ࡱ> NPMy .bjbjEE *:''&KKKKK____ k$_K#t"""""""$$a'"K"KK#KK""!|"À…_r""#0K#"''$"'K" ""K#' :  Somerset LMC Position Paper on GP Appraisal Introduction The LMC supports the principle of GP appraisal on the understanding that it is to be a supportive process We recognise that it has a number of virtues. It is an opportunity for GPs to consider and reflect upon their clinical practice and professional development. It allows the appraisee to get an objective view of their practice, and some feeling for how this compares with that of colleagues. It should help individuals to identify personal, practice, and systems problems and to obtain help in addressing them It will reassure some patients that an assessment of GPs is being undertaken on a regular basis It will form a substantial part of the material that doctors need to collect for their GMC revalidation. Potential problems However, there are a number of difficulties that need to be anticipated if the exercise is to be worthwhile This is extra work for an already overburdened profession. It may be perceived as threatening to the point that some perfectly. competent GPs choose to leave practice rather than undergo it. There must be a mechanism for dealing with issues that are raised. Appraisers must be trusted members of the profession. There is a risk that it will become stale with repitition. It must be adequately funded Funding The DH has said that appraisal must be fully funded by PCTs. In the LMC view this means that all the work that is displaced by participating in the exercise, whether as appraiser or appraisee, must be paid for. The amount of work that GPs should undertake in preparation and so on will be determined by the resource that the PCT chooses to make available. GPs are only required to participate in appraisal when and if properly supported schemes are in place. Preparation The pre-appraisal documentation (copies can be found at  HYPERLINK "http://www.doh.gov.uk/gpappraisal" www.doh.gov.uk/gpappraisal ) is largely straightforward but will take some time to complete. GPs should count all the time that they spend on this, including gathering together papers, background reading, etc. If PCTs allow a limited amount of money for preparation, then GPs should work for as long as they are paid and no longer. If the pre-appraisal form is incomplete as a consequence, then so be it. Some of the material can be prepared on behalf of the practice, and some of it GPs may already be doing as part of a local practice quality programme. If practices are not funded through another channel for GPs to prepare their PDPs then this would be an appropriate use of preparation time. The LMC strongly opposes the inappropriate use of PGEA funds for completing pre-appraisal paperwork. Whilst work in relation to PDPs and reflection about educational activities are legitimate activities for PGEA time, pre-appraisal itself is not. Notice of Appraisal GPs will need 2 months notice of their appraisal date. This needs to be sufficiently flexible to account for reasonable absence for example, because the doctor is on leave and also to ensure that the practice is able to deliver a normal service to patients. Patient care must not be compromised by the appraisal process. Availability of locums will be a crucial matter, but appraisal is most definitely part of the working day and must not be allowed to become an added extra done at times when the doctor is not normally in the practice. If a locum cannot be obtained, then the appraisal will have to be deferred. Appointment of Appraisers The LMC expects appraisers to have a background in general practice medical education, or otherwise to be a respected local member of the profession. The LMC should be informed of the appointments and approve them. Allocation of Appraisers We anticipate that appraisal will normally be carried out by a single appraiser, normally from the appraisees own PCT. GPs should have the right to decline to be appraised by up to two appraisers without giving a reason. They should also be able to request in writing before the allocation that an external appraiser be appointed. The LMC recognises that for educational and quality control purposes some appraisals may need to be undertaken by more than one doctor. Appraisees must be notified of this intention in advance and allowed to object in writing to the proposal. Remuneration of Appraisers Appraisal is a complex and demanding process that requires special skills. This must be recognised in the remuneration package. The LMC view is that there are four elements to this: Full reimbursement of cost to the practice of employing a locum Payment to the appraiser for his skill and expertise Recompense/ incentive to the practice for allowing the appraiser time away for this task. Mileage Under some circumstances the practice may make their own internal arrangements for locum cover. In this case they should be paid the current LMC locum rate for the total period that the appraiser is absent. In other cases they should be paid the actual cost of employing a locum, against an invoice raised by the locum agency or individual doctor. If a PCT salaried doctor is available then this would be an alternative. The appraiser is undertaking work outside of normal general practice that requires special expertise. Time is required after the appraisal to complete a report, a follow up call is expected,and further training may be required. All this must be recognised. The LMC suggests that a personal payment of 150 would be appropriate. A locum never fully replaces an absent partner. Both the practitioner and the practice will have to undertake the displaced work at some time. Furthermore, there needs to be some incentive to the practice to encourage them to allow the appraiser to be absent. The LMC suggests that this payment should be 50. Mileage should be paid for the appraiser to travel from his or her surgery. The current LMC rate is 50p per mile. Reimbursement of appraisees The amount of time required in preparation will vary from individual to individual, and may fall after the first year. It is probably not worth asking GPs to submit detailed costings for their time at this stage but there is a significant gap between the GPC estimate of time required (9 hours) and that proposed by the DH (4 to 6 hours). However, the DH letter (PL/CMO/2002/3) does state that in the first year the time commitment may be higher. GPs should therefore record all the time that they spend on appraisal related work. As a starting point the LMC suggests that appraisees should receive two half day locum payments at either the LMC rate or the actual cost, whichever is higher. If a practitioner can demonstrate that he or she has spent significantly longer on the process, then PCTs should honour any reasonable claim for extra payment. Alternatively, the PCT may have salaried doctors who can be deployed to cover the necessary absence. The LMC advice is that GPs should complete as much of the process as they are reimbursed for. Reporting on Appraisal 10.0 Appraisal should be confidential between the participants. The PCT needs only to know that it has taken place and to receive a copy of the apprasiees PDP. A more extensive appraisal summary may be submitted if necessary. 10.1 Very occasionally the appraiser may identify very serious performance or health concerns. He or she should do their utmost to persuade the appraisee to report these themselves to the LMC, the PCT clinical governance lead, or to Occupational Health. If the appraisee declines to do so then the appraiser may be required under GMC rules to take action. We recommend a discussion with the LMC medical secretary in the first instance. 10.3 However, the appraisee may identify areas where PCT action could produce improvements in some aspect of his or her professional life. The LMC encourages appraisees to identify 2 or 3 such action points for reporting to the PCT, and suggests that appraisers collate these. It will be a useful measure of the value of appraisal to see whether they have been acted on by the time of the appraisal review or the next formal appraisal. 10.4 Appraisers must be prepared to cope with emotional and personal issues that may be revealed by the appraisee in the course of an appraisal. Whilst these may or may not be relevant to the doctors performance, the LMC considers that the appraiser must ensure that the appraisee has a plan of action for dealing with any significant issues before the appraisal process is completed. Follow up of Appraisal All appraisees should have a follow up discussion in about 6 months arranged with their appraiser at the time of the formal interview. This could be undertaken on the phone, but either party should be able to request a face to face interview. Reflection time and the review must be funded by the PCT and should take place in working hours. If educational needs that must be met to ensure safe performance are identified that are outside the scope of normal CME activities then these should be addressed through existing educational channels, funded by the PCT. Appeals Mechanism Appraisees who are unhappy with the conduct or conclusions of an appraisal should preferably say so at the time. They should not sign an appraisal summary with which they are unhappy. The LMC suggests that if any concerns cannot be resolved at the time the appraiser should normally arrange to return at a later date with an independent external appraiser. If this is not appropriate or not successful, the appraisee should in the first instance discuss the position with the clinical governance lead of the PCT who will try to resolve the matter informally. If this fails, then the appraisee should ask for a formal panel hearing to be convened by the PCT. We strongly advise that GPs discuss any problems with the LMC before they reach this point. Harry Yoxall Medical Secretary ./0= !  ' /  DEXrtuv70DJHd ,!(#)###y))**++...żů̧h]5>*CJh]0JCJjh]CJUh]5>*CJ h]5CJjh]5CJUh]56>* h]5>* h]6>* h]>*h]jh]U7./0=H C  !  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