Professional development - Your first appraisal after training

Appraisal can be a useful ongoing chance to reflect on practice, says Dr Lyndon Wagman.

In order to work, once you have completed your training, you need to have your name on a primary care organisation (PCO) medical performers list. To stay on that list, you need to undergo annual appraisals. Over a cycle of five years these appraisals will form part of the package of evidence for revalidation. This could become a chore undertaken for the GMC and your PCO but there are ways to make it an ongoing and educative process.

As both an appraiser and an appraisee, I use this process as a way of reflecting on my past year in practice, thinking about my ongoing educational and personal needs and the general needs of the practice.

The pre-appraisal forms
The forms used for appraisal are standardised and available through the DoH. The meat of the pre-appraisal forms comes in form 3, 'material for appraisal', and is divided into 10 sections that mirror the headings used by the GMC in Good Medical Practice (see box).

Those being appraised often struggle to understand the difference between 'good clinical care' and 'maintaining good medical practice'. The latter asks you to record the things you do to maintain your ongoing medical education, be it through lectures and courses, online learning or the on-the-job education we do when presented with an unfamiliar clinical situation.

'Good clinical care' relates to a broader review of your practice, for example through an audit of your performance, your performance in relation to clinical guidelines, significant event analysis and a review of complaints. This may incorporate your performance within a practice, but should not simply reflect practice-based data.

'Relationships with patients' needs evidence to support your views. Keep any thank you letters. If you work in a single practice, ask to be included in its annual quality framework survey. This can allow you to compare yourself with colleagues.

'Working with colleagues' needs evidence to corroborate your thoughts, where possible. Undertaking a 360 degs appraisal is the gold standard applied within the nMRCGP and applicable to us all.

'Teaching and training' applies to formal teaching, for example of medical students as well as informal supervision or mentoring.

'Management activity' relates to formal roles outside the practice, such as a role within your PCO or an advisory role for the SHA or an NHS trust, not management within the practice.

'Probity' relates to integrity in professional life, including financial and commercial activities. You can give details on the steps you take to ensure this, for example by using an accountant.

The appraisal discussion
Armed with your completed forms, use the appraisal meeting to allow the appraiser to help you reflect more deeply on what you think. It is not pass or fail; the appraiser's skill is in helping you see issues you are missing and helping to decide on an appropriate and relevant plan for the coming year.

Remember it is your professional development, so if you think the appraiser is wrong, tell them. At the end, the appraiser will summarise the appraisal on form 4 and ask you to write a professional development plan for the coming year. The form has space for four entries. Try to make what you commit to clear and focused; the more specific you are the easier it is to achieve.

You send form 4 and the professional development plan to the PCO. If there is information you discuss but do not want them to see this can be entered on form 5 but kept by you alone. As an appraiser I have never needed to use it.

Remember that appraisal is an ongoing process, if you collect the information as you go along it ceases being a stressful chore and can become an adjunct to ongoing reflective practice.

Dr Wagman is a GP trainer in Edgware, London.

Appraisal evidence
Appraisal form 3 'material for appraisal' is divided into 10 sections:

  • Good clinical care.
  • Maintaining good medical practice.
  • Relationships with patients.
  • Working with colleagues.
  • Teaching and training.
  • Probity.
  • Management activity.
  • Research.
  • Health.
  • Overview of development and needs.

Source: DoH; Appraisal for general practitioners working in the NHS.

Learning points

How to get the most from your appraisal

  1. All GPs need to undergo annual appraisal to remain on the medical performers list.
  2. The appraisal is expected to form part of the package of evidence for revalidation.
  3. Collect evidence of your relationships with patients, working with colleagues and clinical performance as you go along, and take it for reference in the appraisal discussion.
  4. Complete the pre-appraisal forms on a computer so that you can cut and paste sections on a year-to-year basis.
  5. Use the appraisal discussion as an opportunity for reflection, facilitated by the appraiser.
  6. Identify specific actions for your professional development plan.

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