Resources and support for appraisers

You will find links, resources, and examples of best practice to support you in the delivery of appraisal. If you can’t find the answer to your question, or would like more information, please email us

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Developing these resources

Appraisers, this page is for you and we want it to be built by you. Thank you to those who have already shared valuable resources with us.

The resources below have been shared with us by the appraiser community as potentially useful to others. Unless explicitly stated, they haven’t been created or endorsed by the College.

If you have any of the following, please get in touch with the team at professionalstandards@rcgp.org.uk.

  • Case studies and examples from your role that you think others would benefit from.
  • Resources that you use in your region to help support appraisees with their reflection, wellbeing or any other aspect of the appraisal process.
  • Examples of processes that have helped you to deliver your role.
  • Sources of support for you as an appraiser.
  • Anything else you think other appraisers would find useful.

Challenging scenarios to discuss at NE appraisers’ conference group-work 11/22

Consider the scenarios described below, and how you might respond to the questions. These will be discussed initially in small groups and then the core points will be brought back to the large group.
 

GP name and number Case details Questions to consider
1. Dr A Dr A is a GP partner who had her first baby early in 2021-she started her maternity leave a couple of weeks before her baby was born. She was last revalidated in November 2018 and her appraisal month is January. Her last appraisal was in January 2021.She had planned to be away from clinical work on maternity leave for around a year. However, when her daughter was around 6 months, she found herself unexpectedly pregnant again. Around the same time, her daughter developed some significant health issues requiring repeated hospital visits, and this combination of factors meant that she decided not to return to work before her second child was born in April 2022. She is due to return to work early in 2023, just before she has been out of practice for two years. She has requested a ‘return to work’ appraisal’ in January 2023 
  • What core areas would you want to cover at this appraisal?
  • What support might she be offered?
  • What are her options in terms or revalidation?
2. Dr B Dr B is a German GP who worked in several OOHs services in the NE for 3 years from 2017. There were a couple of complaints processed via NHSE during that period, which related to both communication skills and clinical knowledge, and Dr B engaged fully with the remediation actions advised at the time. She then returned to Germany for almost two years, before restarting OOHs work in the UK. This work is now based entirely in London where her family is now living. You had a full discussion at her appraisal where she admitted that she had re-started OOHs work in a different area with no local support or any formal induction. She said that she has already had a couple of concerns raised about her attitude/manner, rather than any clinical issues, and she has tried to respond to these with behaviour changes. 
  • Is there anything in this scenario that raises concern for you as an appraiser- if so, what actions do you feel are appropriate to take?
  • Is there anything you would want to share with the appraisal team?
  • Is there any support available for a GP in this situation?
3. Dr C This is the first time you have appraised Dr C who works 4 sessions a week as a salaried GP and one session doing on-line remote consulting for both NHS and private patients. It has been very difficult to make contact with him to arrange his appraisal, and he has sent you almost nothing prior to the appraisal meeting. His last appraisal was December 2019, and he elected to defer his 20/21 appraisal due to Covid pressures. He then requested a postponement of his December 2021 appraisal due to some health issues and staff shortages at the practice, so you are appraising him in June 2022. He has achieved none of his PDP aims from 2019, and he has written very little on his appraisal template. He does not describe any CPD or QIA in any detail although he mentions that he has done ‘a bit’ of on-line learning. He has also sent you a significant quantity of continuous consultation feedback from patients collected by the on-line provider he works for, covering more than 100 patient interactions. He is due to be revalidated in May 2023.
  • What approaches and specific questioning skills might you use during the appraisal meeting to determine what learning he has engaged in since his last appraisal and how he seeks to reflect on and improve his practice as necessary?
  • What does he collect and submit at minimum before May 2023 to make sure that he will be revalidation ready?
  • Is there any other support you might offer him?
  • Do you need to highlight anything to the appraisal team at this stage?
4. Dr D Dr D has been working in an Australian GP job for the last four years. He had intended to stay there permanently with his family, but the reality of forced isolation from family and friends in the UK during the Covid pandemic has made him and his partner reconsider their situation, and he is now keen to return to work in the UK as soon as this can be arranged. He was revalidated in 2018, soon after he moved abroad, and resigned from the NPL and the GMC register soon after this. You appraised him the year before he left for Australia, so he has emailed you for advice. You can of course pass this request directly to the appraisal team, but it might be useful to discuss these issues:
  • What are the formal steps this GP needs to take to return to work in the UK?
  • What ‘return to practice’ support might be available to him?
5. Dr E Dr E is in her late seventies and has been working as an inner-city GP for more than 4 decades-mostly in a single-handed practice. For the last ten years she has been doing 3-4 locum sessions a week at a few local practices where she is well known. She reports that there have been fewer offers of work in the last year, but no formal performance issues have ever been raised as far as you know from her appraisal. Dr E says she is likely to retire in the next couple of years but has no definite plans. She was revalidated two years ago. Your main concern is what you feel to be her professional isolation, she really has no contact with any peers apart from going into practices and doing her locum work. She does not get the opportunity to meet up with any of the GPs or other colleagues she works with and has no peer support network. Her appraisal discussion indicates that she continues to read journals and on-line articles and she says that she continues to enjoy her work.
  • Would this GP raise any concerns for you?
  • Are there any actions you might discuss with her?
  • Do you feel that she needs to be flagged to the appraisal team?
6. Dr F Dr F has worked for the last five years as a locum GP in a few practices she knows well. Early in the pandemic she switched to working exclusively remotely, doing both telephone triage for an OOHs provider and some on-line consultations for a private service. She has not seen a patient face to face for well over two years now. At her appraisal she tells you that she intends to go back to doing surgery-based locums early in the new year.
  • Does this GP need any specific advice at this point. If so, what?
  • Do you need to make any contact with the appraisal team about this GP?
7. Dr H Dr H is a 54-year-old experienced GP partner, and this is your second appraisal with him. Last year you were a bit concerned about the sustainability of his workload, especially as he does not feel appreciated by the practice in which he works as a salaried GP. This year at his appraisal, it is clear that things have is got much worse both at the practice and in his personal life. Professionally he feels over-worked, demoralised, dispirited and very stressed. He feels that GPs are bearing the brunt of peoples’ frustration at long waiting times for referrals and cancelled operations, and he is tired of being shouted at for things that are mostly quite out-with his control. Personally, his stress has affected his marriage and he feels that he is struggling to be the kind of father he wants to be to his children. He feels he never has any emotional energy left to give to his family. Dr H has pretty much decided that he will seek early retirement next year, rather than continue to live and work in a way that is seriously affecting his physical and mental health.
  • Given the issues of retention within the profession, do you feel there is anything as an appraiser you might offer to support this GP?
  • Are there any resources you could share with him?
8. Dr K You are appraising Dr K for the second time and there are no concerns about her own appraisal. However, she raises some concerns about her practice. Covid has worsened a staffing and recruitment situation and there are times when Dr K feels that patient safety is potentially being compromised. She mentions a couple of examples-a relatively inexperienced nurse practitioner who on occasions is left to work in one of the branch surgeries with no GP cover [which led to a significant prescribing error on one occasion] and a senior partner who quite often makes almost no record in the computer record of telephone calls. Dr K also feels that she and the other salaried GPs in the practice carried a disproportionate load during the Covid period, seeing patients face to face, running hot hubs, doing home visits, when two of the senior partners refused to come into the practice at all, and did only a minimum amount of remote working and administrative tasks. She feels this imbalance was not addressed at the time and has not yet been fully redressed.
  • What are the appraiser’s and the GP’s responsibilities here?
  • What actions might need to be taken?
9 The A and E department at a large local DGH has carried out an audit which has shown a significant increase in admissions related to poorly controlled diabetes. The 8 PCNs whose patients are the main users of this hospital’s A+E also have a substantial number of practices with significantly lower than average QOF scores in most of the Diabetes indicators. The clinical directors of these PCNs have been discussing whether it would be possible to ask all GPs working in these PCN areas to put one PDP aim in this year’s appraisal relating in some appropriate way to updating skills and knowledge in DM.
  • Discuss in your group whether this is a reasonable, acceptable or workable request-what might be the gains and difficulties with this approach?
10 In the last year you have appraised two GPs who have written almost nothing in section 6 of the template [or toolkit] and you have struggled to have a discussion about the specifics of what they have learned and reflected on in the last year. This in turn has made it difficult to write in the summary that you have been able to demonstrate effective reflective learning which has had an impact on patient care-you wonder if you should ask them to do more for next year’s appraisal.
In contrast, you have also appraised two GPs who had the same appraiser prior to you appraising them for the first time. When you are reviewing their PDPs from the previous year you are quite surprised to see that one of the GPs had agreed to do a formal full audit of different aspects of their clinical practice and the other had signed up to do a formal records review using the BMA template When you discussed these PDP items with your appraisees, there was some indication that their appraiser had suggested they should do these activities to provide good evidence of QIA and reflection on learning.
  • Discuss in your groups whether GPs should be asked/encouraged to collect and submit any formal written evidence of CPD or QIA, given the ‘low input’ emphasis of the 2022 appraisal process?
11 The GP you are appraising gets very upset when you get to the health and well-being part of the appraisal discussion. It turns out that his partner has had to declare himself bankrupt after a business failure and this has led to severe financial difficulties for both of them. He is very tearful because their previous lifestyle was quite flamboyant with expensive holidays, meals out etc and now they are struggling to pay the mortgage, utilities, car loans etc He is not sure what to do
  • Do you feel this is an issue which can/should be discussed within an appraisal? Are you aware of any agencies that might be able to offer any support here?

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