December 2012, the GP appraisal has moved from being a formative process to a summative one, making it much more challenging for the appraiser.
What does being a GP appraiser involve?
If you were to do 10 appraisals in a year, this could involve 50 hours of work. It is difficult to say how long an appraisal takes, but I estimate two hours to read a portfolio and to start to summarise the evidence the GP has collected.
Then there is the time taken to make contact and arrange a mutually convenient time for the appraisal, and waiting for the GP to sign off their electronic portfolio.
Sometimes evidence is missing and the appraiser needs to chase this up from the GP, particularly if the GP's revalidation date coincides with the appraisal.
Appraisers also need to learn how to use different portfolios, such as the RCGP Revalidation Toolkit, the Clarity Toolkit and the different portfolios used in Wales and Scotland. Some localities still permit GPs to use paper portfolios, or to present some documents in paper format. Similarly, an appraiser may need to see paper copies of colleague and patient questionnaires. This all takes time and organisation.
|How to succeed as a GP appraiser|
One of the keys to satisfactory appraisal and revalidation is reflection by the GP on a learning event or a patient satisfaction questionnaire and whether it affirms good practice or indicates a change in practice is required.
The difficult job for the appraiser is to try to judge if that reflection is adequate and where appropriate, feeds into the GP's personal development plan. When it comes to the appraisal, the appraiser will probably have noted some questions to ask based on these reflections. The appraiser must also ensure that any supporting information provided is sufficient for the purposes of revalidation and on rare occasions, flag up any areas of concern to the responsible officer. Reading portfolios is often best done in your spare time, when you can concentrate and not be disturbed.
Given the change to summative appraisal, changing requirements for revalidation and evolving toolkits, it is difficult for an appraiser to do this in isolation and regular appraiser meetings are required, as well as initial training. All this takes time and commitment, and absence from the practice. Appraisers are paid, so this is a way of negotiating with the team for time away from the practice to carry out appraisals.
The appraisal meeting
Ideally, you will do one appraisal every month. Unfortunately, despite the best will in the world, everyone seems to leave their appraisal towards the end of the appraisal year in March.
This can make the early part of the year stressful, as all your spare time slots are spoken for, so you need to be proactive and try to book them early.
The meeting should be in a location where you will not be disturbed. If it is held at a practice, staff must not disturb either doctor. This time needs to be protected and agreed with your colleagues in the practice timetable. You should set aside up to three hours.
An appraisal should allow for a conversation as well as looking at the portfolio. It is a valuable opportunity for the GP to talk through any difficulties in their practice, for example, a GP who is unhappy at their current practice, or who wants to talk through the possibility of going part-time or retiring.
After the appraisal, there may still be work to do. All of the necessary evidence may not be there and you may have to postpone signing off the appraisal until it is provided. This takes more time and can be a difficult balancing act as you continue to communicate.
I enjoy being an appraiser and it is amazing how much you learn from colleagues and new areas of good practice and innovations. However, being an appraiser requires a fine balancing act to make all the necessary commitments to your practice.
- Professor Charlton is a GP appraiser and professor of primary care education at the University of Nottingham