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Hot Topics and Key Learning - June 2019

Support Groups for 2019-20

With the results of the pilot from last year now in, it has been agreed that we will:

  • Return to each Support Group having more flexibility to set their own dates and times with no further requirement to have a mix of day and evening meetings, other than as agreed by the group
  • Encourage those who are unable to attend their own Support Group to attend an alternative group (not just their buddy group) by advertising all the appraiser Support Groups centrally and setting dates one meeting to the next (ie a Doodle Poll to be released after the meeting for a response within 2 weeks) with the next date being confirmed along with the minutes from the previous meeting)
  • Review appraisers’ attendance at Support Groups in January centrally for central office to put on an additional meeting, if required, to ‘mop-up’ those who have not been able to attend their own

Your first Support Groups for the year should already be in place (or if not, they are being sorted right now) and your Senior Appraiser will be able to tell you more about the new setup at this meeting.

Following a meeting with NHS England, the CPD and calibration requirements for appraisers, of which local Support Group attendance forms a part, have been revised. This document confirms what you will need to demonstrate compliance with this new standard for 2019-20. Appraisers who do not engage with sufficient CPD and calibration to maintain their demonstrable competencies as an appraiser annually will not be allocated any further appraisals until they are able to do so.

CPD 50 credits question

The question has been raised again about appraisers monitoring the “50 credits” required for CPD.  Although the RCGP website recommends that this is a target/threshold for discussion, it is not a requirement for revalidation. Unfortunately, some appraisers are being very rigid about refusing to sign off that appropriate supporting information has been provided where there are fewer than 50 credits, or asking GPs to go back and add more to their portfolio. This is not appropriate; it is more appropriate to use the recommendation to show 50 demonstrated credits as a trigger to discussion. Usually it is possible to comment that the doctor does a lot of additional CPD that has not been recorded and to help them find ways to record it for the coming year (apps. etc). Sometimes, fewer than 50 are appropriate for the context, circumstances, or scope of work. The GMC requires a doctor to do sufficient CPD to keep up-to-date and fit to practice at what they do, with no number attached. 

NHS England no longer look for 50 credits annually, since the soft reboot of appraisal, nor 250 across the five year revalidation cycle. Although there is a space on RMS to fill in a number, Dr Maurice Conlon, the National Clinical Appraisal Lead, has said that he does not enter anything into this optional box as otherwise the IT is driving investigations that are unnecessary. Susi is going to take this back to the RCGP to look at the detail of the text about the credits so that there is less risk of misinterpretation.

Mandatory training for doctors – what should appraisers be doing?

The issue of statutory and mandatory training is a national hot topic going to RCGP Council in a paper on 22nd June 2019. Even BLS and safeguarding are not GMC revalidation requirements for all doctors. The new Intercollegiate document on safeguarding is especially controversial in the context of overcrowded requirements for a doctor’s CPD because the conclusions appear too rigid (and onerous) to meet the competency-based educational needs of many GPs. Appraisers are there to support doctors in producing an appropriate portfolio of supporting information to meet their needs, which may include a discussion about mandatory training, as an employment requirement. You should not be ‘checking’ anything; you should be using your expertise to prompt reflection and discussion.

Quality Assurance – for 2019-20, we will continue to use PROGRESS 2017

There had been a suggestion we might use a different QA tool for this appraisal year but that has been postponed due to further conversations with the South-wide NHS England teams, with whom we want to agree the consistent use of a single appropriate tool. We will hope to have further news on moving forward with this for 2020-21 later in the year.

Did you know you need insurance to facilitate appraisals in an appropriate home office?

The use of a home venue is a national hot topic in primary care appraisals. We have always tried to protect you and your appraisees from charges of collusion or coercion in setting a mutually-convenient venue for the appraisal by asking you to let your Senior Appraiser or the Service know. This calibrates the appropriateness of the choice in advance, creating an audit trail that the decision is reasonable. We have learned of a case (not in Wessex) where a doctor was injured at an appraiser’s home and the home insurance refused to cover the costs because it was a business meeting. The national advice is that if an appraiser facilitates an appraisal at their home in an appropriate home office environment, the appraiser needs the relevant business indemnity insurance. There was also a comment that, in using their home for business, there may be a capital gains tax implication when they come to sell.

Therefore, if you are offering your home office as a venue, you should be able to demonstrate that you have appropriate business indemnity insurance. Food for thought!

Appraisee Feedback

As an Admin Team, we regularly review the feedback received monthly at our team meetings. We have had feedback suggesting that collating it all at the end of the year does not allow timely learning from any appraisals that are merely satisfactory or less than satisfactory. As a result, each month when we review the feedback received, we will email your Senior Appraiser with any “satisfactory”, “borderline” or “poor” responses, or any “no” to having the appraiser again (if appropriate). They will share this with you to enable a more immediate update to you of how you are being perceived during your appraisals. It may also enable you to think back on an appraisal where you have had some issues that may be reflected in the responses and be able to more easily rationalise how those responses may have come about.

NHS England post-appraisal survey of appraisees – feedback

10 out of 16 NHS England areas (including Wessex) provided the feedback from their annual post-appraisal survey of GPs for 2018-19 for a meta-analysis. It showed that, of the 13,440 GPs in England (39%) who were included, 91% report that their appraisal was useful for promoting quality improvement in their work, and 88% report that it was useful for improving patient care. These results over the whole of England mirror those that we have celebrated annually in Wessex for the past ten years but the scale of the survey makes it powerful evidence of a positive impact of appraisal done well. Comments included:

  • ‘Without appraiser support, I would not have continued working.’
  • ‘Perfect balance between challenge and support.’
  • ‘…will help to improve the quality of my patient care.’
  • ‘I am refreshed and ready for the next 12 months… inspired for ongoing career development. Thank you.’

Questions remain about the other areas that were not able to provide their data in time. There was also a theme about the time taken to complete the documentation. To get the benefits of appraisal, we must reduce the burden of documentation so we can maximise the value of the reflection and discussion.

Watch out for the national launch of this NHS England analysis in early-mid June.

RCGP Appraiser Support Survey

Thank you to everyone who responded to this survey which closed on 13th May. The early analysis suggests that there is a noticeable difference in how well-supported appraisers feel they are between the Deanery-led appraisal services (Scotland, Wales, Wessex) and the other NHS England areas. However, one Wessex respondent felt that they were only partially supported and, although we cannot 'un-blind' the survey, if that was you, we would love to hear from you in confidence to understand what we could do better…

For the other results, we will have to wait for the full analysis.