Revamped appraisal could combat GP burnout, says former RCGP chair

GP appraisal should help doctors avoid burnout by focusing more on wellbeing alongside performance, a former RCGP chair and mental health advocate has said.

Professor Clare Gerada: call for appraisal overhaul (Photo: Pete Hill)
Professor Clare Gerada: call for appraisal overhaul (Photo: Pete Hill)

NHS Practitioner Health (PH) medical director Dr Clare Gerada - who in 2010 became the first woman for 50 years to chair the RCGP - has suggested that GP appraisals should be rethought to give doctors an opportunity to discuss their career progress and share concerns.

Speaking to GPonline Dr Gerada said the move could help GPs to fend off burnout and promote discussions around wellbeing - helping to safeguard doctors against anxiety and depression.

The current appraisal system does not give doctors the time they needed to reflect on their careers, discuss future moves or pressure and is too performance-focused, she warned. Dr Gerada also called for the establishment of a national careers advice service to support doctors' professional development throughout their careers and help them through 'pinch points'.

The former RCGP chair's comments come after a recent GMC report revealed one in six GPs were considering quitting medicine entirely within the next 10 months, with one in four giving answers that indicated they were at ‘high risk of burnout'.

GPs lacking support

Dr Gerada said the demands of modern general practice and its heavy workload had left the profession unable to care for itself.

‘What's gone is the time to talk to each other, the time at the coffee machine, the time at the water fountain,’ she said. ‘I used to go and sit down with my partner between patients and have 10-15 minutes chatting about something, maybe not even patients.

‘If you think about somebody who is five years into the job, they've probably got a heavy mortgage, have two kids, they may have a lot of financial issues and have precious little time. But they need time just to be able to step back and reflect, and I think that's what appraisals should be.

‘Maybe every five years, GPs would be sent an email that says; do you want to come and have a chat about what's going on? And, if it is linked to the appraisal system, the appraisal, rather than getting the GP to provide documentation of what they've done in terms of performance, it looks at where you’re going.’

Reflection time

The former RCGP chair argued that appraisals could be changed to encompass personal-professional development, allowing them to discuss concerns at ‘pinch points’ in their career.

‘I think appraisals could be much, much, much more formative. In other words, they could be a process which asks GPs how they are doing and what can be done to help them - not how can I catch you out because you haven't done your child protection training.’

At present, appraisals are a local NHS England process, which feed into the five-yearly revalidation process introduced in 2012. Annual GP appraisals focus on six key areas including CPD, patient feedback, complaints and compliments.

Although doctors must confirm whether they are registered with a GP and self-declare health issues that could be impacting their work, there is a limited focus on wellbeing and career reflection.

A recent GMC report which explored ways to create a more compassionate working environment for doctors found it was 'essential that there is a strong focus on wellbeing and the support available to appraisees in annual appraisals'.

Careers advisory service

Dr Gerada also argued that establishing a national careers advisory service would give GPs the support they needed to discuss professional challenges.

'I think what's lacking is some sort of equivalent NHS PH but for those who are well. This would help doctors to look at the different stages of their career and what support they might need.

‘So you're not even sick, it's not about being sick, but acknowledging that in a career like mine, which is now 40 years nearly - just saying ‘it’s hit and miss’ across 40 years is not good enough. You need people that are looking after you in some way.’

NHS PH has helped to support over 10,000 doctors since its establishment in 2008, with around 1,800 GPs having an active case with the service. Between September 2018 and 2019, the number of GPs registering with the service each month increased by around 10%.

Earlier this month GP leaders called for a crackdown on ‘unsafe’ workloads following the death of two GPs by suicide in the last nine months.

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