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The NHS appraisal scheme for doctors

The standardised NHS appraisal scheme has been in place since 2002, arising partly to address inconsistencies in earlier local, specialty and organisational schemes, partly to embed an element of performance review, following the Bristol and Shipman inquiries (Kennedy, 2001; Smith, 2001–05), and partly as a result of the increasing complexity of doctors’ working practices (Follet and Paulson-Ellis, 2001). The main elements of the scheme are similar for all doctors. The primary aim of the appraisal scheme is to identify personal and professional development and educational needs, with the ultimate aim of improving clinical performance and patient care. Doctors in training, from foundation year two onwards, will be revalidated through their existing regular reviews, the Annual Review of Competence Progression (ARCP) process or its equivalent, the Record of In-Training Assessment (RITA).

Appraisal is linked closely to revalidation and is based on the document Good Medical Practice (GMC 2012b), which describes the principles of good medical practice, and standards of competence, care and conduct expected of doctors in all aspects of their professional work. Appraisal documentation and activities are based on the four core domains of Good Medical Practice Framework (GMC 2012a), each of which is divided into three attributes. 

Domain 1
Knowledge, skills and performance
Attribute 1: Maintain your professional performance
Attribute 2: Apply knowledge and experience to practice
Attribute 3: Ensure that all documentation(including clinical records) formally recording your work is clear, accurate and legible 
Domain 2
Safety and Quality
Attribute 1: Contribute to and comply
with systems to protect patients
Attribute 2: Respond to risks to safety
Attribute 3: Protect patients and
colleagues from any risk posed by your health
Domain 3
Communication, Partnership and Teamwork
Attribute 1: Communicate effectively
Attribute 2: Work constructively with colleagues and delegate effectively
Attribute 3: Establish and maintain partnerships with patients
Domain 4
Maintaining Trust
Attribute 1:  Show respect for patients
Attribute 2: Treat patients and colleagues fairly and without discrimination
Attribute 3: Act with honesty and integrity

Doctors are required to collect and discuss supporting information from a range of sources (patients, colleagues and their own reflections) to demonstrate their competence across these attributes. There are six types of supporting information required by the GMC (GMC 2012c):

  1. Continuing professional development
  2. Quality improvement activity
  3. Significant events
  4. Feedback from colleagues
  5. Feedback from patients
  6. Review of complaints and compliments

The forms completed by the appraisee and the supporting information provided form the basis of the appraisal discussion.

Appraisal is one aspect of the overall clinical governance mechanism of the NHS. However, it is not the main mechanism through which poor performance is identified or addressed. Appraisal should be a positive and forward-looking process and should aim to identify aspects of performance that need development at an early stage and as part of an ongoing CPD process.

There are a number of electronic toolkits available for completing appraisal paperwork, sharing it between appraisee and appraiser online, and producing and managing a PDP. Organisations may request that doctors use a particular toolkit to facilitate the process of appraisal.


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