Preparing for Preparing for appraisal:appraisal:what’s changing ?what’s changing ?

Dr Paula WrightDr Paula WrightGP tutor for Newcastle EastGP tutor for Newcastle EastGP tutor for Sessional GPsGP tutor for Sessional GPsDeanery Adviser on Retainer and Deanery Adviser on Retainer and FCSFCS

Preparing for Preparing for AppraisalAppraisal Form3Form3

Evidence –general issues & Evidence –general issues & specificsspecifics

Pulling it togetherPulling it together

Changing emphasis of Changing emphasis of appraisalappraisal Shift to summative emphasis (to Shift to summative emphasis (to

performance review)performance review) Explicit standards of performance Explicit standards of performance

against which doctors are judged against which doctors are judged Explicit standards of evidenceExplicit standards of evidence Will need to be more robust (QA) Will need to be more robust (QA)

because of link to revalidationbecause of link to revalidation

Form 3 (I)Form 3 (I)1.1. FactualFactual statement about role statement about role

(and changes) and working (and changes) and working circumstancescircumstances

2.2. FactualFactual statements about statements about Progress against last years Progress against last years “actions” and PDP aims “actions” and PDP aims supported by supported by evidenceevidence

3.3. FactualFactual Statements about Statements about personal performance explicitly personal performance explicitly supported by supported by evidenceevidence

Form 3 (II)Form 3 (II)

5.5. ReflectiveReflective Statements about Statements about performance showing performance showing insightinsight into level of competence and into level of competence and areas of weakness.areas of weakness.

6.6. Intentions for Intentions for developmentdevelopment linked to linked to reflections & evidence reflections & evidence on performanceon performance

FORM3- MGMPFORM3- MGMP How were learning needs How were learning needs

identified ?identified ? Why were these learning Why were these learning

activities chosen ?activities chosen ? What reflection has taken place ?What reflection has taken place ? (Difference between GCC and (Difference between GCC and

MGMP)MGMP)

EvidenceEvidence Ideally:Ideally:

1.1. Relevant to the doctor’s individual Relevant to the doctor’s individual work (not just practice work)work (not just practice work)

2.2. Relevant to patient outcomes (not Relevant to patient outcomes (not just process measures)just process measures)

3.3. Objective/ Verifiable/ Validated tool Objective/ Verifiable/ Validated tool for which there are benchmarksfor which there are benchmarks

But…. Tension between 1 and 3 But…. Tension between 1 and 3

Challenge of evidenceChallenge of evidence

Most care is delivered by teams NOT Most care is delivered by teams NOT by individualsby individuals

So difficult to link clinical So difficult to link clinical OUTCOMES measures to PERSONAL OUTCOMES measures to PERSONAL PERFORMANCE (sp locums)PERFORMANCE (sp locums)

Can audit PROCESS MEASURES Can audit PROCESS MEASURES linked to personal practice (e.g. BP linked to personal practice (e.g. BP monitoring, TSH monitoring etc)monitoring, TSH monitoring etc)

So what can we do ?So what can we do ?

Aim for Aim for personal evidencepersonal evidence (personal audit, GPAQ etc) not (personal audit, GPAQ etc) not just practice aggregated datajust practice aggregated data

Personalise the evidence wPersonalise the evidence where here practice data used: personal practice data used: personal role ?role ?

Personal reflectionPersonal reflection on each item on each item of evidence submittedof evidence submitted

Commenting on Commenting on EvidenceEvidence in FORM3 in FORM3 What does this evidence SAY ?What does this evidence SAY ? What does it say ABOUT YOU ?What does it say ABOUT YOU ? How have YOU CONTRIBUTED to How have YOU CONTRIBUTED to

the level of achievement the level of achievement demonstrated ?demonstrated ?

How will YOU ALTER YOUR How will YOU ALTER YOUR PRACTICE in response to the PRACTICE in response to the performance demonstrated ?performance demonstrated ?

Napce –EVIDENCE Napce –EVIDENCE STATEMENT Feb 2007STATEMENT Feb 2007 Essential evidence-personalEssential evidence-personal Essential evidence-organisational Essential evidence-organisational

(practice folder)(practice folder) Optional evidenceOptional evidence

(Leicester/ NAPCE statement)(Leicester/ NAPCE statement)

http://www.appraisalsupport.nhs.ukhttp://www.appraisalsupport.nhs.uk

Evidence: Evidence: Good medical care- Good medical care- AUDITAUDIT personal care-OUTCOMES or personal care-OUTCOMES or Group care OUTCOMES in area where Group care OUTCOMES in area where

has taken an initiative or lead role has taken an initiative or lead role (e.g. COPD etc) (e.g. COPD etc)

PROCESS AUDIT E.g. referrals, PROCESS AUDIT E.g. referrals, admissions, records, prescribing, admissions, records, prescribing,

Structured case reviewsStructured case reviews … … less usefulless useful Qof, PACT, Qof, PACT,

Evidence: Evidence: Maintaining Good medical Maintaining Good medical practicepractice Educational log of activities Educational log of activities with reflectionswith reflections Last years PDP with statement of what has Last years PDP with statement of what has

been achieved and what not (evidence)been achieved and what not (evidence) Evidence of assessment of knowledgeEvidence of assessment of knowledge Structured reflective templateStructured reflective template Less useful: Less useful: Certificates, Handouts or Certificates, Handouts or

programmesprogrammes

Note- for revalidation probably determined Note- for revalidation probably determined by colleges (knowledge test)by colleges (knowledge test)

Relationships with Relationships with patientspatients

Patient surveyPatient survey Complaints data or declaration of Complaints data or declaration of

nonenone optionaloptional Evidence of consultations skills Evidence of consultations skills

trainingtraining Less useful areLess useful are Practice policies about patient removals, Practice policies about patient removals,

confidentiality, and consent etcconfidentiality, and consent etc

Relationships with Relationships with colleaguescolleagues

360 degree feedback (online or 360 degree feedback (online or paper) facilitated by 3paper) facilitated by 3rdrd party, party, validated toolvalidated tool

Account of team workingAccount of team working ……optionaloptional Evidence of learning in context of colleague Evidence of learning in context of colleague

relationshipsrelationships Minutes of practice meetingsMinutes of practice meetings

Teaching and trainingTeaching and training

Outline of teaching sessions Outline of teaching sessions developeddeveloped

FeedbackFeedback Development of educational skillsDevelopment of educational skills

ProbityProbity

Probity statement from Scottish Probity statement from Scottish RCGP revalidation toolkit.RCGP revalidation toolkit.

CRBCRB Conflict of interest statement- Conflict of interest statement-

specially where moving towards specially where moving towards new models of GP with profit armnew models of GP with profit arm

GiftsGifts Disciplinary actions/ investigationsDisciplinary actions/ investigations

HealthHealth

Health statement from RCGP Health statement from RCGP revalidation toolkitrevalidation toolkit

Hep immunityHep immunity

Comment: time off work/ Comment: time off work/ adaptations to work on health adaptations to work on health grounds, Registered with GPgrounds, Registered with GP

Appraisal ToolkitAppraisal Toolkit Many tools for recording evidence:Many tools for recording evidence:

– educational diary with reflectionseducational diary with reflections– PUNS AND DENS; Audit, complaints etcPUNS AND DENS; Audit, complaints etc

can carry over things from one year to can carry over things from one year to next (e.form1,2 pdp etc)next (e.form1,2 pdp etc)

Can access from various sites Can access from various sites Organises all info including documents Organises all info including documents

which can be uploadedwhich can be uploaded Extracts- go into overview/summaryExtracts- go into overview/summary Administrative- linking Administrative- linking

pct/appraisee/appraiserspct/appraisee/appraisers

Pulling it all together Pulling it all together

Forms 1-3 Forms 1-3 EvidenceEvidence Last yearsLast years form4 and PDP form4 and PDP Draft PDP for next yearDraft PDP for next year Index your appraisal folderIndex your appraisal folder Use appraisal toolkitUse appraisal toolkit