With revalidation approaching, the future purpose of GP appraisals is unclear. The White Paper on professional regulation indicated there would be an element of assessment in appraisal, but that it would not continue to be the formative learning activity it is now.
If an appraisal is to allow judgments to be made about GP performance, it will need to include objective evidence of an individual's standards of work that are comparable with other GPs in similar situations.
As well as the evidence of learning and development currently required, it will focus on information giving a clinical governance perspective.
That might relate to complaints, any local concerns, patient surveys and feedback from work colleagues. It might also include information that the primary care organisation (PCO) holds, for example, about prescribing or referral habits.
Revalidation is likely to start in 2009/10 but GPs may be involved in pilots before then. So evidence about GPs' work over the next two years could feature in their revalidation folders if they are in the first cohort for revalidation.
Much of the evidence for annual appraisals should double for revalidation - both for the relicensing component overseen by the GMC and towards recertification by the RCGP. The chart shows how information collected for appraisal is likely to be used for revalidation.
The seven domains of the GMC's Good Medical Practice will probably remain a basis for appraisal when revalidation begins (see box above right).
High-quality information about a GP's personal clinical practice is difficult to provide. The quality framework and prescribing analysis data are not really suitable sources because the first relates to the practice team, while an individual GP's apparent prescribing data may include prescribing by a locum GP or trainee doctor.
Information GPs collect should relate to the clinical outcomes of their own work, their record-keeping standards; patient surveys that pick them out as individuals and 'multi-source feedback' from work colleagues and others.
As the GMC and RCGP develop their thinking about the evidence GPs will need to submit for revalidation, they will specify both essential and desirable data relating to the individual as a doctor (for relicensing) and as a GP (for recertification).
They will also decide whether details must be verified by more than one source.
One of the expected markers for recertification is evidence of participation in quality assured, continuing professional development (CPD). The 'bums on seats' approach of simply listing how many hours were spent learning which topics are obsolete.
GPs should consider undertaking CPD that is accredited by, for example, a university, college or an approved education provider. They should aim to show why they undertook specific CPD and how knowledge gained has been applied to improving services.
The RCGP will issue guidance on how GPs should show the worth of informal learning.
GPs must complete certain statutory training each year, such as fire safety. There is also mandatory training, for example, CPR refresher courses and, for GPs involved in recruiting trainee doctors, equality and diversity training. They should provide evidence of participation in regular training, or better still, passing an assessment of their knowledge or skills.
If done right, preparing for appraisal and revalidation will become routine tasks. In time, reflective practice becomes a state of mind, central to the context of quality improvement and clinical governance activities such as audit, adverse event recording systems and so on.
Reflection is about GPs noticing what they do in their day-to-day work and identifying areas of improvement. It involves looking back to critically analyse situations, events and actions and deconstructing them to understand their component parts - what were the causal factors, why were key actions taken?
- Professor Chambers is director of postgraduate GP education at West Midlands Workforce Deanery and professor of health development at Staffordshire University.
GMC DOMAINS FOR GP APPRAISAL
1. Good clinical care Providing clinical care and effective treatment, keeping records and patient safety.
2. Maintaining good medical practice Keeping up to date, sustaining and improving standards of practice.
3. Relationships with patients The doctor-patient relationship, establishing patients' trust, communicating and preserving confidentiality.
4. Working with colleagues Teamwork, referring patients and delegating tasks.
5. Teaching and training, appraising and assessing Educational activities involving colleagues or students.
6. Probity Being honest and acting with integrity.
7. Health Confirming that the GP has no health problems that impinge on the standards of care they provide.
For more details, visit www.radcliffe-oxford.com where you can also order online. Enter 'GP Reader Offer' in the discount code box at the checkout to get the discount.
To order by phone call 01235 528820 quoting 'GP Reader Offer'.
GPs can get 20 per cent off the full price of any or all of the six books co-authored by Professor Ruth Chambers in Radcliffe Publishing's 'Appraisal and Revalidation' series. Titled Demonstrating Your Competence 1-6, books 1-5 cost £21.95 each and book 6, £23.95 before the discount and each covers a different area of clinical interest.