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Appraisal questions and answers - general

What is appraisal?

Appraisal is a positive process to give doctors feedback on their past performance, to chart their continuing progress and to identify development needs. It is a forward-looking process, essential in identifying the developmental and educational needs of individuals. The primary aim of appraisal is to help doctors consolidate and improve on good performance, aiming towards excellence. In doing so, it will identify areas where further development may be necessary or useful: the purpose is to improve performance right across the spectrum, from the best to the worst. It can help to identify reductions in performance at an early stage; and also to recognise factors, which may lead to a reduced level of performance, such as ill health. Appraisal will underpin CPD and help to develop a reflective culture within service and training.

What is appraisal based on?

The content of appraisal will be based on the core headings set out in the GMC’s Good Medical Practice document (see link below).

The core headings of the Good Medical Practice are:

• Good clinical care
• Maintaining good medical practice
• Relationships with patients
• Working with colleagues
• Teaching and training
• Probity
• Health

Is there standardised documentation for appraisal?

Completion of documents prior to appraisal provides the basis for constructive dialogue between appraiser and appraisee. It then allows a record to be made of both the reflections on past performance and identified professional development needs. NHS appraisal will make use of standardised documentation, which should ensure that information from a variety of NHS sources will be recorded and expressed consistently. The documentation will provide a formal, supportive, consistent structure to the appraisal process. It covers the process in sequence and suggests the information and evidence that the parties to appraisal will wish to bring to the process.

What happens where an issue of poor performance is/concerns are raised during the appraisal discussion?

There should be clear agreed local procedures for resolving individual concerns about appraisal, which fit within the following national model. The process must be able to address any worries or complaints from individual doctors about the fairness and consistency of the scheme, the appraiser, the outcomes of the appraisal or the use of information. An individual doctor’s concerns about their own appraisal should be raised in the first instance with the appraiser. If personal concerns remain, the doctor should discuss them with the Medical Director (for consultants) or senior clinician/clinical governance lead for the PCT (for GPs). The Medical Director or senior clinician/clinical governance lead should in the first instance try to find an informal resolution to the problem through discussion and mediation, involving others as appropriate. If serious concerns are identified that cannot be resolved locally, the case should be referred to the GMC.

In the exceptional circumstances that concerns can not be resolved in this way, the Hospital Trust or the PCT senior clinician/clinical governance lead (or Chief Executive) might convene an appropriately constituted panel to consider the matter further, this should come before the matter is referred to the GMC.

Where concerns or views relate to the appraisal system itself, these should be raised with the Hospital Trust or PCT Chief Executive.

Where there are worries or complaints, the GP will have the right to representation (e.g. from their LMC).

What should be the outcome of an appraisal?

The appraisal should conclude by setting down, as an action plan, the agreements that have been reached about what each party is committed to doing. This should include the essentials of the personal development plan (PDP).

The appraisal should identify individual needs that will be addressed through the PDP. The plan will also provide the basis for assessment of resource needs and clinical governance issues within a practice.

The detail of the appraisal discussion will be confidential to the participants.

Where can I get further information?

Further information can be obtained from your NHS Trust.