Annual appraisal is mandatory for all doctors in the UK and needs to reflect an individual's work, with all elements being considered and covered.
There are a variety of toolkits available in which to document and save one's portfolio and individual deaneries or appraisers may have their favourites but I tend to use the one offered by Clarity (https://appraisals.clarity.co.uk), which is free for RCGP members.
In some respects there is little difference in preparing for appraisal whether one works as a GP locum or a salaried doctor and the criteria for GP appraisal and revalidation remain the same. So what do you need to do as a locum?
Find an appraiser
The local deanery should make contact with all GPs on the local performers list to ensure that each understands when his or her next appraisal is due. The GP will be allotted an appraiser and asked to make contact to arrange the next appraisal.
A GP can have the same appraiser for three appraisals before there is a need to change appraiser. If the same appraiser is offered for a fourth time it is important to raise this with your local appraisal team.
If, for some reason, you are not contacted about your annual appraisal, you should get in touch with the local deanery and establish the appropriate route through which to raise this. Without annual appraisal, one can not revalidate.
Scope of work
An appraisal needs to contain details of all the work you do. Workload may include various roles, such as in hours general practice, out-of-hours care, special interest activities, committee work, medical education, forensic work and insurance medical work. All areas and locations of work should be included in your appraisal portfolio.
Feedback and personal reflection should be sought and noted for each role and both contained within the appraisal documentation. It is useful to consider this early and, if not forthcoming, consider how best to organise an appropriate feedback document to hand out to colleagues or employers involved in any of the duties above.
The aim is to demonstrate that you are operating at a competent level within each role of work and also that you are aware of the areas in which you have comparative strengths and weaknesses in order to self improve and grow in a role.
Continued professional development
The GMC defines CPD as 'a continuous learning process in order to maintain and develop competence and performance' .
The annual requirement for appraisal purposes is 50 hours. CPD activities should be undertaken to cover the scope of a doctor's practice and you should spend time considering and planning how to go about this.
Ideally you need to be organised throughout the year and keep a running log of the CPD activities in which you have engaged.
Some sessional GPs might be concerned about the challenge of finding local group learning activities but often there is a local sessional GP group that organises events or know of them. Practice managers and colleagues are also a useful resource for finding about training and learning events.
Remember that CPD can also include many other activities such as personal reading, online resources and professional conversations. The focus for appraisal is on reflecting on your CPD and considering what you have learned and how it will change your clinical practice.
I have never found it difficult to amass enough annual CPD hours for appraisal purposes but have realised in recent years that it is of more personal use to record fewer hours and spend more time reflecting on these and determining how they are going to help my practice improve.
Quality improvement activities
Quality improvement activities can include areas such as clinical audit, review of clinical outcomes, case review and discussion and evaluation of the impact of a health policy. Whilst a formal complete audit cycle may be challenging to complete for a locum GP, other quality improvement activities should be feasible.
In the past, I have carried out personal audits on all emergency admissions I have made over a fixed period of time, seeing if there was anything I could learn from the discharge summary and consider whether a different pathway might have been more appropriate.
This was fairly straightforward - I advised the practice managers at the places I was working that I was doing this and asked permission to either telephone or call in at the surgery a fortnight after the emergency admission date to discuss the discharge summary detail. I simply then kept a close log of the admissions I made and followed them up as above.
A further element of an appraisal is to consider any significant events in which one might have been involved or had a role. It is good practice to regularly attend significant event meetings, if possible, and many practices where a locum works regularly will often allow the locum to join these. On saying this, it is not a requirement to include a significant event analysis for appraisal or revalidation.
You may not be directly involved in a significant event during the year leading up to appraisal, but significant events can still provide learning opportunities. In the past, I have documented significant events I have heard and found interesting from a meeting I have attended. I write some reflective notes regarding any issues picked up as a result of the event and how these might be addressed in trying to stop a similar event recurring.
Multisource feedback (MSF) needs to be completed at least once in a five-year revalidation cycle. It should be collected from places of work where staff know you and should be anonymised.
Most local locums tend to work repeatedly in the same practice and can ask staff at this practice to hand out the MSF forms available via the GMC website.
Like MSF, patient feedback should be sought from patients in every type of setting in which a doctor works as a doctor once in every revalidation cycle.
Patient satisfaction questionnaires (PSQs) can be downloaded from the GMC website and should be issued to a number of consecutive patients during surgery by the administrative staff. PSQ is anonymous and patients should be reminded of this at the time they are given the form.
It is important to ensure sufficient patient feedback is achieved in order to try to avoid bias but there is not definite number for this. I usually aim for 50 returned questionnaires.
Patient responses must be collated by a third party eg a responsible officer or an appraiser. It is important to remember that patient feedback need only be sought for the roles you perform as a doctor, as opposed to MSF which should be sought from colleagues in every role you work in that requires a doctor to be on the GMC register.
In the appraisal, a doctor needs to reflect on both patient and colleague feedback and consider how practice may be altered in light of this.
Review of complaints and compliments
The final element to consider is a review of a complaints and compliments. Both are potentially useful aids for reflection and need discussion with one's appraiser.
Practice managers will probably forward on any complaints that they receive about you as they will want to respond to patients, but it is a good idea to ask them to forward on all feedback (positive and negative) that they receive about your work, whether from patients, other healthcare professionals or external agencies. Some locums will specify that practices need to do this in their terms and conditions.
Difficulties or queries
The local responsible officer can help anyone, including locum GPs with any concerns regarding appraisal that an appraiser cannot answer. The GMC website also contains a wealth of support and advice regarding appraisal and revalidation.
- Dr Cumisky is a GP locum in Bath