FAQs on Appraisal during the COVID-19 Pandemic: Update 13th January 2021
13 January 2021
What has happened to annual medical appraisals in Hampshire and the Isle of Wight?
Since the flexible restart of appraisals in October 2020, every designated body and Responsible Officer (RO) has the authority to respond to the COVID-19 pandemic in an appropriate way for their organisation and context. On 5th January 2021, the NHS England South East ROs announced a suspension of annual appraisals for GPs connected to the NHS England South East Hampshire and IOW area until 31st March 2021.
This is because the South East is at the centre of the current pandemic surge and the NHS risks being overwhelmed. GPs (including appraisers) in this region are encouraged to engage in extra clinical work and/or the vaccination effort, and suspension of their appraisal (replaced by the offer of a supportive conversation for those GPs who need/want one) is deemed appropriate at this time. By contrast, the South West as a region is – currently, at least - under less pressure, with some of the lowest rates of infection seen across the UK. The ROs here are continuing to offer all GPs their annual appraisal when due, while recognising that some individuals may need to decline the offer depending on their local circumstances.
For our GPs in Hampshire and the Isle of Wight, all GP appraisals, either planned or already booked, up to 31st March 2021, have been cancelled on the automated appraisal system; doctors who were due to have their annual appraisal between 9th January and 31st March 2021 will be issued with an ‘approved missed’ appraisal for the 2020-2021 appraisal year. There will be no repercussions for doctors who have an ‘approved missed’ appraisal because their RO suspended appraisals or, in other areas, because they decline due to COVID-related pressures. Those who particularly want or need an appraisal (because they have missed two consecutive years, or are due to revalidate soon) are likely to be offered the chance to bring their appraisal month forward to the first quarter of 2021-22, although most GPs will see their appraisal moved forwards by twelve months to keep the spread of appraisals through the year.
- We have been advised that all GP appraisals for NHS England South East will be immediately assigned 'approved missed' status for the 2020-21 appraisal year.
- Anyone who missed 2019-20 as well, or where this is the last appraisal before the revalidation recommendation is due, or who really wants a full appraisal, will normally be offered an appraisal in the first quarter of 2021-22.
- For all other GPs, their appraisal month will remain the same.
- Individuals who strongly feel that they want an appraisal now (before the end of March 2021) and have the capacity to do one without detracting from their ability to make a clinical commitment, should let us know and we will discuss it with the Head of Professional Standards and allocate an appraiser who also has capacity, if it is approved.
- Individuals who (at any time, not just when their appraisal was due) want the supportive element of the appraisal conversation without any paperwork at all (in order to discuss the impact of the pandemic and talk to an appraiser who can signpost appropriate support if needed) should contact email@example.com and mark the email CONFIDENTIAL. We will ensure that these requests are dealt with promptly so that these conversations happen when needed - but they will not be appraisals.
What if I still need support?
Whichever region you are in, all doctors should have access to appropriate and timely support during this crisis, so let us know if you feel you need a confidential conversation which can signpost you to the various national, regional, and local support available. You can do this by emailing firstname.lastname@example.org. Please mark your email CONFIDENTIAL.
What has happened to appraisals in Dorset?
The ROs for NHS England South West, which includes Dorset, are still offering every GP an appraisal in the new medical appraisal 2020 process, with an acceptance that some GPs may need to opt out of appraisal at this time. This flexible approach reflects the fact that the pandemic is not currently (6th January) as severe in the South West and recognises that different GPs have different needs.
My appraisal has been suspended. What should I do?
You do not need to contact the appraisal office or complete any documentation. The appraisal administration team will process an ‘approved missed’ appraisal for you and you will miss a whole appraisal year. This will be acceptable to the GMC and will show on your appraisal records as being due to the national emergency caused by the COVID 19 pandemic.
If my appraisal has been suspended, when will my next appraisal be due?
The appraisal year runs from 1st April to 31st March every year.
If you have an ‘approved missed’ appraisal in 2020-2021, ie between 1st April 2020 and 31st March 2021, because of the national emergency and COVID-19 pandemic, your next appraisal will fall due in your usual month in the 2021-2022 appraisal year.
When systems are back to normal, you will be notified once your appraisal is due. In the meantime, if you receive any automated reminders or notifications in error, please be patient while the administrative processes catch up with this unprecedented situation.
I already had an ‘approved missed’ appraisal in 2019-2020, won’t I need an appraisal this year?
No. If the timing is such that you had an ‘approved missed’ appraisal in 2019-2020, for example due to parental leave or sickness, and you have been given an automatic ‘approved missed’ appraisal for 2020-2021 due to the pandemic, don’t worry. This is a national emergency and there will be no repercussions for you. Your next appraisal will cover the whole period since your previous one, even if that is more than two years.
I was due to have my appraiser for the last time for continuity this year. If I have an ‘approved missed’ appraisal, will I be able to complete my appraisals with them next year?
Yes. Having an ‘approved missed’ appraisal does not affect the count for the number of consecutive appraisals with the same appraiser. You will be able to complete your series of appraisals with them for continuity, providing that they are still appraising and have the capacity.
Do I need to contact my appraisal toolkit provider?
It would be reasonable to communicate directly with your appraisal toolkit provider once you have had confirmation that you will have an ‘approved missed’ appraisal. They will be able to close off your current year’s appraisal portfolio and move any entries made already into the next appraisal year for you.
You do not need to contact your appraisal toolkit provider if you do not have time. We anticipate that the appraisal toolkit providers will take appropriate action in due course, although it may take a little longer than if you contact them directly.
What happens to the supporting information I have gathered so far if my appraisal is missed?
At your next appraisal, you will be able to present any supporting information that you wish to share and discuss which has been gathered since your previous appraisal, however long ago that was. This includes supporting information entered into your portfolio prior to the COVID-19 pandemic.
There is well-understood guidance about what to do if there is a significant gap in your appraisals due to parental leave or other long-term absence from work. You should keep your supporting information proportionate to your time in work and present only what is applicable to your whole scope of work between the two appraisals, and of value to you. The new Medical Appraisal 2020 process is designed to reduce the documentary burden so that preparation for your appraisal does not take you away from your patient care, or time to rest and recharge, for any more time than absolutely necessary.
The GMC requirements are that you should declare your whole scope of work that requires a UK Licence to Practise and then discuss how you have kept up-to-date, reviewed and sought and acted on feedback about what you do. You should always check the latest GMC guidance on supporting information for appraisal and revalidation. This year, there is a big increase in flexibility and a shift in emphasis from written reflection before the discussion to a new acceptance that verbal reflection during the discussion is equally valuable. Do what works for you. Most doctors can complete their focused written reflection in around thirty minutes.
How much CPD will be expected at my next appraisal?
Your RO and your appraiser will not expect you to be gathering evidence for appraisal during the pressures of the COVID-19 pandemic and the mass vaccination programme. They recognise that many doctors will not have been collecting documentation about their CPD, although some may have kept detailed learning diaries that reflect their preferred ways of working.
The GMC require you to do enough CPD to keep up-to-date at what you do and to be able to demonstrate that you have done so. Like all doctors, you will be expected to be able to discuss the most important things you have learned and how you kept up-to-date across your whole scope of work during the appraisal meeting. The historic Academy of Medical Royal Colleges guideline for the threshold quantity of CPD you should demonstrate at any appraisal has been 50 credits per year pro rata (based on the length of time in work between appraisals). This amount was always a threshold for guidance (not mandated). Your appraiser will not be counting credits in the new process. It is clear that doctors have all done a huge amount of learning and quality improvement activity, particularly in terms of service redesign, during this national emergency.
When appraisals are resumed, will time spent learning about COVID-19 count towards CPD and QIA?
Of course! CPD is about lifelong learning and anything that you learn about which allows you to demonstrate your reflective practice, including COVID-19, will count. The system redesign needed to work out how to alter how you work to be effective in a pandemic is a good example of a quality improvement activity to reflect on.
What if my revalidation recommendation is due this year and I haven’t done my MSF, patient feedback, etc?
If you have not yet collected formal patient and colleague feedback, there is a clear recommendation that it is now inappropriate to do so. It would be a distraction from urgent clinical care to be doing feedback exercises that are not seamlessly embedded in business-as-usual. The current survey-based formal solicited feedback exercise is a non-urgent non-clinical task that should be deferred to a better time. The updated GMC guidance on supporting information for appraisal and revalidation (Nov 2020) makes clear that there is significant flexibility to collect meaningful feedback in ways that work for your patients and colleagues. You should discuss any feedback that you have been given during your appraisal meeting but if you have not been able to undertake a formal feedback exercise, you should not worry.
Revalidation recommendation due dates up to the end of July 2021 have already been moved forwards (from 17th March 2020 to 16th March 2021 by twelve months (from 17th March 2021 to 30th July 2021 by four months), so there will be time once the COVID-19 pandemic has passed to collect and reflect on feedback surveys.
Even if your revalidation recommendation due date is before your next appraisal, there is a pathway for NHS England to recommend to the GMC to make the decision to defer your recommendation date to give more time for you to collect supporting information. During that time, your UK Licence to Practise will be extended to the new revalidation recommendation date, so you will not be disadvantaged.
What if I want to have my appraisal because of the value of the discussion to me but I am in a region where it has been suspended?
It is inappropriate to spend time preparing for, or having, an annual medical appraisal for revalidation, even within the new Appraisal 2020 process, in a region where the ROs have taken the view that GP appraisals should be suspended because of the pandemic crisis. You, and your appraiser, will need to spend your time on your clinical work, or resting and recharging to maintain your health and wellbeing. A once-a-year intervention is not the right form of support in these circumstances.
There are many coaching and mentoring, listening, buddying and other support resources available to all GPs now when you need support, not just in the month when your appraisal might be due. If you are in a region that has had to suspend appraisal again and you feel you need a confidential and supportive one-to-one discussion, please e-mail email@example.com and mark your e-mail CONFIDENTIAL. We will try to set up an alternative support and signposting conversation with an appraiser trained to help you reflect on the impact of the pandemic and to signpost appropriate resources - but it will not be an appraisal.
It says there is provision for a medical appraisal for revalidation to go ahead in ‘exceptional circumstances’. Does this apply to me?
If you currently have sanctions on your practice and they stipulate that you have to have an appraisal for some reason, then arrangements can be made for this to go ahead. It may not be with your previous appraiser, as they may be a front-line clinician with no capacity to do appraisals at this time. If this is the case, an alternative appraiser will be found so that your appraisal can take place as required. It would be appropriate for you to contact the appraisal office in good time if you know that you are in this situation so that arrangements can be made.
The arrangements for appraisals are a matter for the discretion of your RO. For GPs working in the NHS England South East region, all appraisals between 8th January 2021 and 31st March 2021, apart from the few doctors who have sanctions relating to their appraisal, have been suspended and the GP given an ‘approved missed’ appraisal for this appraisal year.
If I have to have an appraisal due to ‘exceptional circumstances’, should I have my appraisal face-to-face or remotely using videoconferencing technology of some sort?
During the COVID-19 pandemic, there is an overwhelming public health argument that GPs should not meet face-to-face for an appraisal. This is to minimise the risk of transmitting the virus between practices/locations. Appraisal meetings should be held using remote telecommunication videoconferencing technology. You should agree the tool that works best for you with your appraiser beforehand.
Top tips for appraisals done remotely:
- Make sure that you are in a room with the privacy appropriate to a confidential appraisal discussion.
- Test the IT before you start. Is the internet access fast enough to do a video-call? Can you see and hear each other clearly?
- Take regular breaks to avoid looking at the screen and at each other for too long. Ideally, stop for long enough to make a cup of tea every hour or so.
- Remember the camera is not where the image is, so the eye contact is often slightly odd. It may be necessary to clarify more non-verbal cues explicitly than in a face-to-face meeting.
If there are any FAQs you think we’ve missed, or you would like clarification on anything, please let us know at firstname.lastname@example.org.