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What Do The Hidden Half Think?

Post-Appraisal Feedback from those who didn’t initially respond in Appraisal Year 2020-2021.

Authors and Collaborators: Dr Nkolika Anyabolu, Dr Sarah Burns, Dr Julia Hempenstall, Dr Colleen Wylie (Wessex Appraisal Service Primary Care GP Fellows 2021-22), Dr Susi Caesar, Jools Mumford.


The global pandemic has pushed the NHS to capacity. At the centre of this national effort has been the staff. How we support these individuals is of paramount significance as we rebuild healthcare alongside COVID-19.  Appraisal forms a central core to re-establishment of “business as usual” and recovery while supporting staff. The process offers a supportive conversation with a peer to discuss aspects of a doctor’s practice, explore personal development, broaden portfolios, and define career aspirations. 

Following the pressure from COVID-19, the Appraisal Service nimbly adapted and simplified pre-appraisal documentation to cut the amount of time needed for reflection and documentation. This shifted the focus to questioning and supporting the doctor’s wellbeing and signposting to help available if needed. This seismic shift has allowed us to consider the way we approach appraisal allowing for recalibration of the priorities, as well as offering new opportunities. 

After annual appraisal, the appraisee is always sent a post-appraisal feedback survey. The usual response rate is around 63% for return of these questionnaires. In 2020, the response rate in Wessex was significantly lower at just 50% of appraisees.

The aim of this study was to gather feedback about Medical Appraisal 2020 and see if non-responders gave different feedback to the responders. 

This study was also an opportunity to explore the reasons why some doctors do not respond to questionnaires and was conducted by the GP fellows embedded in the Wessex Appraisal Service.


Dorset GPs were selected as the study cohort as they had the least disruption in Wessex in their appraisal delivery during the COVID pandemic.​

171 GPs were identified as non-responders. ​

A roadmap for contacting non-responders was developed using email, text messages, and phone calls​.

The original post-appraisal feedback questionnaire was sent, with 3 additional questions exploring reasons behind their non-response to the original invitation:

  1. What was your main reason for not answering the survey when it was previously sent?
  2. Do you normally respond to your appraisal feedback surveys?
  3. We are looking at how this questionnaire is delivered. In the future. How might you prefer to receive your feedback questionnaire?


Appraisal Year 2020–2021 in Dorset:​​

  • The initial questionnaire was send to 341 GPs ​ - 43% male & 57% female​
  • 170 responded promptly following their appraisal​
  • 171 non-responders – our project cohort​ - 44.1% male & 55.9% female

Of this group, responses were collected from 101 of the 171:

  • 22% replied following a further generic email
  • 17.5% responded after personalised GP Fellow email
  • 8% responded following a text
  • 11.5% responded following a GP Fellow telephone call
  • 41% remained as non-responders
  • 62% of responders stated they would normally respond to the post-appraisal feedback questionnaire

The following reasons were given for a lack of response at the original time of asking (see poster).

Overall, dissatisfaction is higher and positivity lower in the study cohort in relation to their appraisal when compared to initial responders but overall levels of dissatisfaction remained low.

Most of the cohort still ‘strongly agreed’ or ‘agreed’ that appraisal supported personal and professional development, quality improvement, improving patient care, and preparation for revalidation​. However, neutrality was higher (by 11.1% on average) and extreme positivity is lower.

How would our responders like to be contacted next time? (see poster).

What did our respondents think of their appraiser skills and overall appraisal? Does it differ from those who responded at the time? (see poster).


  • The number of responses received will depend, to some extent, on having an up-to-date and clean database of contact information
  • Annual appraisal is a good opportunity for appraisers to check that contact details, including email addresses and mobile numbers of appraisees are correctly captured. This facilitates the use of data for both administrative and permitted research purposes.
  • Sending out a reminder email may increase response rates (in our study, by almost 40%)
  • Individuals may choose not to respond for a variety of reasons and this should be respected
  • Further research is required to ascertain if the difference in results between our cohort of respondents and those who responded initially is significant. There may be true differences in views about appraisal between these doctors. However, there are also a number of potential confounding factors, eg inaccurate recall (as appraisal for most of our respondents was several months prior to completion) or respondents feeling pressurised to respond, which might skew their perspective.