Preparing for appraisal: what’s changing ? Dr Paula Wright GP tutor for Newcastle East GP tutor for Sessional GPs Deanery Adviser on Retainer and FCS

Preparing for Appraisal Form3 Form3 Evidence –general issues & specifics Evidence –general issues & specifics Pulling it together Pulling it together

Changing emphasis of appraisal Shift to summative emphasis (to performance review) Shift to summative emphasis (to performance review) Explicit standards of performance against which doctors are judged Explicit standards of performance against which doctors are judged Explicit standards of evidence Explicit standards of evidence Will need to be more robust (QA) because of link to revalidation Will need to be more robust (QA) because of link to revalidation

Form 3 (I) 1. Factual statement about role (and changes) and working circumstances 2. Factual statements about Progress against last years “actions” and PDP aims supported by evidence 3. Factual Statements about personal performance explicitly supported by evidence

Form 3 (II) 5. Reflective Statements about performance showing insight into level of competence and areas of weakness. 6. Intentions for development linked to reflections & evidence on performance

FORM3- MGMP How were learning needs identified ? How were learning needs identified ? Why were these learning activities chosen ? Why were these learning activities chosen ? What reflection has taken place ? What reflection has taken place ? (Difference between GCC and MGMP) (Difference between GCC and MGMP)

Evidence Ideally: Ideally: 1.Relevant to the doctor’s individual work (not just practice work) 2.Relevant to patient outcomes (not just process measures) 3.Objective/ Verifiable/ Validated tool for which there are benchmarks But…. Tension between 1 and 3

Challenge of evidence Most care is delivered by teams NOT by individuals Most care is delivered by teams NOT by individuals So difficult to link clinical OUTCOMES measures to PERSONAL PERFORMANCE (sp locums) So difficult to link clinical OUTCOMES measures to PERSONAL PERFORMANCE (sp locums) Can audit PROCESS MEASURES linked to personal practice (e.g. BP monitoring, TSH monitoring etc) Can audit PROCESS MEASURES linked to personal practice (e.g. BP monitoring, TSH monitoring etc)

So what can we do ? Aim for personal evidence (personal audit, GPAQ etc) not just practice aggregated data Aim for personal evidence (personal audit, GPAQ etc) not just practice aggregated data Personalise the evidence where practice data used: personal role ? Personalise the evidence where practice data used: personal role ? Personal reflection on each item of evidence submitted Personal reflection on each item of evidence submitted

Commenting on Evidence in FORM3 What does this evidence SAY ? What does this evidence SAY ? What does it say ABOUT YOU ? What does it say ABOUT YOU ? How have YOU CONTRIBUTED to the level of achievement demonstrated ? How have YOU CONTRIBUTED to the level of achievement demonstrated ? How will YOU ALTER YOUR PRACTICE in response to the performance demonstrated ? How will YOU ALTER YOUR PRACTICE in response to the performance demonstrated ?

Napce –EVIDENCE STATEMENT Feb 2007 Essential evidence-personal Essential evidence-personal Essential evidence-organisational (practice folder) Essential evidence-organisational (practice folder) Optional evidence Optional evidence (Leicester/ NAPCE statement)

Evidence: Good medical care- AUDIT personal care-OUTCOMES or personal care-OUTCOMES or Group care OUTCOMES in area where has taken an initiative or lead role (e.g. COPD etc) Group care OUTCOMES in area where has taken an initiative or lead role (e.g. COPD etc) PROCESS AUDIT E.g. referrals, admissions, records, prescribing, PROCESS AUDIT E.g. referrals, admissions, records, prescribing, Structured case reviews Structured case reviews … less useful … less useful Qof, PACT, Qof, PACT,

Evidence: Maintaining Good medical practice Educational log of activities with reflections Educational log of activities with reflections Last years PDP with statement of what has been achieved and what not (evidence) Last years PDP with statement of what has been achieved and what not (evidence) Evidence of assessment of knowledge Evidence of assessment of knowledge Structured reflective template Structured reflective template Less useful: Certificates, Handouts or programmes Less useful: Certificates, Handouts or programmes Note- for revalidation probably determined by colleges (knowledge test) Note- for revalidation probably determined by colleges (knowledge test)

Relationships with patients Patient survey Patient survey Complaints data or declaration of none Complaints data or declaration of none optional optional Evidence of consultations skills training Evidence of consultations skills training Less useful are Less useful are Practice policies about patient removals, confidentiality, and consent etc Practice policies about patient removals, confidentiality, and consent etc

Relationships with colleagues 360 degree feedback (online or paper) facilitated by 3 rd party, validated tool 360 degree feedback (online or paper) facilitated by 3 rd party, validated tool Account of team working Account of team working …optional …optional Evidence of learning in context of colleague relationships Evidence of learning in context of colleague relationships Minutes of practice meetings Minutes of practice meetings

Teaching and training Outline of teaching sessions developed Outline of teaching sessions developed Feedback Feedback Development of educational skills Development of educational skills

Probity Probity statement from Scottish RCGP revalidation toolkit. Probity statement from Scottish RCGP revalidation toolkit. CRB CRB Conflict of interest statement- specially where moving towards new models of GP with profit arm Conflict of interest statement- specially where moving towards new models of GP with profit arm Gifts Gifts Disciplinary actions/ investigations Disciplinary actions/ investigations

Health Health statement from RCGP revalidation toolkit Health statement from RCGP revalidation toolkit Hep immunity Hep immunity Comment: time off work/ adaptations to work on health grounds, Registered with GP Comment: time off work/ adaptations to work on health grounds, Registered with GP

Appraisal Toolkit Many tools for recording evidence: Many tools for recording evidence: –educational diary with reflections –PUNS AND DENS; Audit, complaints etc can carry over things from one year to next (e.form1,2 pdp etc) can carry over things from one year to next (e.form1,2 pdp etc) Can access from various sites Can access from various sites Organises all info including documents which can be uploaded Organises all info including documents which can be uploaded Extracts- go into overview/summary Extracts- go into overview/summary Administrative- linking pct/appraisee/appraisers Administrative- linking pct/appraisee/appraisers

Pulling it all together Forms 1-3 Forms 1-3 Evidence Evidence Last years form4 and PDP Last years form4 and PDP Draft PDP for next year Draft PDP for next year Index your appraisal folder Index your appraisal folder Use appraisal toolkit Use appraisal toolkit