Consultant Appraisal: A Brief Guide · appraisal arrangements will be an important element in that overall process. Consequently, Chief Executives will be responsible for effective

SCOTTISH EXECUTIVE Working together for a healthy, caring Scotland

Consultant Appraisal: A Brief Guide

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contentsIntroduction 4

What is appraisal? 4

Why introduce appraisal for consultants now? 5

Where does appraisal fit with GMC revalidation and

clinical governance? 6

What is in it for me? 8

How will the appraisal system work? 9

What about confidentiality? 12

What if I don’t want to be appraised? 12

When will the new system be introduced? 13

Will I receive any support/training on appraisal? 13

Who will appraise me? 14

How will third-party-input work? 16

What kinds of evidence will I need to collect,

and where will I get it from? 17

How will I find the time? 18

What happens if my appraiser and I disagree? 18

Will identified training/development needs

be resourced? 19

What do I do next? 19

Where can I get further information? 20

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INTRODUCTION

As a medical or dental consultant you are probablyalready aware that, earlier this year, the BMA and theUK Health Departments have now reached agreementon a national scheme for introducing regular appraisalfor all consultants working in the NHS.

Consultants who believe in, and recognise, thebenefits of continuing personal and professionaldevelopment throughout their careers, will quicklycome to appreciate the value of regular appraisal as aneffective framework through which their developmentcan be considered and supported.

The purpose of this leaflet is to provide some basicinformation about the new scheme and how it is to beimplemented. It also tries to answer some frequentlyasked questions and explains how you can find outmore.

WHAT IS APPRAISAL?

Appraisal is not a process of assessment that onepasses or fails, and the new scheme is not aboutscrutinising doctors to see if they are performingpoorly.

Appraisal is about helping individuals to improve theway they work and the services they provide,themselves and with others.

Consultant Appraisal – A brief guide

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Appraisal goes beyond simply judging individuals onwhat they have achieved over the past year. It offers aframework for planned, constructive, professionaldialogue. It provides the opportunity for reflectionabout current performance and progress. This is usedas a platform to set goals for future professionalpractice and development which will also contributeto the needs of the organisation in which theindividual works.

Appraisal should therefore be a positive, constructiveprocess which is mutually beneficial to both theindividuals being appraised and also to theorganisation in which they work.

WHY INTRODUCE APPRAISAL FOR CONSULTANTS NOW?

Most organisations already operate systems of appraisalamong professional staff groups. Indeed, manyenlightened NHS organisations have already introducedappraisal for consultant medical staff. They believethat they should have access to the same sort offrameworks as other professional groups for supportingpersonal development within a constructiveperformance review process and aligning this withorganisational needs. Such local arrangements arevalued by the consultants participating in them.

In recent years health care and health improvementbecome ever more sophisticated, requiring the

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application of greater levels of knowledge and skills. Inkeeping with higher expectations from patients, thepublic at large, and indeed the profession itself,doctors increasingly accept that they must monitor,review, and improve (if necessary) their clinical skillsand practice. Appraisal will be an important tool formeeting these requirements in a positive way.

In addition, the General Medical Council is in theprocess of introducing a compulsory revalidationprocess for doctors, the purpose of which is tomonitor doctors’ clinical performance, and NHSorganisations themselves have to demonstrate highstandards of clinical governance.

It is against this background that appraisal is nowbeing introduced for all consultants.

WHERE DOES APPRAISAL F IT WITH GMCREVALIDATION AND CLINICAL GOVERNANCE?

Revalidation is the process whereby the GeneralMedical Council will establish a doctor’s fitness topractice and with it, the right to remain on the medicalregister. The process will have a five-yearly cycle.

The GMC has agreed, following discussion andagreement with the UK Health Departments and theprofession’s representative organisations to allow theappraisal process to be the principal vehicle throughwhich the evidence required for revalidation will be


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collected and presented for senior hospital and publichealth doctors, provided the process proves to besatisfactory for this purpose.

Appraisal for consultants will produce much of thesame evidence that consultants themselves willultimately require for GMC revalidation. It thereforemakes sense to run both processes side by side, thusavoiding duplication of effort. However, whereas theevidence will be used in an evaluative assessment inthe revalidation process, its use in appraisal will bedifferent. The revalidation cycle is essentially aretrospective process looking at clinical performanceover the previous five years. In the case of appraisal, itwill be employed in a formative way on a year-to-yearbasis to ensure development of professional practiceand to set professional objectives.

Clinical governance has been defined as “corporateresponsibility for clinical performance” and is a clearresponsibility of all NHS organisations. They arerequired to fulfil this responsibility by pulling togetherand monitoring the systems that ensure services meetquality and safety standards. NHS organisations arealso required to ensure that we learn from mistakes,and that we continually develop services to meet newdemands and standards of care. The new consultantappraisal arrangements will be an important elementin that overall process. Consequently, Chief Executiveswill be responsible for effective implementation andoperation of consultant appraisal in their organisations.

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A combination of these requirements – revalidation,personal development and clinical governance – hasled to the mandatory introduction of a national appraisalscheme for consultants. While such an approach maynot be ideal for all local circumstances and requirements,it does mean that appraisal becomes establishedpractise applied through a consistent approachthroughout the profession. Sensitive and flexibleimplementation of the national requirements canensure that these are effective in meeting local needs.

WHAT IS IN IT FOR ME?

Appraisal will only succeed, and be of value to individualparticipants, if they recognise that the processprovides appraisees with opportunity and support forreflection, and constructive feedback on whichpersonal and professional development can be based.Also, through this process, the appraisee can raise anddiscuss issues of concern relating to their contributionto the range and quality of clinical services provided.

Of course, at a more basic level, doctors who do notmeet the GMC evidence requirements will not berevalidated and will therefore not be allowed topractise. However, dwelling on this would placeappraisal in a somewhat threatening and negativecontext. Suffice to say that doctors are likely to getmore out of appraisal overall if they focus on thedevelopmental aspects of the process which willbenefit their practice in the long run.


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HOW WILL THE APPRAISAL SYSTEM WORK ?

The official documents notifying the scheme toHealth Boards and NHS Trusts in Scotland were NHScirculars PCS (DD) 2001/2 and 2001/7. If you do notalready have copies of these, they can be obtained bycontacting your Trust Medical Director or Director ofPublic Health Medicine in NHS boards. Alternatively,copies can be downloaded from the NHS in Scotlandwebsite www.show.scot.nhs.uk

At the core of the appraisal process will be an annualmeeting between the consultant (appraisee) andhis/her appraiser. The purpose of this meeting is toensure the opportunity for constructive dialoguethrough which the doctor being appraised can reflecton his/her work and consider how to progress his/herprofessional development. These meetings willprovide a positive process to give consultantsfeedback on their performance, to chart theircontinuing progress and to identify and plan fordevelopment needs.

The appraisal meeting should be arranged well inadvance to afford the opportunity for the appraiserand appraisee to gather together the necessary datato support a meaningful and constructive dialogue atthe meeting.

The content of the appraisal will be based on theheadings contained in the GMC’s “Good Medical

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Practice” document as well as relevant managementissues, including the consultant’s contribution to theorganisation and delivery of local services and priorities.

The GMC’s core headings are:

• Good clinical care• Maintaining good medical practice• Relationships with patients• Working with colleagues• Teaching and training• Probity• Health

For the appraisal meeting to be successful, it will beimportant for both the appraiser and appraisee toprepare beforehand. The following questions shouldbe thought through in advance of the appraisal meeting:

• How good a consultant am I?• How well do I perform?• How up to date am I?• How well do I work as part of a team?• What resources and support do I need?• How clear am I about my service objectives?• How well am I meeting my service objectives?• What are my development needs?• How might these be met?

Documentation will be required to support andrecord the evidence, discussion and outcomesassociated with the appraisal process.


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Each consultant will be required to prepare anappraisal folder into which they will recordinformation and insert evidence and data which willhelp the appraisal process. The first time round, thecompletion of the folder may take quite a bit of timeand effort, but once set up, it can be updated asnecessary on an ongoing basis.

NHS circular PCS (DD) 2001/7 encloses a set of sixforms to support the appraisal process. These formsvariously provide a framework for:

• Completion of the job folder• Summarising the appraisal process• Informing review of the consultant’s job plan• Recording information of a detailed and/or

particularly confidential nature which both partiesfeel may inform or help the next appraisal roundand which will remain confidential to the appraiseeand appraiser

Copies of the six forms in Microsoft Word format,which can be used for electronic completion of theforms, are also available on the SHOW website.

As mentioned before, the Chief Executive has overallresponsibility for ensuring appraisal of consultantstakes place and he/she will receive copies of thosecompleted forms which summarise the outcome ofthe appraisal.

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WHAT ABOUT CONFIDENTIAL ITY ?

Appraisal is a confidential process. The meetings willbe held in private and the completed documentationwill, at all times, be treated as confidential.

Only documentation summarising the appraisal willbe seen by individuals other than the appraiser andappraisee. This will be restricted to the ChiefExecutive and Medical Director (and Clinical Directorif he/she is not the appraiser).

WHAT IF I DON’ T WANT TO BE APPRAISED?

Hopefully, when you have learned more about the newscheme, you will recognise the value of the process toyou, and will decide that you are keen to participate.

In addition, appraisal is now a condition of thenational employment contract for consultants andrefusal to participate would be a breach of contractand a disciplinary matter. The national conditions ofservice are also clear that non-participants would beprecluded from consideration under the discretionarypoint and distinction award schemes.

Finally, you must also bear in mind that the GMC hasagreed to appraisal as the vehicle to revalidation,which will be necessary for a doctor to remain on themedical register and therefore maintain the right topractice.


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WHEN WILL THE NEW SYSTEM BE INTRODUCED?

The first appraisal cycle will commence in the yearbeginning 1 April 2002.

The period leading up to then should be used byconsultants and appraisers to start thinking aboutpreparing their appraisal folders and to familiarisethemselves with the requirements of the process.

Obviously, the process will not be perfect from dayone. In a whole range of areas, participants’ comfortwith, and their ability to make best use of, the newprocess will develop with experience. However, if theright degree of effort is applied to its introduction wemight reasonably expect that after two or three yearsthe appraisal of consultants will have become a well-established process that is valued by all participants.

WILL I RECEIVE ANY SUPPORT/ TRAINING ONAPPRAISAL?

Yes. To kick-start a training and developmentprogramme, a series of awareness-raising sessions willbe offered to all consultants between January andApril 2002. The sessions will build on the work of theconsultant body who have contributed to theproduction of this guide. We recognise that a numberof local NHS organisations have already begunprogrammes of training for consultants. Based onadvice from Trusts and Boards, the awareness-raisingsessions will target the most appropriate areas.

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The training programme will be delivered inconjunction with local NHS organisations and theplan is for the design and delivery to be carried out inpartnership with the Scottish Council for PostgraduateMedical and Dental Education and other keystakeholders.

During the year 2001, consultant nominations wererequested from Trusts to form a Scottish Core Group.About 80 consultants now form this group, and afurther 80 nominations have been sought so that agroup of 160 consultants can be intensively trained byApril 2002. This process will allow for all NHSorganisations to have their own consultant appraisal“champions” to support the training process locally.

All consultants in Scotland will receive appraisaltraining by October 2002. Work is currently beingprogressed on identifying appropriate learningmaterials that will be made available as soon aspossible.

WHO WILL APPRAISE ME?

Firstly, it is a clear requirement that appraisal of aconsultant will always be carried out by anotherconsultant on the medical or dental register.

The recommended framework for “cascading”consultant appraisal is the medical management


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structure. Ideally, therefore, consultants would beappraised by their respective clinical directors who,in turn, would be appraised by the Medical Director.

In many situations, however, it will not be that simple.For example, the number of consultants in a clinicaldirectorate may be too great to expect the ClinicalDirector to be the appraiser for all of them. In suchcircumstances, local discussions will be required toagree an effective and acceptable “cascade” structure.For example, if there is a structure of “lead consultants”within a directorate, they might be identified asappraisers.

Special arrangements will also need to be made forthe appraisal of clinical academics or consultants whoregularly work in more than one trust. In both cases,the consultant concerned should still only have oneappraisal and one NHS appraiser, but there will haveto be input from the university or other trust. Theprecise arrangements will have to be agreed betweenthe organisations concerned and with the individualdoctor to be appraised.

In circumstances where a clinical director is not aregistered consultant, the consultants within thedirectorate will be appraised by either the MedicalDirector, or an appropriate consultant selected by theMedical Director. In either of these cases, however, theClinical Director will be fully consulted before theappraisal meeting takes place to ensure that the

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appraiser and appraisee are aware of, and consider, allrelevant issues at the appraisal meeting.

As you can see, Trusts have a lot of work to do todevelop their appraisal cascade structures and thisshould be actively underway at this time.

Your Chief Executive is ultimately responsible forensuring that an appropriate appraiser is identified andthat the person nominated is properly trained toundertake the role.

HOW WILL THIRD-PARTY INPUT WORK ?

In addition to the situations described above, therewill be other circumstances where third-party input tothe appraisal process will be required. For example, asingle-handed practitioner at a hospital is likely tohave an appraiser from a different clinical specialty. Inthese circumstances, arrangements will have to bemade to identify a professional peer from anotherhospital or trust to contribute to the specialistprofessional aspects of the appraisal.

In all of the situations where a third party is involved,discussion will need to take place between thenominated appraiser, the appraisee and the third party,as to how this contribution will be integrated into theappraisal process. This may be through consultationand discussion before the appraisal meeting, or on thebasis of an agreed contribution to the meeting itself.


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WHAT K INDS OF EVIDENCE WILL I NEED TO COLLECT,AND WHERE WILL I GET IT FROM?

The appraisal process is not intended to require thegeneration of significant amounts of new evidence orinformation; rather it should aim to capture relevantinformation that already exists. What goes into thefolder will, in many cases, be available from clinicalgovernance activity, the job planning process andother existing sources. However, action is likely to berequired in many trusts to ensure that systems aredeveloped or refined to enable data to be readilyaccessed to support the consultant appraisal process.

The process itself may assist consultants to identifythe data they would consider relevant to theirspecialty or personal clinical practice that would beusefully brought to their appraisal. One result of theappraisal process will be to identify areas where thereare gaps to be filled or where perhaps data need tobe better collated or presented. This is likely to bemore apparent in the early years after appraisal islaunched, and some requirements may have to bespecifically addressed over time with the assistanceand support of your Trust.

Consultants will need to consider which documentsthey will require to collect for the appraisal process inlight of the circulars and other guidance they receive.Many of the Royal Colleges have already issuedguidance on good practice within their specialty.

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This sort of “portfolio” may be useful when thinkingabout information and documentation needs forappraisal.

HOW WILL I F IND THE T IME?

It is recognised that, to be done effectively, the newappraisal arrangements will require a significantinvestment of time by both consultants and theirappraisers. This is likely to be greatest in the initialyear when consultants are preparing their appraisalfolders for the first time.

Employers have been instructed that they mustrecognise that the preparation time and time forcarrying out appraisals are not additional toconsultants’ other duties and responsibilities, andtherefore should be included during usual workinghours. This is an issue that Trusts will be required toaddress locally, according to their particularcircumstances.

WHAT HAPPENS IF MY APPRAISER AND I D ISAGREE?

If something cannot be resolved between you, therewill be an opportunity for a further meeting to takeplace involving your Medical Director or Director ofPublic Health Medicine.


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WILL IDENTIF IED TRAINING /DEVELOPMENT NEEDS BERESOURCED?

It would be unrealistic to say that this will happenevery time for every consultant because the appraisalprocess does not create a new “pot of gold” to payfor training. However, what appraisal can do is ensurethat a robust discussion takes place about the relativepriority and benefit of fulfilling identified training anddevelopment needs, both for the individual consultantand the service within which he/she works. This shouldensure an equitable and targeted approach toallocating the available resources. The other benefitthat can emerge from the discussion is to consideralternative ways of addressing training anddevelopment needs.

WHAT DO I DO NE XT ?

If you have not already got copies of the PCS circularsreferred to at the start of this guide, you should getthese as soon as possible and familiarise yourself withthe details of the new requirements. They areavailable on www.show.scot.nhs.uk. Like many of thesecirculars, they can be pretty heavy going, but it isimportant that you understand what you will berequired to do. In particular, you need to acquaintyourself with the various forms involved in theprocess. You should also start thinking about whatwill need to go into your appraisal folder and howyou will gather this material.

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WHERE CAN I GET FURTHER INFORMATION?

No doubt once you have looked at all thedocumentation you will have questions that are notanswered in this guide. At least some of these willrelate to local issues that are specific to theimplementation of the consultant appraisal requirementswithin your Trust or Board. You should address thesequestions to your Medical Director or any othernominated contact that has been notified to you.

If you would like to understand more about theprocesses and benefits of appraisal, there arenumerous references you could follow up. A fewsuggested ones are:

• Appraisal for Medical Consultants – a handbook ofbest practice by Dr Steven Wilkinson and Dr KweeMatheson

• The Use of Evidence in the Appraisal of Doctorsby Wilkinson, Sanger and Matheson

Both of these booklets are published by EarlybravePublications Ltd. (www.earlybrave.com)

• Appraisal in Action

Published by The British Association of MedicalManagers


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• The Perfect Appraisal by H Hudson

Published by Random Century House, London

• Appraisal and Assessment in Medical Practiceby J W R Payton

Published by Mantiecor Europe Ltd

A helpful website on educational appraisal• www.appraisalskills.com

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This booklet was prepared on behalf of the ConsultantAppraisal Design Group, the membership is as follows:

Dr Ann Maree Wallace, Lothian Health Board

Dr Bill Anderson, North Glasgow University NHS Trust

Professor Andrew Calder, Academy of Royal Collegesand Faculties in Scotland

Dr Clifford Eastmond, Grampian University HospitalsTrust

Dr Richard Metcalfe, South Glasgow UniversityHospitals NHS Trust

Dr Charles Lind, Ayrshire and Arran Primary Care Trust

Dr William Reid, Tayside University Hospitals NHS Trust

Dr Rob Murdoch, South Glasgow University HospitalsNHS Trust

Dr Karen Watson, West Lothian Healthcare NHS Trust

Dr Roger White, Ayrshire and Arran Acute HospitalsTrust

Dr Matty Lough, Ayrshire and Arran Acute HospitalsTrust

Dr Alan Connacher, Tayside University Hospitals NHSTrust

Mrs Lyndsay Lauder, Argyll and Clyde Acute HospitalsNHS Trust

Ms Liz O’Neill, Lothian University Hospitals NHS Trust


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Ms Elizabeth Kelly, Scottish Executive Health Department

Dr Robin Cairncross, Scottish Executive HealthDepartment

Dr Hugh Whyte, Scottish Executive Health Department

Ms Lorna Clark, Scottish Executive Health Department

Mrs Kerry Chalmers, Scottish Executive HealthDepartment

Mr Steven Haddow, Scottish Executive HealthDepartment

Documents

Consultant Appraisal: A Brief Guide · appraisal arrangements will be an important element in that overall process. Consequently, Chief Executives will be responsible for effective