Supporting information and reflection on your appraisal

There are six types of supporting information to collect and reflect on. Adapted from the GMC’s supporting information: 

These are: 

1. Continuing professional development (CPD)
2. Quality improvement activity
3. Significant events
4. Feedback from patients or those to whom you provide medical services
5. Feedback from colleagues
6. Compliments and complaints

At least annually:  

1. You should be able to demonstrate you are keeping up to date by doing adequate and relevant CPD for every role and reflecting on the significant learning and changes you have made as a result. We recommend you focus on two or three significant changes to reflect on rather than creating long lists of mandatory training or CPD that you have done, although a basic log kept throughout the year may be an easy way to demonstrate the spread of your CPD.    
2. You should be able to demonstrate that you review the quality of your work by showing you have done at least one quality improvement activity (QIA) for your GP role. Examples include reflection on case discussions, an audit of referrals or minor op or coil fitting outcomes, a review of an area of prescribing, writing or revising a practice policy or patient information leaflet, or monitoring patients on a medication such as DMARDs. You could also include PUNS (patient unmet needs) and DENS (doctors educational needs) – where you make a note whenever you see a patient where you are not sure how to manage the problem and subsequently read up on the management of this condition.
3. You should take part in your organisations’ significant event processes and declare any significant events or serious incidents in which you have personally been named or involved. You should have reflected on any learning and subsequent change in practice or system change as a result of what has been learned. Locums may not be invited to take part in actual meetings, but all doctors should know how to identify significant events and learning events and the process to contribute. We recommend locums have peer support from the practices where they are regularly employed and/or are a part of a peer learning group where they can discuss learning events. 
4. You should reflect on any informal feedback from your patients.
5. You should reflect on any informal feedback from your colleagues.

At least once every revalidation cycle (usually five yearly) in order to have a positive revalidation recommendation you will need to have: 

1. Reflected on GMC-compliant formal feedback from patients from your whole scope of work (collected after your previous revalidation date). The majority of patients should be from your NHS GP practice. If you are struggling to get replies from patients because of the nature of your role, you should contact your RO to explain, and they can approve surveys with fewer responses. When doing your feedback survey, you must take a “hands off” approach. Ideally an administrator hands/texts/emails surveys to every consecutive patient and anonymous paper copies are collected by an administrator and sent to the survey provider or the survey provider collates the replies. Your survey provider alerts you when you have enough responses to close the survey. You receive the collated anonymised results benchmarked against peers and you reflect ahead of your meeting on the results. ‘Cherry picking’ respondents is unlikely to give you valuable feedback, may jeopardise your revalidation recommendation and is likely to require you to repeat the survey in a GMC-compliant way.
2. Reflected on GMC-compliant formal colleague feedback (since your last revalidation date). We recommend, when sending invitations, you aim for replies to be proportionate to your time spent in different roles and for the majority of replies to be from clinicians. Some ROs may have specific requirements that you can clarify through your appraiser or appraisal office.
3. Included QIA for each role at least once.

Verbal reflection in your appraisal discussion is just as valid as what you write in your submission. The most useful supporting information to include is that which impacted your personal practice, or which helped you identify actions or changes you need to make. Therefore, we recommend you write a brief summary of the most impactful learning, quality improvement activities, and feedback you’ve received from colleagues, patients and others you’ve provided professional services to, such as GPs in training. Avoid lengthy reflections on everything you have done since your last appraisal. If you don’t reflect in your portfolio in advance of the meeting your appraiser will ask these questions and it facilitates your professional development to have thought about the answers before you meet.

Consider - If your PDP, PUNS and DENS or feedback do not lead you to particular clinical learning topics, consider using the GP curriculum, or signing up to SIGN or NICE guidance alerts as a resource for your CPD supporting information and reflection.

The list below are the reflective prompts you’ll see when preparing. Look at them as aids to your personal reflection - if you answer all that are applicable you will have provided good evidence that you are a reflective practitioner. 

You’ll then need to sign a declaration stating whether you have been named in any significant events or serious incidents since your last appraisal. If you have, you’re required to provide a brief reflective commentary in your submission. This should include consideration of your participation in the investigation, your response, and any actions taken. You’ll then have the opportunity to discuss it further with your appraiser. 

1. What have you done to keep up to date across the whole of your scope of work?
2. What are the most significant things you have learned?
3. Have you identified any learning needs that you need, or want, to address or key learning to be shared? If so, what action have you taken as a result?
4. What have you learned from reviewing your practice across the whole of your scope of work?
5. What are the most significant things you have changed as a result and how effective have those changes been? 
6. What else do you want to change (if anything)?
7. What have you learned from any feedback, solicited or unsolicited, you have had about your practice, both individually and as part of the teams you work in:  

1. from your patients or their carers  
2. from any other group you provide medical services to, including teaching, training and appraising  
3. from your colleagues  
4. from any compliments you have been personally named in? 

What have you changed, or do you want to change (if anything), because of any feedback you have received?