North of Tyne GP Appraisal –Connecting appraisal outcomes and re-licensing -the responsibilities of appraisers - a draft policy for further discussion February 2008
The White Paper Trust Assurance and Safety refers to re-licensing as requiring:
A- Successful completion of annual appraisal (which is increasingly understood to include submission of an adequate or minimum dataset)
B-Multi-source feedback
C- a local “sign off” by the GMC affiliate that any performance concerns about the doctor have been appropriately dealt with.
GP appraisers have a potential role in steps A and C of re-licensing.
In step A: they can confirm that the doctor has engaged adequately in appraisal, by submitting a form 4 and PDP and an additional checklist that shows that the minimum dataset for evidence (recommended by the PCT) has been submitted.
In step C: Appraisers may at times identify early indicators of potential performance concerns but be unsure of the best course of action to take . These indicators may need to be discussed further as indicated below. They would only become a defined performance concern after due investigation by the Medical Directorate and the Practitioners’ Advisory Group
These two scenarios are discussed separately below.
1. Engagement in the appraisal process
Ø The basic evidence required for appraisal has not been formally defined at a national level, although guidance is available from the NAPCE Leicester statement , and the RCGP Revalidation evidence document.
Ø The North of Tyne Appraisal Strategic Group has approved a minimum data set for GP appraisal evidence [attached as Appendix 1] This has been circulated to all GPs and appraisers
Ø From the beginning of the appraisal year 2008-2009, appraisees will be expected to produce this minimum evidence set to support their appraisal , and the appraiser will record whether these items have been submitted on a separate checklist[appendix 2]
Ø The appraiser will not be put in a position of judging whether lack of evidence should be a “recorded concern”. Their role is to factually document evidence seen and other relevant key points on the supplementary check list to make it easier for directorate to make decisions relating to performance and revalidation at a later date
2. Concerns that may arise during the appraisal process
It would be exceptional for serious concerns about performance to be first raised at an appraisal interview. If appraisal does reveal that a GP’s health, conduct or performance poses a threat to patients, then this information must be passed to the clinical governance lead, and the appraisal interview should be stopped
Department of Health 2002
This is the only official guidance for appraisers on how to deal with concerns that might arise during the appraisal process. It appears to be extremely rare for an appraisal interview to be stopped for this reason. There is no further Department of Health advice on how appraisers should respond to concerns not serious enough to warrant immediate terminate of the appraisal interview. This paper outlines possible courses of action for appraisers who encounter appraisees in difficulty.
Potential performance concerns / Actions agreed and issues for discussion /Issues from the appraisal interview that have caused appraisers concern-
The appraiser is concerned that the appraisee may be at risk of underperforming in the future ,but no evidence that he or she is poses an immediate threat to patient safety. This list is not comprehensive but examples include:
-Significant negative 360 or patient feedback
-Several significant complaints or significant events or refusal to discuss complaints
-Lack of reflection-eg- no weaknesses at all identified or poor quality evidence or evidence that is not adequately personalised
-Serial under-achievement in successive PDPs or minimalist PDPs / OPTION [1]
Anonymous informal discussion (which may be face-to-face or in writing) with appraisal lead or medical director about the issue which is giving concern to the appraiser.
OPTION [2]
Request for advice on a NAMED BASIS. from appraisal lead or medical director-.the appraisee will be made aware that this is occurring . These concerns will be brought to the next monthly Practitioners’ Advisory Group where a decision will be made as to whether the concern that has been highlighted needs further investigation or not.. All documentation written in addition to the Form 4 must be shared with appraisee.
OPTION [3]
The appraiser directs the appraisee to local organisations which may be able to provide help:
e.g. GP choices, occupational health, the deanery
The appraisee’s performance gives rise to serious concerns regarding patient safety. / The appraiser stops the appraisal interview and refers the doctor formally to the medical director/ head of clinical governance and procedures for management of underperformance are triggered.
Appendix 1
North of Tyne –Minimum Dataset for Evidence for GP Appraisal
Core- essential / AdditionalGENERAL / Last years form 4.
SRT = Structured Reflective Template from NAPCE Leicester Statement on evidence-now available on appraisal toolkit www.appraisals.nhs.uk
Or via NCGST website www.apprasialsupport.nhs.uk
Good Clinical Care / 2 out of 3 of the following
· Clinical audit (see detailed comments about audits in above section)+ Structured reflective template.
· Significant event audit with action points/learning outcomes
· Case review -Structured reflective template
The audit and SEA must relate to an area of clinical practice in which the appraisee has a personal role, has had personal involvement in discussing or which impacts on the appraisee work (to be clarified in the SRT). / QoF
PACT data
Practice protocols.
Maintaining Good medical practice / All of the following
1. Last years PDP with evidence (or reflections) about completion of aims
2. Certificates of CPR (18months) and child protection training (3 yearly).
3. log or diary of Educational activities throughout including reflections, personal learning points / Puns and DENS
certificates of attendance/On-line module certificates
personal notes from events
Relationships with patients / · Once every 3 years- Patient survey including mean scores for each question allowing comparison with national benchmarks and Structured Reflective Template
· Annually -Declaration of complaints including learning points and SRT / Skills refresher training-evidence
video consultation analysis
Practice policies on: Patient removal
Consent, Chaperone
Relationships with Colleagues / Once every 3 years: Peer feedback or 360 feedback+ Structured reflective template / Written account of effective team working
Probity / Current GMC certificate and ONE of
· Probity statement- Scottish Royal college of GP (revalidation toolkit document)
· NAPCE Probity Structured reflective template / Practice policy on:
handling of gifts from patients
dealing with drug reps CRB clearance
Health / · NAPCE Health Structured reflective template OR
· Health statement- Scottish Royal college of GP (revalidation toolkit document)
Your form 3 should indicate:
1. What does it say ABOUT YOU ? In what way have you to contributed to the level of achievement demonstrated ? (e.g. I gave a talk to colleagues on pain management including costs which has had an impact on practice)
2. In what way will you alter you practice in response to the performance demonstrated ? (e.g. I have taken on the role of lead for nursing home patients and need to approach the sedative prescribing issue systematically using the help of the pharmacist).
Appendix 2
Supplementary appraisal summary form for medical directorate- Evidence of participation in Appraisal
Name of Appraisee………………………Name of Appraiser ………………..Date……………….
Core- essential / Tick if seenGENERAL / Last years form 4
Good Clinical Care / 2 out of 3 of the following
The audit and SEA must relate to an area of clinical practice in which the appraisee has a personal role, has had personal involvement in discussing or which impacts on the appraisee work (to be clarified in the SRT). / ------
Clinical audit (see detailed comments about audits in above section)+ Structured reflective template.
Significant event audit with action points/learning outcomes
Case review -Structured reflective template
Maintaining Good medical practice / Last years PDP with evidence (or reflections) about completion of aims
Certificates of CPR (18months) and child protection training (3 yearly).
log or diary of Educational activities throughout including reflections, personal learning points
Relationships with patients / Once every 3 years- Patient survey including mean scores for each question allowing comparison with national benchmarks and Structured Reflective Template
Annually -Declaration of complaints (or absence of) including learning points and resolution SRT
Relationships with Colleagues / Once every 3 years: Peer feedback or 360 feedback+ structured reflective template
Probity / Current GMC certificate
Probity statement- Scottish Royal college of GP (revalidation toolkit document) OR NAPCE Probity Structured reflective template
Health / NAPCE Health Structured reflective template OR
Health statement- Scottish Royal college of GP
"The appraisee states that he/ she is not involved in any CURRENT OR
RECENT (LAST 12 MONTHS) disciplinary OR PERFORMANCE procedures with the PCT or GMC."
The appraisee works at least 1 session per week on average
Breaks from work during this appraisal year:
Months
reasons
This form has been completed by the appraiser based on the statements made and evidence presented by the appraisee. Significant omissions from this evidence list do not in themselves constitute performance concerns- a decision as to whether further investigation is needed in any individual case will be made by the Deputy Medical Director working with the Practitioners Advisory Group. All forms will be reviewed by the North of Tyne Medical Directorate. For further information about the purpose of this form please read the accompanying guidance “Appraisal and licensing North of Tyne NHS”.