A Brief Appraisal Guide for ST 3 GPRs

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					A Brief Appraisal Guide for ST 3 GPRs.

Dr Di Jelley
Deanery Appraisal and Revalidation Advisor
Collingwood Surgery      North Shields
Contact: di.jelley@nhs.net 0191 2571779

Produced April 2008

       A. Introduction -why is appraisal necessary?

       B. Getting started- for ST3 GPRs

       C. Producing your PDP

This guide has been written for the Deanery website to make
sure all doctors in ST 3 for GP training have access to all the
necessary forms , and to provide GP trainers with basic
guidance in preparing for, and running the appraisal

  A. Introduction – why is appraisal necessary?
        Annual appraisal is a contractual requirement for all qualified GPs and GPs in
         training should have the opportunity to gain some experience of the appraisal
        The recently published ‘Gold Guide’ on Speciality Training suggests that GPs in
         training should undergo annual educational and NHS ’work-place’ appraisals.
         However, recent guidance from COGPED [Committee of GP Education
         Directors] has challenged the need for formal annual appraisal during every
         year of ST training .It has been suggested that the documentation produced in
         the e-portfolio and the educational supervisors 6 monthly reviews do not need to
         be supplemented by additional appraisal documentation every year.
        he Northern Deanery has made an interim decision about appraisal requirements
         for all three years of Speciality training in General Practice and these are
         summarized in the table below
        We feel there is significant value in continuing to use a formal appraisal process,
         as is currently used with Phase 3 GPRs, at the end of the ST 3 year . This
         provides a summary of the trainee’s achievements and development needs,and
         a PDP to guide their CPD for the following year .
        This ‘end of GP speciality training’ appraisal will use documentation from the e-
         portfolio for evidence purposes ,but will use also Forms 1-4 adapted from the
         Gold Guide. The appraiser will be the ST 3 trainer, who will carry out and write up
         a formal appraisal interview, as is currently done for all Phase 3 GPRs.

ST        Appraisal requirements                     Comments
ST1       6 monthly reviews with educational         No additional appraisal documentation
          supervisor and completion of               to be completed
         supervisor’s annual report, which will
         include highlighting development
         needs for the following year
ST2      6 monthly reviews with educational         No additional appraisal documentation
         supervisor and completion of               to be completed
         supervisor’s annual report, which will
         include highlighting development
         needs for the following year
ST3      Needs to undergo a formal appraisal        The appraisal will be the responsibility
         interview carried out by ST 3 trainer in   of the trainer[as it is currently]- if the
         the final month of the attachment. This    ST 3 has an educational supervisor
         will be done using the amended ‘Gold       who is not the trainer, then they will
         Guide’ forms contained in this             just complete their annual report, not
         document                                   carry out the appraisal


        B. Getting started-what to do now- guidance for ST3

        1.Understanding the documentation
   Annual appraisal for doctors in training is to be carried out using slightly
    amended forms from the Gold Guide ,[see below]. All the documentation
    is based around the nine areas in the GMC’s document Good Medical
    Practice (www.gmc.org.uk) . An expanded version of this document
    adapted specifically for General Practice can be found on the RCGP
    website-(www.rcgp.org.uk)- both of which are worth referring to referring
    to. A summary of these two documents is attached as appendix 2. A
    summary of the recent White Paper on Medical Regulation is attached as
    Appendix 3
   The nine areas are as follows
        1. Clinical care
        2. Maintaining good practice
        3. Relationships with patients
        4. Working with colleagues
        5. Teaching and training
        6. Probity
        7. Health
        8. Research
        9. Management
   As a GP in training it is likely that most of your evidence collection and
    development needs will fall within sections 1 to 4, unless you are in a job
    which has a specific teaching, research or management component.
    Probity and health are important sections and the GOLD Guide forms
    contain specific self-declarations in these areas, which do not currently
    require production of other specific evidence.

   Forms 1 and 2 provide personal and biographical data. Once filled in
    these can be stored electronically , then up-dated and re-used in
    subsequent years.

   Form 3 provides a summary of the evidence you have selected to
    support your work in each of the relevant Good medical Practice areas
    listed above. Unlike the Form 3s completed by qualified GPs, as a
    Speciality trainee you are only asked to bring together appropriate
    evidence for each section, almost all of which is already contained in your
    e-portfolio. Form 3 in the Gold Guide does not require a written
    commentary on your strengths, weaknesses and development needs.
    However, we feel writing down a few reflections on your strengths and
    development areas forms a very useful basis for the appraisal discussion,
    and follows the model you will be asked to use when you are a qualified
    GP. We have therefore slightly amended the forms in the Gold Guide to
    include a small free text section, and we have removed some of the
    sections which are only relevant to hospital jobs. At the end of Form 3 you
    are asked to list the evidence that you have actually assembled in your

   Form 4 summarises the outcome of your appraisal interview-it is the
    agreed record of your appraisal and forms the basis of your PDP. This is
    written up by your trainer and then agreed by you and jointly signed off for
    submission to the deanery

   Your PDP is written by you and should be based on the action points
    defined during the appraisal interview. PDP aims should be specific,
    measurable and achievable –they will form the basis for your on-going
    learning in the next year, and will be re-visited at your next appraisal

   All the forms are reproduced electronically on the Deanery website
              2. What to do now

   Assuming you are now near the beginning of your final ST 3 GP post ,ie in
    the last six months of your training year , your main task is to read the
    information above and the electronic appraisal preparation Forms 1- 3, and
    be quite clear what information you need to be assembling in your portfolio
    over the next few months

   If there is anything you are not sure of, discuss this with your trainer as soon
    as possible. It is really important you don’t reach the end of your ST 3 year
    and suddenly realize you are lacking several pieces of important evidence,
    which need to be submitted for your appraisal

   Your appraisal should take place in the final month of your ST3 year , and will
    be carried out by your trainer NOT your educational supervisor [unless these
    are the same person] It will draw on information that you have collected in
    your educational portfolio but the appraisal documentation is not at present
    included in the portfolio

   Consult the table below to be sure that you will be well prepared for your
    appraisal .
      Preparing for, and completing, your ST 3 appraisal-tasks for the
      ST 3 trainee

Time    Appraisal tasks
Month 1    Read through this guide and Forms 1-3 to make sure you are clear
              what evidence you need to collect over the next few months
           Discuss this with your trainer if you have any queries
Months     Collect all necessary evidence –most of it will be integrated within the
2-4           portfolio such as case discussions, video reviews, 360 feedback etc
           Organize with your trainer when your patient feedback will be elicited
Month 5    Start filling in Forms 1-3 electronically, and assembling your file of
              evidence, listing all the relevant evidence. The evidence itself can be
              printed off from the e-portfolio , with additional information eg course
              certificates, clinical presentations etc added into the file.
           You need to discuss with your trainer whether you both prefer this to
              remain as a ‘virtual’ folder , with all documents read on screen or on-
              line, or whether it is easier to print out one paper copy for your trainer
              to read and for you to keep
           Agree your appraisal date with your trainer
Month 6    Submit your appraisal folder[paper or electronic] to your appraiser two
              weeks before the agreed appraisal date
           Take part in the appraisal interview at the agreed date
           Read, edit if necessary, and sign off the Form 4 that your trainer
              produces after the appraisal interview
           Produce your PDP for the following year, based on the action points
              agreed with your trainer
           Discuss this with your trainer in one of your final teaching sessions,
              and add the final version, with a copy of your Form 4, to your appraisal

   B. Writing your PDP
When you have had your appraisal , your trainer will complete your Form 4, which is a
summary of the discussion and the agreed ‘action points’ for your professional
development over the last year. You need to edit this as necessary and then transfer
the action points into your PDP for the next year . Use the guidance below to produce a
learning plan that represents around 50 hours of study/reading etc over the next year

 What makes a ‘good ‘ PDP

      Each learning need is clearly explained and described in specific terms eg” to become
       confident in switching Type 2 diabetics to insulin” is much more useful than ‘update
       diabetes knowledge”
      Action points are all SMART –Specific, Manageable, Achievable ,Realistic and in an
       appropriate Ttime frame
      Learning needs show a balance between personal and practice priorities [if working in
       a practice context]
      There is a clear statement on how each learning need will be addressed- resources to
       be used, courses or training sessions to be attended etc
      A realistic time frame for responding to the need is included in the plan
      The intended outcome is stated –either personal or for the practice or both, that should
       be the result of responding to the identified need.
      The overall plan is achievable and corresponds roughly to around 50 hours of
       intended study time
      The PDP demonstrates an approach that has an overall focus of improving patient

An example of a couple of specific learning aims is attached below

What              How will I address         Date by      Outcome
development       them?                      which
needs have I?                                task to
                                             be done
Explain the       Explain how you will       The date     How will your
need.             take action, and what      agreed       practice
                  resources you will         with your    change as a
                  need?                      appraiser    result of the
                                             .            development
To Develop my     -to join RVI               over next    Improve
skills in         dermatology evening        year         management of
What                How will I address    Date by     Outcome
development         them?                 which
needs have I?                             task to
                                          be done
dermatology         ‘skin club’ for GPs               patients with
                    -to do at least three             skin problems
                    BMJ learning modules
                    on dermatology topics
                    -to discuss any
                    challenging skin
                    problems with clinical
                    colleagues when
To improve          -to read up work that   within    Improve
consultation        has been done in this next year   communication
skills in area of   area-several recent               with patients
sharing             BMJ articles                      and hopefully
decision            -to try to apply these            better patient
making              skills in the                     satisfaction
                    -to review at least one
                    video to view this area
                    with young
                    practitioner group

Appendix 1

Summary of the requirements for each section of Good Medical Practice

1. Standards for Good Clinical Care
     Make an adequate assessment of the patient's conditions, based on the history
      and symptoms and, if necessary, an appropriate examination;
     provide or arrange investigations or treatment where necessary;
     take suitable and prompt action when necessary;
     refer the patient to another practitioner, when indicated.
     recognise and work within the limits of your professional competence;
     be willing to consult colleagues;
     be competent when making diagnoses and when giving or arranging treatment;

     keep clear, accurate, legible and contemporaneous patient records which report
      the relevant clinical findings, the decisions made, the information given to
      patients and any drugs or other treatment prescribed;
     keep colleagues well informed when sharing the care of patients;
     provide the necessary care to alleviate pain and distress whether or not curative
      treatment is possible;
     prescribe drugs or treatment, including repeat prescriptions, only where you have
      adequate knowledge of the patient's health and medical needs. You must not
      give or recommend to patients any investigation or treatment which you know is
      not in their best interests, nor withhold appropriate treatments or referral;
     report adverse drug reactions as required under the relevant reporting scheme,
      and co-operate with requests for information from organisations monitoring the
      public health ;
     make efficient use of the resources available to you.
     not allow your views about patients' lifestyle, culture, beliefs, race, colour,
      gender, sexuality, disability, age, or social or economic status, to prejudice the
      treatment you provide or arrange
     give priority to the investigation and treatment of patients on the basis of clinical

2 .Standards for Maintaining Good practice

         . You must keep your knowledge and skills up to date throughout your
          working life. In particular, you should take part regularly in educational
          activities which maintain and further develop your competence and
         keep up to date with the laws and statutory codes of practice which affect
          your work
         work with colleagues to monitor and maintain the quality of the care you
          be continually aware of patient safety
          take part in regular and systematic medical and clinical audit, recording data
           honestly. Where necessary you must respond to the results of audit to
           improve your practice, for example by undertaking further training;
          respond constructively to the outcome of reviews, assessments or appraisals
           of your performance;
          take part in confidential enquiries and adverse event recognition and reporting
           to help reduce risk to patients;

3 .Standards for Working with colleagues

      You must always treat your colleagues fairly. In accordance with the law, you
       must not discriminate against colleagues, including those applying for posts, on
       grounds of their sex, race or disability.
      You must not allow your views of colleagues' lifestyle, culture, beliefs, race,
       gender, sexuality, or age to prejudice your professional relationship with them.
      You must not undermine patients' trust in the care or treatment they receive, or in
       the judgment of those treating them, by making malicious or unfounded criticisms
       of colleagues.
      You must respect the skills and contributions of your colleagues;
      maintain professional relationships with patients;
      communicate effectively with colleagues within and outside the team;
      make sure that your patients and colleagues understand your professional status
       and specialty, your role and responsibilities in the team and who is responsible
       for each aspect of patients' care;
      participate in regular reviews and audit of the standards and performance of the
       team, taking steps to remedy any deficiencies;
      be willing to deal openly and supportively with problems in the performance,
       conduct or health of team members.
      Have satisfactory arrangements for handing over responsibility for patients, both
       for communicating information and ensuring quality of care, when you are not
       able to provide it
      Make suitable arrangements for referral of patients to a health care professional
       of known competence when additional care is required

4. Standards for Relationships with patients
      treat patients with courtesy and consideration
      treat all patients equally and ensure that some groups are not favoured at the
       expense of others
      be aware of how personal beliefs can affect the care that is offered to the patient,
       and take care not to impose beliefs and values on patients
      maintain the patient’ dignity and respect during physical examination
      obtain informed consent to examination, investigation and treatment
      respect the autonomy of the patient to refuse treatment
      inform patients and their carers about their condition in a way they can
      empower patients to take decisions about their management
      keep patient information confidential
      seek consent before sharing information-do not discuss patients where
       confidential information can be overheard
      avoid situations where personal and professional interests might conflict
      apologise appropriately if things go wrong-have an adequate complaints
       procedure in place
      be able to justify why ending a professional relationship with a patient is fair, and
       communicate these reasons with the patient

5. Standards for Teaching and Research


      Be honest and objective when appraising or assessing any doctor, including one
       you have trained
      Provide honest and justifiable comments when providing references or writing
       reports about colleagues
      Contribute to the education of students and colleagues willingly
      Develop skills attitudes and practices of a competent teacher if you have
       responsibilities for teaching
      Ensure students and junior colleagues are appropriately supervised

      Put care and safety of patients first when participating in research
      Ensure all projects you are involved in have ethical committee approval, and that
       patients have given informed consent
      Conduct all research in an ethical manner with integrity and honesty
      Be satisfied that foreseeable risks will be outweighed by benefits for all
      Ensure that patients are aware they are participating in research, whose
       outcomes may not be predictable
      Respect participants’ rights to confidentiality
      Record and report results accurately
      Do your best to complete all projects or ensure they are completed by others
      Keep clinicians informed of their patients’ involvement in a research project
      Follow the protocol agreed by the ethical committee

6. Good Medical practice standards for Probity

      If you publish information about the services you provide, the information must be
       factual and verifiable. It must be published in a way that conforms with the law
       and with the guidance issued by the Advertising Standards Authority.
      You must be able to justify any claims you make about the quality of your
      You must not in any way publish information about your services that exploits
       patients' vulnerability or lack of medical knowledge.
      You must be honest and trustworthy when writing reports, completing or signing
       forms, or providing evidence in litigation or other formal inquiries. This includes
       not providing documents that are misleading because they omit relevant
      Be honest and open in any financial arrangements with patients, including fees
       and charges for treatment
      You must not encourage patients to give lend or bequeath gifts to you
      Act in your patients’ best interests when making referrals-declare any financial
       interests you might have in specific institutions and do not pressurize patients
       into having private treatment
      Be honest in all financial dealings with employers, insurers etc.
      Avoid treating patients in an institution where you or your family have any
       financial interest-or if you do this, declare this financial interest openly

7. Good Medical practice standards-Health

      Take and follow advice from a consultant in occupational health or other suitably
       qualified colleague, on whether and how you should modify your practice if you
       know you have a serious condition which you could pass on to patients, or if your
       judgement or performance could be significantly affected by a condition or its

Appendix 2 - Trust , Assurance and Safety –White Paper on
Health Professionals’ regulation March 2007

Some notes on core content of White Paper:

      Sets out a programme of reform for the regulation of health professionals based
       on the CMO’s response to the Shipman Inquiry findings [Good doctors safer
       patients-published July 2006]
      Part of a comprehensive strategy to improve sustain and improve quality
      Concerns all health professionals working within the UK healthcare system [NHS
       , private sector, research, education, public health etc ]
      Aim is to support all individual practitioners as well as early identification of any
       performance concerns

Main drivers :
  •   Patient shift from passive acceptance of, to active involvement in ,health care
  •   Human error likely to increase in line with both technology development and
      rising patient expectations
  •   Good communication between patients and professionals to be supported and
  •   Better rehabilitation services for health professionals in difficulty
  •   High profile media cases have led to public demand for regular review of
      competence , early detection of problems and rapid response to any detected
      poor practice

Covers seven core areas

  •   [1]Changes in professional regulatory bodies [GMC,GDC etc]-their
      membership and roles
  •   [2] Revalidation –ensuring continuous fitness to practise- division into two core
      components –re-licensure [annual appraisal, 360 feedback and clinical
      governance sign off] and re-certification [knowledge and skills testing put in place
      by each Royal College for their own speciality]
  •   [3] and [4] Tackling performance concerns locally and nationally- medical
      directors at Trust and PCT level responsible for performance concerns for all
      doctors on their performers list. Concerns about individuals will remain ‘recorded’
      and accessible to other employers until resolved.
  •   [5] Education and the role of Regulatory bodies-closer links between
      regulation of undergraduate, post graduate and continuing education for all
      health professionals
  •   [6] Information about health professionals-greater public access to
      information about health professionals
  •   [7] New roles and emerging professions-new regulations for psychologists,
      psychotherapists etc

  Revalidation –a summary
Re-licensure                                  Re-certification
   • Satisfactory engagement in annual            • Comprehensive assessment
       appraisal which will be both                  against standards drawn up by
       summative [has performance met                RCGP for GPs likely to be based
       specific standards] and formative             on GMP for GPs
       [looking forward to any changes that       • External QA of process to ensure
       might be needed]                              they are robust yet cost-effective
   • Participation in at least one                   re time taken away from patient
       independent 360[multi-source]                 care
       colleague feedback survey in the 5         • GPs will not need to join RCGP to
       year period [including specific               be re-certified ,but there will be a
       feedback on communication skills]             cost attached
   • Confirmation that any concerns about         • Information to be drawn from
       a doctor’s conduct or fitness to              clinical audit, employer appraisal,
       practise have been resolved to                knowledge tests, patient feedback,
       satisfaction of medical director and          CPD and observation of practice
       GMC affiliate                          Acknowledgement that more
                                              experienced doctors may deal with more
                                              complex patients, and analysis of
                                              treatment outcomes must take account of