Appraisal is a formative, systematic and regular review of past achievements with constructive planning of future learning needs. It is not a single event but part of a continuous process of lifelong review and planning of personal and professional development and an integral part of learning during your GP career.
It is sometimes confusing to consider the terminology and identify the links between personal and practice development, appraisal, clinical governance and revalidation requirements. This guide aims to demystify these issues.
Continuing professional development and appraisal are complimentary. Preparing for your appraisal offers the opportunity to reflect on past achievements and plan your future learning.
Appraisal and revalidation are closely linked and in Wales the appraisal system is already highly developed and has been quality assured since 2004.
Key Principles of GP Appraisal in Wales
In Wales, a single system of GP appraisal is centrally managed by the Revalidation Support Unit (RSU or the unit), Wales Deanery. GP Appraisal is a process which contributes to the development of individual GPs and therefore to the overall quality and safety agenda.
The objectives of GP appraisal in Wales are to:
- Provide individuals with an opportunity to: reflect on their practice and their approach to medicine; reflect on the supporting information they have gathered and what that information demonstrates about their practice; identify areas of practice where they could make improvements or undertake further development; demonstrate that they are up to date
- Provide opportunities for communication between doctors and the organizations in which they work relating to skills, capacity, organisational level objectives, constraints and learning needs
- Provide assurances to the organisation/s that doctors are remaining up to date across their whole practice
- Provide a route to revalidation that builds on and strengthens existing systems with minimum bureaucracy
GP Appraisal Online
A single online system is provided to facilitate the appraisal system for GPs in Wales - the Medical Appraisal and Revalidation System (MARS). MARS is designed to facilitate the appraisal process and to enable GPs, Appraisers and Responsible Officers to meet the requirements of revalidation. Through MARS GPs, Appraiser and Responsible Officers can also access guidance materials and a range of CPD resources. You can access MARS here:
GP Appraisal and CPD
The Unit is committed to retaining and building on the developmental aspect of appraisal. As the Unit also manages delivery of CPD for GPs in Wales, the two processes are closely linked:
- GPs are encouraged to reflect on their CPD as part of their annual appraisal
- The appraisal process helps GPs to plan their development for the coming year
- The learning objectives declared at appraisal are analysed and used to inform on-going delivery of CPD across Wales
- The Medical Appraisal and Revalidation System includes a wide range of CPD resources including information about CPD events available across Wales
Appraisal, Revalidation and Clinical Governance
Annual appraisal is a key component of Revalidation. Although appraisal and revalidation are separate processes, both are structured around the core responsibilities set out in the GMC's framework booklet Good Medical Practice.
Revalidation also requires confirmation that doctors are engaging in appropriate clinical governance activity. GP Appraisal lies at the educational end of the spectrum of clinical governance processes. The appraisal process contributes to the overall clinical governance framework as it provides assurances that GPs are planning and reviewing their CPD in a structured way.
An exceptions management protocol details how information is shared between appraisal and other clinical governance processes undertaken by the Health Boards including performance management.
Constraints identified by GPs in their appraisals are collated and reported in an aggregated format to the LHBs to help inform planning of service delivery.
Quality Management of GP Appraisal
To ensure the appraisal process itself is fit for purpose and meets defined quality standards, the Unit has a comprehensive Quality Management Framework. We define Quality Management (QM) as an overarching framework for managing policies, systems, processes and activities relating to GP Appraisal and CPD in Wales.
QM is integrated into all our work and has been a crucial element of the GP appraisal process in Wales since its inception and pilot in 2001.
The aim of QM is to ensure that GP Appraisal and CPD continuously develop in order to meet, and wherever possible exceed, defined quality standards.
Our strategy is to deliver Quality Management through the related processes of Quality Control (QC), Quality Assurance (QA) and Quality Improvement (QI) . QM is a continuous cycle: QA reviews the effectiveness of QC; QI is informed by both QC and QI; the outcomes of QI feed back into QC and their implementation is reviewed through QA.
The Quality Standards (QS) for GP Appraisal and CPD are based on national standards as defined by external organisations including the General Medical Council (GMC), the Royal College of General Practitioners (RCGP) and the Revalidation Support Team (England).
Additionally, the Unit works collaboratively with partner organisations both within Wales and further afield, including for example the Health Board Medical Directors and their teams, the Welsh Assembly Government, GP Committee Wales and centrally, Royal College of GPs Wales and centrally, Public Health Wales, the Community Health Councils, the Business Service Centres, the General Medical Council, and the Revalidation Support Team (England). These interactions enable us to ensure the appraisal process meets the needs of key stakeholders and is continuously updated and improved to address changing external requirements.
MARS has been designed to reflect the good medical practice framework for appraisal and assessment as set out by the GMC. This framework sets out criteria, which are marked on 4 domains with three attributes in each. The Welsh appraisal system mirrors these requirements to ensure that the process of documenting continuing personal and professional development will be facilitated and encourage GPs to use the website to provide representative evidence of personal and professional activities to satisfy the requirements for appraisal, clinical governance and risk management and revalidation.
Clinical governance provides a framework for ensuring quality and patient safety in primary care and doctors are encouraged to document their contributions to practice-based clinical governance work in their appraisal folders. Practices will also be required to complete the all Wales practice clinical governance self-assessment toolkit. Each Local Health Board (LHB) has a Responsible Officer who overseas the revalidation process, they make recommendations about individuals to the GMC, based on the information contained in the appraisal summary and other information available from local governance processes.
The Toolkit can be accessed at http://nww.nphs-cgtool.wales.nhs.uk (login and password required).
Source: Public Health Wales
Successful completion of the evidence set over a five-year period and an absence of other concerns should allow a recommendation to the General Medical Council that the doctor should be revalidated.