1. GP Appraisal in the UK’s National Health Service
Michael Harris
Bath, UK

2. United Kingdom (UK) ... or Great Britain (GB) or England?

3. My work General Practitioner (GP)
Honorary Research Fellow, University of Bath

4. The UK’s National Health Service (NHS)
we love the nhs, our colleagues and pts do as well

5. Total workforce of 1.18 million (Canton Bern 969,000, Bern city 124,000, Biel 51,000

6. Quiz The population of the UK is about 62 million
The NHS employs the same number of people as the population of:
A) Kyiv?
B) Dnipro?
C) Luhansk?
D) Uzhgorod?
Total workforce of 1.18 million (UK 65m, Ukraine 45.2m, Kiev 2.8m, Dnipro 1.1m, Luhansk 470k, Uzhgorod 120k

7. Quiz The population of the UK is about 62 million
The NHS employs the same number of people as the population of:
A) Kyiv?
B) Dnipro (1.18 million)
C) Luhansk?
D) Uzhgorod?
Total workforce of 1.18 million (UK 65m, Ukraine 45.2m, Kiev 2.8m, Dnipro 1.1m, Luhansk 470k, Uzhgorod 120k

8. Quiz Every week the NHS treats: A) 3 million people?
B) 1 million people?
C) 500,000 people?
Around 3 million people are treated in the NHS in England every week. 
An NHS patient yesterday became the first in the world to undergo heart surgery performed by doctors using a robotic arm.
Father-of-two Kenneth Crocker, 70, had the procedure to correct an irregular heartbeat while the surgeon was in another room.

9. Quiz Every week the NHS treats: A) 3 million people
B) 1 million people
C) 500,000 people
Around 3 million people are treated in the NHS in England every week. 
An NHS patient yesterday became the first in the world to undergo heart surgery performed by doctors using a robotic arm.
Father-of-two Kenneth Crocker, 70, had the procedure to correct an irregular heartbeat while the surgeon was in another room.

10. Quiz In the UK, the average patient directly pays for treatment:
A) 20% of the cost?
B) 10% of the cost?
C) 5% of the cost?
D) nothing?

11. Quiz In the UK, the average patient directly pays for treatment:
A) 20% of the cost?
B) 10% of the cost?
C) 5% of the cost?
D) nothing

12. Quiz The percentage of doctors in the NHS who are GPs is: A) 50%?
B) 25%?
C) 10%?
D) 5%?

13. Quiz The percentage of doctors in the NHS who are GPs is: A) 50%
B) 25%?
C) 10%?
D) 5%?

14. The National Health Service
the SWISS frequent flyer programme
or use "heartsink"? 14

15. GP care (primary care)

16. GP care (primary care) All British citizens register with their own GP
35,000 GPs for a population of 60 million
Most patient care is given in that patient’s GP practice (by the GP or his/her team)
‘cradle-to-grave’ care

17. The “gatekeeper" role The "gate-keeper" role
patients can only access specialists if they have been referred by a GP (except in an emergency)
as soon as the medical problem has been assessed and sorted out, specialists hand patients back to their GPs for on-going care
The GP is the central point for everything relating to patient care
hospital findings, investigations

18. NHS Appraisal

19. NHS Appraisal
All doctors and nurses in the NHS must have an appraisal every year
GPs
specialists
trainees
hospital nurses
practice nurses

20. What is the NHS Appraisal?
An annual, formative interview with experienced colleague
Doctors take supporting information (evidence) to their appraisal to show how they are meeting professional values
The Appraiser gives systematic feedback
focusing on the doctor's efforts to review and improve practice

21. What is the NHS Appraisal?
Appraiser and doctor agree a ‘Personal Development Plan (PDP) for the next year
The appraisal should be a positive process:
it aims to identify areas of performance that need development
as part of an ongoing CPD process.
It’s not the main way to identify poor performance.

22. What areas of performance does NHS Appraisal look at?
1: Knowledge, skills and performance
Maintain your professional performance
Apply knowledge and experience to practice
Ensure that all clinical records are clear, accurate and legible
2: Safety and Quality
Contribute to and comply with systems to protect patients
Respond to risks to safety
Protect patients and colleagues from any risk posed by your health

23. What areas of performance does NHS Appraisal look at?
3: Communication, Partnership and Teamwork
Communicate effectively
Work constructively with colleagues and delegate effectively
Establish and maintain partnerships with patients
4: Maintaining Trust
Show respect for patients
Treat patients and colleagues fairly and without discrimination
Act with honesty and integrity

24. How do doctors demonstrate their competence?
Doctors have to collect and discuss ‘supporting information’ (evidence) from:
patients
colleagues
their own reflections

25. How do doctors demonstrate their competence?
There are six types of supporting information:
Continuing Professional Development
Quality improvement activity
Significant event analysis
Feedback from colleagues
Feedback from patients
Review of complaints and compliments

26. 1 Continuing Professional Development (CPD)
Minimum 50 ‘credits’ (hours) per year
CPD can be:
reading (e.g. journals)
discussions in GPs’ practices (e.g. case discussions)
on-line learning
postgraduate medical education courses
GPs need to provide evidence that they have thought about, and learnt from, these

27. 2 Quality improvement activity
Examples:
clinical audit (e.g. proportion of patients with hypothyroidism who have had thyroid function tests in the last year)
a review of a clinical case
an analysis of prescribing
an analysis of referrals to specialists

28. 3 Significant event analysis
An analysis of something that went wrong
or could have gone wrong
Examples:
prescribing errors
a delayed cancer diagnosis
a complaint
a breach in confidentiality
coping with a staffing crisis

29. 4 Feedback from colleagues
Once every 5 years
‘360 degree feedback’
GP asks for written, anonymous feedback from other GPs, nurses, staff…

30. 5 Feedback from patients
Once every 5 years
Standard questionnaires
analysed externally
compared with national averages

31. 5 Feedback from patients: example

32. 6 Review of complaints and compliments
allow doctors to review and improve their practice
what changes did the doctor make as a result of the complaint?
Doctors can also bring any compliments they have received
e.g. patient ‘thank you’ letters

33. Health and Probity
Discussion of anything that may put patients at risk
relating to the doctor’s own health
e.g. an alcohol problem
relating to probity (honesty, moral principles that relate to medical practice)
e.g. gifts of money from patients

34. Resuscitation & child protection updates
Certificates from recent courses

35. Personal Development Plan
The key output of the appraisal
GP & Appraiser agree a Personal Development Plan (PDP) for the GP
what are the doctor’s learning needs?
both ‘wants’ (what GP wants to learn) and ‘needs’ (what GP needs to learn)
at least 3 per appraisal
how will the learning happen? (Personal study? Lecture? Discussion with colleagues?)

36. Personal Development Plan

37. Personal Development Plan
The PDP, and evidence of completion, are reviewed a year later
What was achieved?
What wasn’t achieved, and why?

38. How long does it take? Typically 8 hours preparation by GP
Appraisal lasts 2-3 hours

39. Who does the appraisals?
Experienced GPs
GP Appraiser training course
regular meetings for discussion and to compare their decision-making (‘bench-marking’)

40. What happens if the doctor doesn’t have NHS appraisals?
The doctor will lose the license to practice

41. Is it worth it?

42. Thank you for listening!
Michael Harris
with thanks to Ulrike Naumann

43. Any questions?