RCGP Guide to Supporting Information for Appraisal (March 2016)
Here is that rarest of beasts, a guidance document that makes things more sensible. This really will reduce inconsistencies in interpretation and streamline recommendations: it has been welcomed by local appraisers.
- All learning can now be counted as CPD whether it arises from formal “learning activities” or from quality improvement activities (QIAs), reflection on significant events, complaints or any other feedback. One hour equals one CPD credit but the routine “doubling for impact” will not be accepted from 1st April 2016.
- There will no longer be any requirement to scan in certificates of attendance for CPD. Appraisers have always preferred to talk about what has been learned and what difference it made to practice. This recommendation actually reinforces a sense of trust during an appraisal.
- It is expressly stated that appraisal is about documenting quality and not quantity of CPD. The new guide recommends that GPs provide a few high quality examples that shows how we keep up to date, review what we do and reflect on feedback across the whole scope of our work over the five year revalidation cycle. There is no need to record everything and certainly not over and above the annual average 50 CPD credits.
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Significant Events are now better defined and are really serious. The GMC has decided these now mean a serious or critical incident in which you were named or personally involved in which serious harm did, or could have, occur to a patient. (In the national Revalidation Management System these are now defined as Serious Incidents Requiring Investigation or Serious Untoward Incidents and APPRAISERS are recording “none” in most cases, having been instructed to disregard most “GP SEAs” for these purposes.) Only incidents which meet this GMC level of harm need to be recorded as Significant Events at appraisal. The more usual “GP” type of SEA can therefore be included in QIAs – see next point.
- Quality Improvement Activities can take many forms. There is no requirement for GPs to do a formal two cycle audit once in the five year cycle (although some may still wish to do so) but case reviews, SEAs and so on can all be included in this field and it is recommended that QIAs are included in every year, covering the whole scope of work over the five year cycle.
- Colleague Feedback still needs to be done using a GMC-compliant survey once in the cycle. However other forms of feedback, for example for training doctors from their trainees or for appraisers from their doctors (the forbidden term “appraises” is used and perhaps is being rehabilitated?) need not be GMC-compliant in terms of numbers or anonymity. Smaller surveys like this might be better kept out of the main survey.
- Patient surveys. Patient groups told the RCGP that it was “unacceptable” that GPs, who see more than the GMC recommended minimum number of patients in a single day, only have to review a patient survey once in five years. Nevertheless the new guide states that a formal survey still need only be done once each cycle. However, GPs are now recommended to reflect upon other feedback every year. Examples given range from “throw away” remarks and compliments, to the formal Friends & Family and the National Patient Surveys. No additional work need to be undertaken, just reflection on what is received.
Finally, and really importantly the new guide stresses that, where the specifics of a recommendation are not applicable in a particular context then it is a matter of professional judgement (sic) between the doctor and the appraiser to decide on the most appropriate recommendation for the individual although prior advice and approval from the responsible officer is advisable. This is a very welcome document.
Dr Barry Moyse
Deputy Medical Director
