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OPINION VIEWS


Just what we need for GP appraisals – more red tape


Dr Stephanie de Giorgio argues that GP appraisals are becoming too onerous and bureaucratic


At this time of year, our Resilient GP forum and others are full of stressed and annoyed GPs trying to ensure their appraisal documentation is up to date and ready for those dreaded few hours. Questions and rumours abound regarding what is actually required to pass. Disaster stories of hours of work being rejected due to a technical detail are shared. Newly qualified GPs are trying to find out what the hell is expected. I have to go through that myself, but


I have also been a GP appraiser for three years and know more than most. So why have I recently been considering whether to continue in that role? After all, it is well paid, non-patient facing and doesn’t require indemnity fees – the veritable holy trinity of extra GP income these days. The reasons against being a GP appraiser are multiple and as with so much in the NHS these days, it is a combination of NHS England mission creep, over-regulation and a feeling of an unfair disparity between different areas of the country. This year, our appraisal team merged with another and its rules were adopted. These were tougher than had been previously applied in our area and are apparently what will be applied all over England eventually.


Regional variations Some of these rules will be familiar to appraisers, but these new ones are more onerous and significantly more prescriptive. They will not be familiar to others yet because of the ridiculous regional variation of the appraisal system in England. A GP in one area may still be able to choose their appraiser and have a relaxed chat over a cup of coffee, while in another, GPs are assigned someone


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more clearly defined than that) have to be appraised separately and uploaded. There has to be way more navel gazing – sorry, reflection. The patient satisfaction questionnaire has to include patients from all areas of practice – what do pathologists do about this? These rules come from a combination of the GMC, RCGP and NHS England. Each responsible officer uses their own interpretation of the rules. Is this robust and fair?


and subjected to a three-hour grilling about their practice. This disparity makes a mockery of a system that has been put in place to ensure patient safety. Are patients in one area of the country ‘safer’ than those in another because the appraisal system is more ‘robust’? I think not. Does appraisal ensure patient safety at all? Unlikely. As is so frequently uttered, Harold Shipman would undoubtedly have sailed through. The new requirements for me as an appraiser include 50 CPD points and three personal development plan tasks just for being a GP. Any other roles need extra. No impact can be claimed. All ‘extended practice’ roles (yes, it is no


Harold Shipman would have sailed through


Adding to the above, this year NHS England decided that doctors’ appraisals needed to be added to the same system as other NHS employees – something called RMS. So now we have to upload the entire appraisal to this system. In many cases, appraisees haven’t been told about this. I have told mine, has your appraiser told you? This is another layer of bureaucracy of dubious necessity. What would happen if all GPs resigned from appraiser roles? NHS England would probably bring in more non- medical appraisers. That is enough to make me continue for now. I hope that I can provide a formative, supportive and useful hour or two for those I appraise. The hoops have to be jumped through, but it can still be pleasant. I have no time for aggressive, nit-picking, pedantic appraisers; they make their colleagues’ lives miserable and do nothing to improve the system. Appraisal is here to stay for now. I am still part of it so that it continues to be peer led, formative and supportive. When the balance tips to performance management, I am out of there.


Dr Stephanie de Giorgio is a GP in Kent and co-founder of Resilient GP


52 February 2016 Pulse


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