Appraisals

Last updated:

Stages of an appraisal

A medical appraisal is undertaken annually at a meeting between a doctor and a colleague who is trained as an appraiser.

The doctor is required to collect supporting information that is relevant to their scope and nature of work.

If more detailed guidance is needed, individuals should contact their appraiser responsible officer. It may also be appropriate to discuss specialty issues with the appropriate college or faculty.

 

  • Stage 1: Inputs into appraisal

    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.

     

    Supporting information

    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:

    1. Continuing professional development
    2. Quality improvement activity
    3. Significant events
    4. Feedback from colleagues
    5. Feedback from patients
    6. 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.

     

    Reflection

    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.

  • Stage 2: The confidential appraisal discussion

    The discussion, which normally takes between 1 and 2 hours, explores the evidence that the doctor has submitted and considers the development needs of the individual. 

    The discussion is confidential although there may be circumstances in which the appraiser must share information with others, in line with their professional duties - where issues of patient safety are raised for example. 

    When in doubt the appraiser or the doctor may wish to discuss this with the appraisal lead, responsible officer or nominated deputy.

  • Stage 3: Outputs from appraisal

    The doctor's personal development plan (PDP)

    The doctor and the appraiser should agree a new personal development plan at the end of the appraisal. The plan should contain a list of personal objectives with an indication of the period of time in which items should be completed and how completion should be recognised.

    The personal development plan represents the main developmental output for the doctor. It may be appropriate to combine this plan with any objectives arising from job planning and from other roles so that the doctor has a single development plan.

     

    The summary of the appraisal discussion

    The doctor and the appraiser should agree a written summary of the appraisal discussion, including an overview of the supporting information and the the extent to which the supporting information relates to all aspects of the doctor's scope and nature of work. It should also include the key elements of the appraisal discussion itself.

    It may also be helpful for the appraiser to record a brief agreed summary of important issues for the doctor in that year to ensure continuity from one appraiser to the next.

     

    The appraiser's statements

    The appraiser should make a series of statements to the responsible officer that will, in turn, inform the responsible officer's revalidation recommendation to the GMC. The appraiser should discuss these with the doctor.

    The appraiser's statements should confirm that:

    1. An appraisal has taken place that reflects the whole of a doctor's scope of work and addresses the principles and values set out in Good Medical Practice
    2. Appropriate supporting information has been presented in accordance with the Good Medical Practice Framework for Appraisal and Revalidation and this reflects the nature and scope of the doctor's work
    3. A review that demonstrates appropriate progress against last year's personal development plan has taken place
    4. An agreement has been reached with the doctor about a new personal development plan and any associated actions for the coming year.

    There may be circumstances where an appraiser is unable to make a positive statement. For example, a doctor may not have made significant progress with the previous year's personal development plan because of a period of prolonged sickness. In this event, the issue is drawn to the attention of the responsible officer and it does not mean that the doctor will not be recommended for revalidation.

    The doctor and the appraiser should each have the opportunity to give comments on the statements to assist the responsible officer in understanding the reasons for the statements that have been made.

    The appraiser must remain aware when conducting an appraisal of their duty as a doctor as laid out in Good Medical Practice. The appraisal summary should include a confirmation from the appraiser that they are aware of those duties.

    "I understand that I must protect patients from risk of harm posed by another colleague's conduct, performance or health. The safety of patients must come first at all times. If I have concerns that a colleague may not be fit to practise, I am aware that I must take appropriate steps without delay, so that the concerns are investigated and patients protected where necessary."

    This provides the context for a further statement that:

    1. No information has been presented or discussed in the appraisal that raises a concern about the doctor's fitness to practise.

    The appraiser and the doctor should both confirm that they agree with the outputs of appraisal and that a record will be provided to the responsible officer.

    If agreement cannot be reached the responsible officer should be informed. In this instance the appraiser should still submit the outputs of the appraisal, but the responsible officer should take steps to understand the reasons for the disagreement.

  • Timetable

    • 4 weeks before
      Agree a time and place to meet with appraiser. Prepare supporting evidence.
    • 2 weeks before
      Complete documentation and forward to appraiser(s). There may be computer-based or online systems for this.
    • Appraisal
      Discuss the work undertaken in the previous year informed by the supporting evidence and agree development needs.
    • Within 2 weeks
      Complete appraisal forms and submit summary and PDP to clinical director/head of department and responsible officer.

    Your responsible officer or suitable person will usually make a recommendation for revalidation once every five years and the GMC will inform doctors of their revalidation date. 

    View our revalidation FAQs