1. 1 Difficult Appraisals Workshop Purpose: Driving Action Through Reflection about Significant Events in Appraisal Mayur Lakhani

2. Good Appraisals are key to the future of general practice Are we fulfilling the true potential of appraisal? Focus has been on the doctor-regulator relationship Focus needs to be on doctor-patient relationship By-> Formative and developmental A true appraisal can make all the difference more professionally happy GPs

3. Evidence that knowledge and adherence to standards declines with time elapsed since graduation Participation in recertification is consistently associated with better standards, and fewer adverse patient claims

4. What strategies do you adopt? ( *adapted from NRST ) Too much documentation The high flyer The cynic/unbeliever/imminent leaver The dependent/disempowered The disclosure of poor performance The disclosure of illness/addiction Whistleblowing about a colleague low or none engagement or the reluctant reflector The doctor with non standard roles or multiple roles Failure to agree the sign off statements Appraising senior doctors or the appraisal where there is power imbalance The doctor on the verge of burnout or who breaks down

5. Discussing uncomfortable things or saying things that need to be said

6. The expectation today Describe and offer an incident or event that caused you difficulty as an appraiser NOT Merely a descriptive account of the experience REFRAMING: How did it make you feel and why? Is there any other way of looking at this? What do others think? Is there a best practice comparator? 6

7. Seven Steps To Driving Action Through Reflection What happened? How did I perform ? What did I think/feel ? Why did I think or feel this way? How did my thoughts/ feelings affect others? What are consequences ? How can this help me in the future?

8. Discussion in Groups 8

9. Health Concern During discussion, a GP declares a diagnosis of depression and ongoing assessment for a bipolar disorder. State the standards by which you would assess this? How would your risk assess this situation? What would you write in your MAG summary?

10. Challenging situations A doctor’s 360 reveals (colleague and patient) Dysfunctional relationship with staff and some patients Problems of attitude and being abrupt on occasions, directive style of practice Colleagues frustrated as he is not a team player – example e.g. does not believe in end of life care for non cancer conditions and will not change/implement EOLC scheme His structured reflective template and action plan does not include any action to address this behaviour What would you do? How would you have this discussion?

11. Language is so important Messages Direct but can be threatening Gentle/indirect/avoiding point directly but useful opener clear People do not like you, you will have to change You are avoiding the issue, you have to do end of life care for LTCs, there is no two ways about it Have you thought about how you interact with others or how you come across? Is there something that you are not seeing or missing here? It is my role to point out this problem so that I can help you consider how you can be the more effective as a doctor Working with others is a key part of team work in modern health care This feedback suggests you are having difficulty with this and the broader agenda like EOLC I would like to explore how you might change this

12. What will you do next? What have you learnt today? What will you do next? Within 72 hours Within 3 months Within 12 months 12