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The appraisal process

Every doctor undergoing appraisal needs to prepare an appraisal folder demonstrating information, evidence and data to inform the process, which can be updated as necessary. The process is not about acquiring new evidence or information, but pulling together what exists already.

The doctor and appraiser will agree a written overview of the appraisal, which should include a summary of achievement in the previous year, objectives for the next year, key elements of a personal development plan, actions expected of the organisation, a standard summary of the appraisal and a joint declaration that the appraisal has been carried out properly.

Chief Executives of NHS organisations are accountable for ensuring appraisal takes place, that appraisers are properly trained to carry out this role, and are in a position to undertake appraisal of a doctor's whole practice, including clinical performance, and where appropriate, service delivery and management issues.

Preparation

Successful appraisal depends on both the parties giving their contribution some thought beforehand. Both parties should give themselves enough time to produce, exchange and consider any documents necessary for the appraisal - a few weeks rather than a few days in advance is best. GPs should have at least two months' notice of their appraisal appointment. Where, for whatever reason, a third party needs to contribute to an appraisal - or, indeed, where a special appraiser has to be called in - this should also be discussed and agreed well in advance.

We suggest that it would help the process greatly if both the appraiser and the appraisee thought through the following questions before the interview:

AL(MD)6/00, (Department of Health 2000) paragraph 13, explains that 'To be successful, the appraisal scheme must be introduced with an appropriate level of support to appraisers and appraisees. Adequate time should be allocated for the preparation...'. It is essential, therefore, that adequate time is allocated, both for the appraiser and the appraisee. Employers must recognise that preparation time and time for carrying out the appraisal are instead of, rather than additional to the consultant's existing duties and workload, and therefore should take place during usual working hours. In order to prepare for appraisals, individuals should be explicitly released from other duties for a specified period of time and GPs should be given protected time. It must be recognised that appraisees undergoing their first appraisal will require further time for work involved in setting up their appraisal folders.

Using the appraisal documentation

The Chief Executive has overall accountability for ensuring appraisal takes place and will receive copies of the forms summarising the outcome of the appraisal; Forms 1-4 (Form 4 only for GPs).

Job planning and comparative data for consultants

The introduction of an appraisal scheme for consultants is linked closely with job planning arrangements. The appraisal process and the interview provide an important opportunity to draw together information and data from which the job plan and a work programme are shaped. The documentation here - Form 5 - provides for a record of the basic information underpinning discussion of the job plan (including any pertinent internal and external comparative information), so that it can be used as a cross-reference between this and the other parts of the appraisal process.

Form 5 for GPs is an optional form to provide a fuller account of the appraisal discussion than is covered in Form 4.

Concerns arising during appraisal

It would be exceptional for serious concerns about performance to be raised first in an appraisal. However, both the appraiser and the appraisee need to recognise that as registered medical or dental practitioners they must protect patients when they believe that a colleague's health, conduct or performance is a threat to patients (GMC Good Medical Practice paragraph 23; GDC Maintaining Standards paragraph 2.4). If, as a result of the appraisal process, the appraiser believes that the activities of the appraisee are such as to put patients at risk, the appraisal process should be stopped and action taken. The appraiser must refer the matter immediately to the senior clinician/clinical governance lead and [PCT] chief executive to take appropriate action. This may, for example, include referral to any support arrangements that may be in place. If the situation is then remedied the appraisal process can continue. Nothing in the operation of the appraisal process can over-ride the basic professional obligation to protect patients.

Evaluation

• Revalidation Piloting Exercise - Stage 2: Report from the Revalidation Technical Group