Scope and nature of work
The doctor should define the scope and nature of the work that they carry out as a doctor.
The GMC has confirmed that this should include all roles and positions in which the doctor has clinical responsibilities and any other roles for which a licence to practise is required.
For example, it should include work for voluntary organisations and work in private or independent practice and should include managerial, educational, research and academic roles.
The GMC guidance 'Supporting Information for Appraisal and Revalidation' sets out the six types of supporting information that a doctor will be expected to provide over the course of each five-year cycle in relation to their scope of practice:
- Continuing professional development
- Quality improvement activity
- Significant events
- Feedback from colleagues
- Feedback from patients
- Review of complaints and compliments
Collectively, this evidence should address the four domains of the Good Medical Practice Framework for Appraisal and Revalidation.
These four domains are:
- Knowledge, skills and performance
- Safety and quality
- Communication, partnership and teamwork
- Maintaining trust
Attributes within these four domains and examples of principles and values may be seen in the Good Medical Practice Framework for Appraisal and Revalidation.
The medical royal colleges and faculties have produced specialty guidance frameworks that offer additional guidance and detail and assist the doctor in preparing for appraisal. You should refer to these if you are within a specialty.
The preparation of supporting information for appraisal and revalidation is important, but it is the reflection on the information that will lead to identification of areas for development and improvement – the key benefit of reflection is the learning that comes from it, and the positive actions that the doctor can take forward.
It is not always necessary to record reflections on each and every item of supporting information. It may be more appropriate to record reflections on a summary, or category of the information, keeping in mind the learning outcomes. The appraisal process should ensure that this reflection occurs. The GMC does not require a specific way to reflect. Doctors can discuss individual arrangements and expectations locally to establish if an acceptable alternative to written reflections can be used (although this option may be more suited to doctors working in secondary care).
The 2018 Gold Guide ‘A Reference Guide for Postgraduate Specialty Training in the UK’ sets out the arrangements agreed by the four UK health departments for specialty training programmes. This includes a number of references to reflection. It notes that trainees must reflect regularly on their standards of medical practice in accordance with GMC guidance on licensing and revalidation, participate in discussion and any investigation around serious incidents in the workplace, and record reflection of those in their educational portfolio.
The recent case involving Dr Bawa-Garba, a junior doctor who was convicted of manslaughter by gross negligence in November 2015 and removed from the medical register in January 2018 following a High Court judgement, has led many doctors to feel they are no longer able to reflect honestly, openly and safely, due to fears of recrimination – and resulted in a call for some doctors (GPs) to disengage from written reflections until adequate safeguards are in place. However, Dr Bawa-Garba's medical defence organisation have confirmed that her e-portfolio (or the duty consultant’s trainee encounter form) did not form part of the evidence before the court and jury.
The GMC has also confirmed that it will never ask a doctor to provide his or her reflective statement when investigating a concern about them, or ask for this to be provided by Royal Colleges or third parties. Although it is rare and unusual for a court to order the disclosure of this kind of material, in theory they can do so. However, doctors’ reflections have often led to the discontinuance of disciplinary and GMC action. They can form an important part of a doctor’s defence in fitness to practise hearings and can be used to demonstrate remediation and current safe practice.
All doctors should be aware of existing guidance on reflection. Guidance on entering information on e-portfolios was published by the Academy of Medical Royal Colleges (AoMRC) in November 2016, and additional interim guidance on reflective practice has also been published following the case of Dr Bawa-Garba. This guidance makes clear that any written reflections should be fully anonymised. Further guidance has been produced by the medical defence organisations, including the Medical Defence Union. If you are approached to disclose any appraisal information or training documentation you should seek guidance from your medical defence organisation.
Along with the AoMRC, the Conference of Postgraduate Medical Deans, and the Medical Schools Council, the BMA will be contributing to the development of GMC guidance for all doctors and medical students on how to approach reflective practice. This guidance is due to be published in summer 2018.
In response to the Williams review into gross negligence manslaughter (GNM) in healthcare, the BMA recommended that legal protection is provided to reflections in all education and training documents, such as e-portfolios and all annual appraisals, training forms and the Annual Review of Competence Progression – this recommendation will also form part of the BMA’s submission to the GMC’s review into GNM.
Review of last year's personal development plan (PDP)
The doctor should provide a commentary on the previous year's personal development plan (PDP). It is generally expected that the previous year's objectives would have been completed although circumstances and priorities may have changed (for example, a doctor's job may have changed).
It may also be that some objectives take longer than a year to complete and it may therefore be inappropriate for the plan to be completed, although this should normally be recognised and agreed at the time the plan is written.
The appraisal portfolio should include the personal development plan and summaries of appraisal discussion for each year in the current revalidation cycle.
Achievements, challenges and aspirations
The doctor may also wish to include a commentary on recent achievements, challenges and aspirations, to help review practice and plan for future development needs.
Declarations before the appraisal discussion
Doctors should make a declaration that is visible to the appraiser that demonstrates:
- acceptance of the professional obligations placed on doctors in Good Medical Practice in relation to probity and confidentiality
- acceptance of the professional obligations placed on doctors in Good Medical Practice in relation to personal health
- personal accountability for accuracy of the supporting information and other material in the appraisal portfolio
Organisations have an obligation to assist doctors in collecting supporting information for appraisal. A doctor cannot be held responsible for genuine errors in information that has been supplied to them.