Older GP appraisers 'may be more lenient', study suggests

Older GP appraisers are more likely than their younger counterparts to interpret questionnaire data from patients and colleagues more leniently when assessing GPs' performance, evidence suggests.

Appraisal: older GP appraisers tended to be less hawkish than younger colleagues
Appraisal: older GP appraisers tended to be less hawkish than younger colleagues

Researchers found that older appraisers are more likely to give GPs the benefit of the doubt when assessing multisource feedback (MSF), a British Journal of General Practice (BJGP) study shows.

GPs are required to collect MSF on their work as part of the appraisal process, involving feedback from patients and colleagues in the form of questionnaires.

This data is assessed by appraisers, who are expected to make ‘accurate and consistent judgments’ about the doctor’s safety, conduct and performance drawn from this evidence.

Over 100 appraisers from north-east England participated in the study. They were invited to review eight anonymised GP MSF reports representing different combinations of poor/high patient and colleague questionnaire scores.

One of the reports was constructed to have poor colleague and patient results, as the researchers said these are uncommon among GPs in real-world practice.

GP appraisal

The appraisers then gave each a rating from 1-4 on how concerned they were about the GP’s practice and the acceptability of their performance, in addition to an overall rating of 1-5.

The researchers, from Exeter and Plymouth, then compared how the different appraisers had assessed the reports.

Overall, they found there was ‘broad consensus’ in the appraisers’ interpretation of the evidence, although there was some variation in their tendency to be more stringent or lenient relative to their peers.

Researchers found that ‘hawk-like’ tendencies – where reports were rated more strictly – were more common among appraisers overall than ‘dove-like’ tendencies.


But this varied among appraisers, with the results suggesting that older appraisers in particular may be more dove-like than younger appraisers, tending more towards lenient interpretations of revalidation evidence.

The extent to which this proves problematic in real-life practice has ‘yet to be established’, the researchers said.

The appraisers’ gender, ethnicity and region of primary care qualification were not linked to more hawk- or dove-like behaviour.

The researchers wrote: ‘Despite the complexity of information in the featured MSF reports, appraisers’ assessments suggested that they could detect variations in MSF score patterns.

‘For each report, there was broad consensus about the level of concern and acceptability of the GP’s performance and about actions that could be discussed in the appraisal meeting.

‘Appraisers varied, however, in their tendency to be more stringent or lenient in their assessment of MSF reports relative to their peers. In particular, there was some evidence that older appraisers may be more lenient than younger appraisers in this regard.’

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