Local Implementation of GP Appraisal€¦ · Web viewSections about research and management activities, and other professional roles, are also included in the NHS appraisal documentation

Contents of GP Personal Appraisal File

Introduction

Section A: All About Appraisal1. What is appraisal?2. Revalidation and comparison with appraisal3. The process and responsibilities

Section B: Newcastle Appraisal System4. Aims and objectives of the local scheme5. Specification of GP Appraisers6. How to identify your appraiser7. Support available for appraisal8. Confidentiality9. Accountability and responsibility for the scheme10. Monitoring the system11. A Learning Organisation 12. How to raise a concern or make a complaint

Section C: Undertaking Appraisal13. Preparing for appraisal14. The appraisal interview15. Developing a personal development plan16. Follow up17. The NHS Appraisal Toolkit18. Methods of Reflection

Section D: Completing the Appraisal Documentation

Section E: Personal Appraisal Documentation19. Form 1 20. Form 2 21. Form 3 22. Form 4 23. Form 5

Section F: Resources

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Introduction

In Supporting Doctors, Protecting Patients (1999) the Chief Medical Officer proposed that all doctors employed in or under contract to the NHS should be required to take part in regular appraisal. The NHS Plan confirmed that participation in annual appraisal would be a condition of contract from 2001. The Department of Health expects PCTs to ensure implementation of GP appraisal from April 2002.

Negotiations with the BMA General Practitioners’ Committee have resulted in agreement to proposals with the proviso that GP time to undertake appraisal is fully funded and protected. There is an onus on both PCTs and GPs to deliver - support for GP appraisal will be a mandatory function for PCTs and participation in appraisal will also be a GP contractual requirement.

A small Implementation Group is overseeing the introduction of GP appraisal in Newcastle. Overleaf details of members of this group are provided. Members can be contacted directly if you have any queries or concerns.

This Personal Appraisal File has been produced by the PCT in partnership with the LMC. It is based on work initiated by Debbie Freake and further developed by Laura Bond, Professional Development Manager at South Tyneside PCT. It is intended to help GPs understand the nature of the appraisal process, how the local system works. It aims to give as much guidance as possible, both to facilitate satisfactory completion of appraisal and to ensure that practitioners can derive maximum benefit from the appraisal process. We would strongly recommend that practitioners read the file and very much hope that you will find it useful.

Dr Debbie Freake Dr Relton CummingsMedical Director ChairNewcastle PCT Newcastle & North Tyneside

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Local Medical Committee

GP Appraisal Implementation Group Membership

Name Debbie Freake

Title Medical Director

Work address Newcastle Primary Care TrustBenfield RoadWalkergateNewcastle upon Tyne NE6 4PF

Tel No (0191) 219 6055

Fax No (0191) 219

E-mail address [email protected]

Name Relton Cummings

Title LMC representative

Work address 17 Osborne RoadJesmondNewcastle upon Tyne NE2 2AH

Tel No (0191) 281 4588

Fax No (0191) 212 0379


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Name Prof Tim Van Zwanenberg

Title Professor of Post Graduate General Practice

Work address Faculty of Health, Social Work and EducationCoach Lane CampusNewcastle upon TyneNE7 7XA

Tel No (0191) 222 8926

Fax No


Name Alison Smith

Title PCT PEC member

Work address Westerhope Medical Group377 Stamfordham RoadWesterhopeNewcastle upon TyneNE5 2LH

Tel No (0191) 243 7000

Fax No (0191) 243 7006

E-mail addressSmithAlisonA86025WesterhopeMEDNE52LH@nant-ha.northy.nhs.uk

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Name John Bookless

Title Postgraduate Tutor

Work address Throckley Primary Care CentreTillmouth Park RoadThrockleyNewcastle upon TyneNE159PA

Tel No (0191) 210 6700

Fax No (0191) 210 6702


Name Val Wadge

Title

Work address 48 Osborne RoadJesmondNewcastle upon TyneNE2 2AL

Tel No (0191) 281 4060

Fax No (0191) 281 0231

E-mail address

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Name Dawn Solomon

Title Primary Care Support Manager


Tel No (0191) 219 6037

Fax No (0191) 219 6066


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Section A: All About Appraisal

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About appraisal Section A1

What can appraisal do for me?

It is an opportunity to explore priorities amongst competing demands

It provides a vehicle to influence resources and policy It provides access to objective advice on practice issues It is a source of personal and professional support It is a means to improve professional practice and satisfaction

Many GPs have expressed misgivings with regard to appraisals. In part because of the additional pressure on already scare time. But, also because it has often been viewed in the context of poor performance and ‘policing’ of the profession. A key objective for our local scheme is to ensure that GPs can derive maximal benefit from its introduction and view appraisal as a positive improvement to their working lives.

What can appraisal do for the profession?

A successful approach to appraisal can help the GMC discharge its responsibilities to set professional standards and regulate the profession. Equally the British Medical Association (BMA) has a strong interest in the reputation of doctors and a commitment to quality. In addition, the Royal College of General Practitioners (RCGP) pioneers quality development.

What can appraisal do for the public?

Improving quality of care received Improving confidence in doctors in the wake of negative attention

What can appraisal do for the NHS?

As contract holders for GPs the PCT will wish to ensure that GPs are not only competent to practice but appropriately resourced, supported and developed to meet agreed expectations of them.

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What is appraisal?

Although appraisal is a long established concept there has been a positive shift from one of performance assessment to performance development.

Appraisal is a formative and developmental process. It is a positive process, to:

give individuals feedback on past performance chart and acknowledge continuing progress identify development and learning needs

The content of GP appraisal is based on the GMC’s core headings set out in Good Medical Practice (a copy of this guidance is provided in the Resources Section (Section F):

1. Good clinical care2. Maintaining good medical practice3. Relationships with patients4. Working with colleagues5. Teaching and training6. Probity 7. Health

Sections about research and management activities, and other professional roles, are also included in the NHS appraisal documentation.

The Department of Health commissioned the School of Health and Related Research (ScHARR) at the University of Sheffield to undertake detailed work on appraisal for GPs in 2000. ScHARR defined appraisal as ‘ a positive, developmental, employer led, two way, action orientated process, primarily directed at quality improvement’.

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ScHARR view appraisal as an opportunity for:

Exploring role expectations, negotiating relative priorities, and setting and aligning individual and organisational objectives at a local level

Reviewing progress towards achieving previously agreed objectives and agreeing future objectives

Recognising and valuing achievement Exploring what is needed from the organisation to help and

support the individual in making the best contribution they can Identifying personal development needs and the means of

addressing them, and forming a personal development plan (PDP) Helping the individual to produce information for any external

accreditation purposes (e.g. revalidation) Exceptionally (because there should be other mechanisms), early

identification of any individuals struggling or poorly performing Securing continued overall improvement in performance

NB: The appraisal discussion will be limited to the information you choose to include either on the form or during the meeting.

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Section A2How is appraisal linked to revalidation?

Revalidation is a different concept to appraisal. Appraisal is designed to facilitate personal continuous improvement year on year throughout the working life of a doctor. It is intended to be of direct benefit to the individual appraised, and an aid to achieving personal objectives.

Revalidation is a five yearly process run by the General Medical Council. It is designed to ensure a basic minimum standard that can be expected by the public of doctors. It aims to ensure the competence of all doctors and can sanction removal from the General Medical Register or registration subject to certain conditions being met (for example, remedial training).

Appraisal will provide a regular, structured system for recording progress towards revalidation and identifying development needs (as part of PDPs) which will support individual GPs in achieving revalidation.

While appraisal and revalidation will be based largely or wholly on the same sources of information, and appraisal summaries will inform revalidation, the objectives of the two processes are distinct and complementary. Revalidation involves an assessment against a standard of fitness to practice in line with the seven headings of the GMC’s guidance ‘Good Medical Practice’. It will allow a doctor’s licence to practice to be renewed. Appraisals are concerned with the doctor’s professional development within his or her working environment and the needs of the organisation in which the doctor works.

Despite these differences, appraisal and revalidation should be linked for the sake of economy of effort, with the GMC’s Good Medical Practice as common ground. Despite the fact that appraisal and revalidation are distinct processes, the benefit of appropriate information sharing is considerable. The arrangements for the introduction of appraisal for GPs will integrate appropriately with those for revalidation.

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This means that for revalidation purposes satisfactory completion of Form 4 plus supporting documentation over a five-year period will meet the purposes required for revalidation.

Precise revalidation guidance for doctors is still under development. This guidance will be circulated to you as soon as it becomes available. Revalidation will not commence until at least two years after the legislation has been approved (expected December 2002). Thus, it is likely that the first doctors will be revalidated from 2005.

The table overleaf identifies some of the key differences between revalidation and appraisal:-

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Appraisal and Revalidation: The Differences

Appraisal RevalidationLed by individual practitioners and the PCT, and focused on the development of the individual practitioner

Led by the GMC

A way of aligning organisational (PCT and practice) and individual objectives

A way of checking that an individual doctor is fit to practice

Part of the wider systematic approach to performance management and development in the PCT

Part of the individual lifelong requirement of being able to practice as a doctor

An annual process A quinquennial processA process internal to the PCT A process external to the PCTA local process, customised to suit individual and local circumstances

A national process which is standard for all doctors, whoever employs/contracts them

A two-way process, it considers contextual, environmental and systematic factors

A one-way process

Primarily developmental (or formative) process

An assessment (or summative) process

As far as possible, a process with accepted, agreed outcomes

A process with imposed outcomes

Confidential, with many outcomes shared narrowly

A matter of public record

Adapted from Appraisal for GPs, ScHARR, University of Sheffield, 2001

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Section A3Process and Responsibilities

Generally a GP is expected to undergo appraisal with an approved GP appraiser on an annual basis. Time spent by the appraisee in preparing for and undertaking the appraisal interview is reimbursed through provision of locum costs through the PCT. It has been agreed with the LMC that this is likely to be equivalent to 2 ‘sessions’ of GP time.

The tables overleaf detail the appraisal process:-

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Outline of process and responsibilities

Appraisee responsibilities

Before During Appraiser responsibilities

Before During

Collection of information

Continuously collect appropriate information and data for your appraisal file (more information is provided in Section C)

Arranging the appraisal meeting

Contact your appraiser to arrange the appraisal meeting (perhaps 2 months prior to the meeting)Agree a convenient time and suitable venue

Notify Medical Director’s office at the PCT of the arrangements

Producing the appraisal documentation

Produce the appraisal documents preferably using your PC. Photocopy the appraisal forms and supporting documentation, retaining the originals in your appraisal file (more information is provided in Section C)

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Before During

Sharing the appraisal documentation

Following completion of the appraisal forms 1-3 (details about each form are given below) send them to your appraiser, along with supporting documentation, 3 weeks prior to the appraisal meeting

Review the documentation prior to the appraisal meeting (details about each form are given below)

Form 1Basic Details

Complete entire formDiscuss information on form

Review information on formDiscuss information on form

Form 2Current Medical Activities

Complete entire form – providing a brief and factual description of the work you do in the practice and in other postsReview and discuss information

Review information on form

Discuss information on form

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Before During

Form 3Material for Appraisal

Complete the entire form and collect supporting documentary evidence (more information to assist you in completing this form is provided in Section 8


Sign off the form

Review information on form


Sign off the form

Draft a PDP Whilst completing Form 3 think about your development needs and draft you PDP for the coming year

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During After Appraiser responsibilities

During After

Form 4Summary of Appraisal Discussion with Agreed Action and Personal Development Plan (PDP)

Consider items for inclusion on PDP ensuring all objectives are SMART objectives

S – SpecificM – MeasurableA – AchievableR – RelevantT – Timebound

Completion of the PDP is the responsibility of the appraisee

Completion of the Summary Statement (Form 4) is the responsibility of the appraiser

Form 5Detailed confidential account of appraisal interview

Completion of this form is optional.

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During After Appraiser responsibilities

During After

Signing off the summary documentation

Agree and sign off the summary documentation (Form 4) and the PDP within 2 weeks of the appraisal meeting – forward in confidence to the PCT Medical Director– using the Consent Form acknowledge whether this information may be shared with the Primary Care Support Manager to assist with education and training planning

Agree and sign off the summary documentation (Form 4) and the PDP within 2 weeks of the appraisal meeting

Mid-year review discussion/meeting

Contact your appraiser for a mid-year review of progress towards agreed objectives, no longer than 6-7 months after your appraisal meeting

Discuss with the appraisee (telephone or face-to-face) their progress towards agreed objectives

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Section B: Newcastle Appraisal System

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Section B: 4Aim and objectives of the local scheme

Aim

To improve the working lives of doctors in Newcastle, ensuring GPs derive maximal benefit from the introduction of annual appraisal, by helping them consolidate and improve on good performance.

Objectives

To provide GPs with:

access to objective feedback and guidance on practice issues

a source of personal and professional support an opportunity to explore priorities amongst competing

demands an opportunity to identify the need for adequate resources to

enable service objectives to be met an opportunity to improve professional practice and

satisfaction

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Section B: 5Specification for GP Appraisers

In Newcastle we have encouraged as many GPs to train as appraisers as possible. The PCT and LMC believe that this enables the GP community to have ‘ownership’ of the appraisal process, rather than it being seen as something imposed from outside.

We believe that this is a demanding, but also worthwhile role that will be respected by the GP profession and by PCTs. We would particularly encourage those who have been or are currently actively involved in undergraduate or postgraduate teaching/training of doctors, nurses or other professions.

The success of appraisal will be directly related to the skill of the appraiser. It is considered important by both the LMC and PCT that GPs feel confident in those who appraise other GPs. GP training and everyday work and experience places us in a good position to become first-rate appraisers who use excellent communication skills.

However, our GPs skills alone are not sufficient to become successful GP appraisers. All potential appraisers will be given tailored and accredited training on GP appraisal, and GPs will have a choice of appraiser.

All appraisers will:- Be a practicing GP (or recently retired/resigned)

Be committed to the concept of appraisal

Be respected by his/her peers and PCT colleagues

Have good or even exceptional interpersonal skills

Be fully trained in GP appraisal

Be familiar with the local system and relevant documentation

Have an adequate knowledge of the appraisee’s practice circumstances

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Be aware of what resources are available locally and nationally to support practitioners and practices, and how to access these, and of how to ensure that organisational action points can be picked up by the PCT

The PCT will be responsible (in collaboration with the LMC) for ensuring suitability of appraiser in terms of capability, capacity, and professional and organisational credibility. We will endeavour to ensure that appraisers are drawn from different age/sex/ethnic groups with experience across a range of general practice settings. The anticipated large pool of Newcastle appraisers will help us achieve this and maximise choice for local GPs.

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Section B: 6

How to identify your appraiser

There are a number of different ways in which appraisal systems might be operated and different ways of identification of appropriate appraisers. We would like GPs to have as wide a choice of both system and appraiser as possible in order that GPs can feel confident in the appraisal process.

We have asked all GPs and practices to consider and choose one of 3 options for their own appraisal: -

1. In-House Appraisal: One or more GPs in a group practice are trained as appraisers. They apprise the other GPs within the practice. They may in turn be appraised by another trained GP within the practice or may choose to undertake their own appraisal external to the practice.

2. Reciprocal Arrangements with one or more practices: as an example, GPs in Practice A would be appraised by a trained appraiser in practice B, and vice versa. The arrangement might include more than 2 practices.

GPs in practices who have discussed and agreed on either Option 1 or 2, should be aware at an early stage of their intended appraiser. Appraisees and appraisers should make contact as soon as possible to confirm arrangements and consider possible interview dates.

3. Individual Arrangements: GPs who do not wish to consider practice arrangements will be provide with a list of trained GP appraisers who are happy to undertake individual appraisals. GPs will be asked to express any preferences or objections in confidence to the Medical Director who will then matched GPs with appraisers. You will then be informed as soon as possible and given full contact details. Your allocated appraiser will not be informed for a fortnight after this.

If you are unhappy with the appraiser to whom you have been allocated, then you should let the Medical Director or the nominated LMC contact (see introductory section) know as soon

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as possible. Preferably this should be within a 2-week period, i.e. before the allocated appraiser has been informed.

The PCT will make every endeavour to ensure that you are allocated an appraiser in whom you have confidence. Where the preferred options seem to be exhausted the Implementation Group will suggest a suitable alternative, in discussion with both parties. Ultimately the PCT Chief Executive is responsible for nominating a suitable alternative and his/her decision on this matter will be final.

Once you have been satisfactorily allocated an appraiser we would encourage you to make contact with him or her as soon as possible so that you can identify any uncertainties or problems and consider a date for the appraisal interview.

Peer review

The review of the more specialist aspects of GPs’ clinical work, which may be outside the experience of the appraiser, should be carried out by peers who are acquainted with that area of practice, e.g. GP NSF lead on IHD may look for feedback from the local consultant cardiologist. The appraiser and appraisee should identify appropriate peer reviewers and the outcome discussed at the appraisal meeting.

A Peer Review Feedback Questionnaire is provided at Page 60.

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Section B: 7Support available for appraisal

Financial

As agreed with the LMC, the PCT will reimburse the GP appraisee the equivalent of 2 locum sessions to support the appraisal process including preparation, interview and follow-up. As far as is practicably possible, participation in (including preparation for) GP appraisal should be undertaken in normal working hours. It has been estimated that the appraisal process may take between 4.5 and 6.5 hours per GP. This estimates 1.5 hours for the appraisal interview and the remainder reflecting the time required for preparation and review.

GPs and their practice colleagues may choose to provide cover from within the practice, and locum payments may be used to support this. Other GPs may choose to use external locums. Alternatively some practitioners, especially those from very small practices may choose to use the services of Prime Care (previously HealthCall).

Locum expenses will be reimbursed to practitioners/practice at the rate agreed with the LMC. Practitioners/practices will need to submit an invoice on completion of the appraisal interview and submission of Form 4 in order to receive reimbursement.

Finding Locums

The PCT will assist practices in finding locums wherever possible but responsibility for these arrangements lies with the individual GP. Practices/practitioners should contact their locality managers for assistance if required.

Understanding Appraisal

In addition to this file, GPs are encouraged to take advantage of training sessions on GP appraisal. This will help GPs gain as much as possible from the process. There will be various sessions run on a regular basis and at different times in order to suit GP need. Practices will be circulated with details.

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Support needs arising from appraisal

All approved appraisers will be aware of the various support mechanisms available to help practitioners who feel in need of additional support. If practitioners prefer, they can contact any member of the Medical Practitioners Support Group. Contact details for members of this group are:

Name Debbie FreakeTitle Medical Director


Tel No (0191) 219 6055


Name Dr Steve Blades, Title Chair Newcastle PEC

Work address Newcastle PCTBenfield RoadWalkergateNewcastle upon Tyne NE6 4PF

Tel No (0191) 219 6023


Name Dr Ian Winterton, Title LMC

Work address Gosforth Memorial Medical CentreChurch Road, GosforthNewcastle upon TyneNE3 1TX

Tel No (0191) 285 1119

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Name Dr Bernard OlsburghTitle LMC Rep

Work address Whitley Bay Health CentreWhitley RoadWhitley Bay NE26 2ND,

Tel No (0191) 253 1113

Name Dr Trevor White

Work address Falcon House Surgery17-19 Heaton RoadHeatonNewcastle NE6 1SA

Tel No (0191) 265 3361

Name John Black

Work address 18 Preston AvenueNorth ShieldsTyne and Wear, NE30 2BS

Name Dr Malcolm ThomasTitle Assistant Director,General Practice

Work address Postgraduate Institute for Medicine and DentistryUniversity of Newcastle10-12 Framlington PlaceNewcastle NE2 4AB

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After your Appraisal – supporting your ongoing development

Hopefully you’ll feel encouraged and enthusiastic after your appraisal, but it will be at least 6 months before you talk to your appraiser again. How can you keep up your enthusiasm and make sure you follow through on your plans and good intentions?How can you find a space to go on thinking about what came up?

Here are some ideas:- Meet at least monthly with one or two colleagues for at least

an hour in a quiet place. Take turns to talk about how work is going and your progress with your appraisal targets. Listen carefully to each other and allow time to examine barriers to moving forward. Set achievable mini targets for the next meeting.This can be called co-mentoring. Primary Care Choices runs training groups to develop skills in doing this and match up co-mentors. PCC can also provide ‘on the job’ support and facilitation for people doing co-mentoring. Co-mentoring is, of course, free.

Find a mentor – someone to talk to regularly in the same way, who can help you reflect, support, encourage and challenge you and help you to keep moving forward. Primary Care Choices can put you in touch with an appropriate trained GP or counsellor mentor, and will pay for 6 one hour sessions/yr; you can make your own arrangements with a mentor if you want more than this.

Coaching – like mentoring, this is personal, supportive and developmental, with emphasis on building on your strengths. It can be done by phone or email after an initial meeting with your coach. Primary Care Choices can help you find out more, set it up, and may pay for initial sessions.

If your appraisal has been difficult or upsetting, it may be helpful to talk to someone neutral, to make sense of what happened and see how best to carry on. Primary Care Choices can put you in touch with a mentor or counsellor to meet with for some support.

PRIMARY CARE CHOICES is financed by the PCT and backed by them and the LMC in providing a range of support to GPs and other Primary Care colleagues. It is however completely independent and confidential.

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PRIMARY CARE CHOICES CONTACT DETAILS

Dr Jane Dammers and Dr Gail YoungCentre for Primary and Community Care LearningRoom H 209University of Northumbria, Coach Lane CampusNE7 7XA

Confidential voicemail 2156056 Secretary 2156699E mail: [email protected]

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Section B: 8Confidentiality

Confidentiality is of natural concern to GPs. Many practitioners are wary of taking the opportunity for full and frank discussion with their appraiser for fear of this issue.

For the appraisal to be effective, the interaction between the appraiser and the practitioner needs to be as open as possible. Appraisal for GPs is a professional process of constructive dialogue, in which the doctor being appraised has a formal structured opportunity to reflect on his/her work and to consider how his/her effectiveness might be improved. The giving of feedback (by the appraiser) and the disclosure of areas of concern (by the practitioner) are related processes, both of which rely on trust.

There are certain parts of the appraisal process that are not confidential and we wish to be explicit on this issue. However, in the vast majority of circumstances those parts of the appraisal process that are shared with other bodies do not need to be of concern, and indeed by their very nature may be of benefit to the individual.

There are 3 areas of potential concern regarding confidentiality: -

1. Revalidation

Form 4 plus supporting documentation to Form 3 is likely to provide the information necessary for revalidation purposes. These will need to be available for submission to the GMC on a 5 yearly basis, although it is anticipated that in practice usually only the forms themselves will be requested.

2. Probity and Health Issues

This is in fact also part of revalidation requirements but deserves a special mention. One of the GMC core headings includes probity and health. The GMC clearly has a desire for revalidation purposes to ensure minimum standards. These 2 areas are however not the interest of an appraisal process, unless concerns or difficulties

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exist which interfere with personal development. Separate mechanisms are in place within the PCT to deal with both of these issues.

It would be exceptional for serious concerns about performance to be first raised in an appraisal which should be a formative process. However both the appraiser and the appraisee need to recognise that as registered medical practitioners they must protect patients when they believe a colleague’s health, conduct or performance poses a threat to patients1.

There are, however, real concerns as to how detailed information in sections 3 and 4 relates to the Human Rights Act. We would advise appraisers and GPs to complete the section in Form 4 in brief, in line with the accompanying notes for Form 4.

The previous section gave details of members of the Medical Practitioners Support Group who can be contacted regarding health issues.

3. Information held by the PCT

The PCT Chief Executive is required by the Department of Health to hold a summary record of the appraisal interview, and copies of Form 4 will therefore also be held by the PCT. This responsibility is delegated to the Medical Director who will keep forms in confidence and in a secure place. Access/use will comply fully with requirements of the Data Protection Act.

A key reason for this is to ensure that common themes are addressed by the PCT in order to enhance personal development opportunities.

Forms 1-3 are held by both the appraiser and the appraisee. Form 5 is the opportunity for appraisees to keep a confidential record of the appraisal interview if they so wish. In practice, it is not expected that many GPs will use this optional form.

It is therefore advised that the practitioner and his/her appraiser take great care in agreeing the wording of 1 GMC Good Medical Practice paragraphs 26-28

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completion of the summary documentation. This should not be submitted to the PCT (or GMC) until both parties are satisfied that is represents not only a true record, but that it contains only information required to satisfy the purposes of the PCT of GMC.

The DETAIL of the appraisal interview remains confidential at all times.

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Section B: 9

Accountability and Responsibility for the Scheme

This sets out the responsibility and accountability for different individuals who have an interest in GP appraisal.

Newcastle GPs: GPs will have a contractual requirement to participate in the agreed local appraisal system within the national framework. They will need to prepare for the appraisal discussion, agree objectives, action and the outline of a personal development plan with their appraiser.

They will need to agree on matters beyond his/her control, which inhibit performance and should be referred. Appraisals should be used as the opportunity to prepare evidence for inclusion in the GMC Revalidation Folder. The GP should seek to achieve objectives and fulfil the personal development plan, making contact with their appraiser throughout the year as appropriate.

Newcastle GP Appraisers: The appraiser will prepare for and undertake appraisal with a number of designated GPs. He/she will agree with appraisees the agenda, conduct the appraisal in line with good practice and support the GP in reviewing their practice and in setting objectives for the coming year. He/she will maintain appropriate contact and review with the appraised GP throughout the year

He/she will record appraisal outcomes and pass these to the Medical Director. He/she will maintain confidentiality regarding the detail of the discussions. He/she will identify warning signs of GPs who may be struggling and agree with them how this is dealt with. In extraordinary circumstances, where seriously deficient or dangerous practice is encountered, (in keeping with professional responsibilities of individual practitioners) he/she will refer in line with PCT procedures

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Newcastle & North Tyneside LMC: The LMC will play a full role in development, implementation and monitoring of the scheme in partnership with the PCT. The LMC will play a role in representing concerns expressed by GPs about either the scheme or individual appraisal experience, and ensuring that legitimate concerns are dealt with appropriately.

Newcastle PCT Medical Director: is the lead director responsible for appraisal. He/she is responsible for co-ordinating the design, implementation and conduct of the appraisal system and will lead the process in partnership with the LMC of identifying and allocating potential appraisers.

The Medical Director will work with the appraisers to ensure that appraisal agendas work within the overall strategic vision for the PCT and conversely will be responsible for ensuring that cross-cutting education, workforce and service development themes inform the work of the PCT, and that appropriate action is taken. He/she will be responsible for any evaluation process of the appraisal system.

Newcastle PCT Chief Executive: is the PCT officer ultimately responsible for the discharge of the responsibilities as detailed in the PCT Function Regulations (yet to be amended)

Postgraduate Tutors/Northern Deanery: Advise on CPD issues arising from individual appraisal and overview reports, and support the development of PCT education and training strategies to address these.

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Section B: 10Monitoring the System

Particularly in the early days of GP appraisal, there are likely to be a variety of technical hitches and concerns that arise. The system should become more streamlined over time, with improving confidence of practitioners, increasing experience of appraisers and better mechanisms to ensure protected time.

Once the appraisal system is up and running the Implementation Group will take on a monitoring role. This will be to ensure continued adjustment of the scheme in light of feedback received.

Following appraisal, both practitioners and their appraisers will be asked to complete feedback forms.

These will cover: practical issues, problems encountered and seek comments and suggestions for improvements to the scheme.

The forms will also ask for an estimation of the ‘usefulness’ of the exercise. Anonymised themes from these and from concerns/complaints will be presented to the Implementation Group on an annual basis.

Informal or written feedback can be made directly to members of the Implementation Group at any time. If practitioners wish to raise a serious concern or make a complaint there is a mechanism to do so – see Section B: 12.

The Implementation Group welcomes all feedback and will do its utmost to ensure that the scheme can improve over time.

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Short-term review of the annual appraisal scheme for GPs

Before the appraisal meeting

Collecting information:

How much time did you spend collecting information prior to the appraisal meeting?How useful was this information to the appraisal meeting?Did you encounter any problems in this information-gathering exercise?

Completing the forms in preparation:

Were the forms understandable?Did they cover the appropriate areas?How much time did you spend completing the documentation?How helpful was it to the meeting?How did you use the preparation forms? Complete in one go, complete over several months, complete in linear fashion?

The appraisal meeting:

Was the appraisal meeting delayed at all – if so for how long, by whom?How long did the appraisal meeting last?How useful was it in achieving the scheme’s objectives?

To provide GPs with:

access to objective feedback and guidance on practice issues

a source of personal and professional support an opportunity to explore priorities amongst competing

demands an opportunity to identify the need for adequate resources

to enable service objectives to be met an opportunity to improve professional practice and

satisfaction

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How useful was it as an opportunity to exchange views?Has there been any change in the relationship between you and your appraiser?What knowledge and insight did you gain as a result of the appraisal process?

After the appraisal meeting:

Describe your feelings after the meeting.How long after the meeting did you complete/have sight of your appraisal record?

Do you feel that appraisal has been a useful process thus far?

How satisfied are you with the scheme and what suggestions do you have to improve it?

Adapted from The Peer Appraisal Handbook Haman et al (2001)

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Section B: 11A Learning Organisation

In addition to ensuring that feedback can improve the scheme itself, the PCT wishes to use the information collected through appraisal to inform the work of the PCT.

Individual appraisals will identify development needs, priorities and obstacles to delivering quality care. Aggregated, this data can provide the PCT and the LMC with valuable information that can inform PCT prioritisation and strategies. For instance, a recurrent identified need for training in a certain clinical area may result in the PCT providing this training as part of it Education and Training Plan.

The Medical Director will be responsible for presenting an Overview Report to the PCT Board on an annual basis. This will draw on anonymised themes identified from the appraisal forms, and will include the action to be taken by the PCT in addressing common themes. This information will also be presented to the Implementation Group and to the Local Medical Committee who will expect to see action taken in these areas in subsequent months.

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Section B: 12

How to raise a concern or make a complaint

There is an agreed procedure for dealing with concerns. Any worries or complaints about the fairness of consistency of the scheme, the appraiser, the outcome of the appraisal or the use of information can be raised.

Where the concern/complaint relates to elements of the appraisal system itself then this should be addressed to the Medical Director or directly to the Chief Executive of the PCT. Where this is deemed to be inappropriate because of the seriousness of the concern, then this should be address to the Medical Director or Chief Executive of the Strategic Health Authority which is responsible for performance management of the PCT.

Where the concern relates to individual appraisal then wherever possible this should be discussed with the appraiser in the first instance. Where this is not deemed appropriate then the GP should discuss the concerns with the Medical Director. Informal resolution through discussion and mediation will be the preferred method of dealing with these concerns.

Where concerns cannot be resolved at this level then a panel will be constituted to consider the matter further. This will be made up of two GP PEC members, and 2 LMC representatives and will be chaired by a Non-Executive Director with responsibility for complaints. The Medical Director will service the committee and provide necessary information, including written submission from the complainant. The complainant will have the right to representation.

The final recourse within the PCT would be to the PCT Board. Beyond this it would be for the GP to take the matter outside of the organisation as they would any other serious dispute or grievance.

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41

Section C: Undertaking Appraisal

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Section C: 13

Preparation

Preparation for appraisal should be completed during protected time that has specifically been set aside. The appraiser should ensure that the GP being appraised has up to 2 months advance notice of the date of their appraisal. The GP being appraised should prepare for the appraisal by identifying those issues, which he/she wishes to raise with the appraiser and prepare an outline personal development plan (PDP). Further information on completing the appraisal documentation is provided in Section 8.

The GP and the appraiser should gather information and reflect before the appraisal meeting on the following:

Achievements and challenges in the last 12 months (clinical and non-clinical), seen where relevant in the context of earlier appraisals

Service, practice and (where relevant) wider objectives for the next year and beyond

Personal (and, if appropriate to a discussion about the individual in context, practice) development needs, and how these development needs can be met.

The information and paperwork to be used in the appraisal discussion should be shared between the appraiser and appraisee at least two weeks in advance to allow for adequate preparation. The appraisal discussion should be based on accurate, relevant, up-to-date and available data.

Peer review

The review of the more specialist aspects of GPs’ clinical work, which may be outside the experience of the appraiser, should be carried out by peers who are acquainted with that area of practice, e.g. GP NSF lead on IHD may look for feedback from the local consultant cardiologist. The appraiser and appraisee should identify appropriate peer reviewers and the outcome discussed at the appraisal meeting.

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A Peer Review Feedback Questionnaire is provided at page 60.

If during the appraisal it becomes apparent that more detailed discussion and examination of any aspect would be helpful and important, the appraiser or appraisee can request peer review. This should be completed within one month and a further appraisal discussion arranged as soon as possible thereafter to complete the appraisal process.

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Section C: 14

The appraisal interview

Book the time for the meeting well in advance. Always allow more time than you think you’ll need (at least two hours), especially if you are not experienced in conducting or participating in appraisals. If you do find you run out of time during the session, schedule another appointment, don’t rush to complete in the time remaining.

The appraisal discussion should be held in a comfortable work setting, free from interruptions and distractions such as phone calls and demands from other staff.

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Section C: 15

Developing a personal development plan (PDP)

The Personal Development Plan (PDP) is one of the formal outputs from the appraisal and as such the final version of your PDP is a shared document that both you and your appraiser formally agree. This final version of the PDP is prepared by the practitioner after the appraisal meeting and then signed off by the appraiser.

Key development objectives for the following year and subsequent years should be set in the PDP. These objectives may cover any aspect of the appraisal such as personal development needs, training goals and organisational issues, CME and CPD.

A PDP is a useful tool to help individuals plan and meet their development needs. It can then be used as a basis for enabling a comprehensive action plan to be developed.

To be of value, individuals will need to update their plans on a regular basis – as part of the appraisal process.

A PDP will help to describe personal development objectives and the development activities designed to help achieve them. A PDP should take account of:

Professional development needs The requirements of the practice Personal ambitions

Key stages to preparing a plan are:

Identify current level of competence Specify competencies to develop Decide how to develop these competencies and by when Set performance criteria to be achieved as a result of the

development Take development action Decide how and when to review progress

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In developing the PDP remember to develop objectives using the SMART model:

Specific Measurable Achievable Relevant Timebound

CPD in primary care should be purposeful, patient-centred and educationally effective. It should integrate consumer and patient interests with those of the NHS both nationally and locally. It should be constructed in such a way as to encourage team working within primary care and facilitate the appropriate adaptability of professional roles.

The process of CPD should:

Be purposeful and personally motivating Consider the development needs of the practice Be evidence-based where possible Develop knowledge of and opportunities for research and

development Place the individual at the centre of the educational process Take account of both uni-professional and multi-professional

learning needs

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Section C: 16

Outcomes and follow up to the appraisal meeting

The appraisal should conclude by setting down, as an action plan, the agreements that have been reached about what each party is committed to doing. This should include the essentials of the personal development plan (PDP).

The appraisal should identify individual needs that will be addressed through the PDP. The plan will also provide the basis for assessment of resource needs and clinical governance issues within a practice.

The detail of the appraisal discussion will be confidential to participants.

The appraiser an appraisee should agree a written overview of the appraisal (Form 4) to include:

A synopsis of achievement in the previous year Objectives (an action plan) to be pursued by the appraisee

over the next year The key elements of a PDP for the appraisee Actions expected of the PCT to address needs in the local

context or the wider system A standard summary (Form 4) of the appraisal as

recommended by the GMC for the individual’s revalidation folder

A joint declaration that the appraisal has been carried out properly (Form 4).

The key points of the discussion and outcome must be fully documented and copies held by the appraiser and appraisee. Both parties must complete and sign the appraisal summary statement (Form 4) and send a copy, in confidence, to the Chief Executive at the PCT. All records will be held securely and access/use will comply fully with the requirements of the Data Protection Act 1998.

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Where significant problems or needs have been identified, observations about further operational, financial or premises help required by the GP should be sent to the Medical Director or PCT Chief Executive for action. The detailed content of the appraisal itself should be confidential between the doctor and the appraiser.

It would be exceptional for serious concerns about performance to be first raised in appraisal. The appraisal itself should be formative. However, both the appraiser and appraisee need to recognise that as registered medical practitioners they must protect patients when they believe that a colleague’s health, conduct or performance poses a threat to patients (GMC Good Medical Practice paragraphs 26 to 28).

However, where it becomes apparent, during the appraisal process, that there is a potentially serious performance issue, which requires further discussion or examination, the appraiser must refer the matter immediately to the Medical Director (or if preferred to the LMC or a member of the Medical Practitioner Support Group) to take appropriate action. This may, for example, include referral to any support arrangements that may be in place.

The Medical Director will collate and submit an aggregated and anonymised report on appraisal outcomes, annually, to the PCT Board. The report will not refer, explicitly or implicitly, to any individuals who have been appraised. The report will highlight emerging training and development needs, and organisational or service themes requiring action or investment. It will also review the overall process and operation of the appraisal scheme.

Mid year review meeting

The appraiser and GP should make arrangements at least once more during the course of the year to review progress in relations to the actions and PDP. This discussion could take place via telephone rather than an actual face-to-face meeting.

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Section C: 17

The NHS Appraisal Toolkit

The NHS Appraisal Toolkit (www.appraisals.nhs.uk) is an on-line resource that brings together advice, guidance, best practice, practical tools and access to a community of peers in the appraisal domain. It provides a range of background material about appraisal. It will help both the appraiser and the GP:

With the process of appraisal, by adding context Guiding the GP through the process, taking information

entered by the GP and producing it in the format of the standard appraisal form

Producing an electronic appraisal record Giving decision support to the process

The Toolkit can be used in immediate preparation for appraisal. Or, perhaps more usefully, can be returned to many times during the year to support reflective practice.

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Section C: 18

Methods of reflection

Different people prefer different methods of reflection. Some people will jot down notes while others may write more formally. Some people will talk things over with colleagues or with their partner(s), while others may sit and think, or go for a walk.

The formal part of the preparation for the appraisal is completion of the appraisal questionnaire. For some the process of completing this questionnaire will stimulate all the reflection required, others will need to use other methods of reflection before they fill in the questionnaire, or they may need to break off part way through.

Some prompts for reflection are:

Appraisal Questionnaire (Forms 1-3) Review of critical incidents diaries/ significant event logs Review of audits Review of practice report or practice professional

development plan Review of complaints or suggestions from patients Review of prescribing data, referral data and other aspects of

practice performance Review of educational activities

As a result of this reflection you may wish to gather some evidence by looking at the way you practice. There are forms available in this section to help you record this information:

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Audit Complaints record Education diary Health questionnaire Learning needs diary My practice record (activities, meetings, other organisations I

work in) Patient feedback record Peer review feedback form Probity record Significant events Teaching and Training Record

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Audit record table

An electronic copy of this form is available on request.

Audit date

Topic Discussion Action/Learning Points

Review

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Complaints record


Complaint date

Complaint In house?

Discussed/ Circulated

Action/ Learning Points

Review date

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Education Diary


Date Title Duration Topics Covered

Reflections Further actions

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Learning Needs Diary


PUN = patient unmet needDEN = doctor educational need

Date PUN Completed DEN Action

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Individual Practice Record


Activity

Service Individual role

How well is this service resourced?

Action points

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Meetings

Type of meeting

Who attends?

How frequent?

How are action points dealt with?

How are outcomes communicated to the rest of the organisation?

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Other Organisations I Work In

Organisation Type of work

My role How well is this service resourced?

Action points

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Peer Review Feedback Form


Area of practice for peer review: ____________________________________________________________________

Feedback questionnaire for Dr ___________________________________________ Date: ___________________

What are the Dr’s strengths in this area?

Where could there be improvement?

Good clinical care

Keeping up-to-date

Good relations with patients

Working with colleagues

Teaching and training

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Probity Record


Probity date

Instance Concern about probity

Examples of good practice

Action

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Significant Events


Event date

Description Discussion Action/Learning Points

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Teaching and Training Record


Date Topic Learners Duration Outcome/ Reflection

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Section D: Completing the Appraisal Documentation

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FORM 3: MATERIAL FOR APPRAISAL

This form, and the papers you supply with it, will be the main basis of your appraisal. It is organised around the headings used by the General Medical Council in Good Medical Practice and the Royal College of General Practitioners in Good Medical Practice for General Practitioners. It is strongly recommended that you look at these documents as prompts. A copy of Good Medical Practice is provided in Section F. The same headings will be used to summarise your appraisal discussion in Form 4.

The wording under each heading differs, but typically you are asked to provide:

a commentary on your work an account of how your work has improved since your last

appraisal your view of your continuing development needs a summary of factors which constrain you in achieving what you

aim for.

It is not expected that you will provide exhaustive detail about your work. But the material should convey the important facts, features, themes or issues, and reflect the full span of your work as a doctor within and outside the NHS. The form is a starting point and framework to enable you and your appraiser to have a focused and efficient discussion about what you do and what you need. It is a tool, not an examination paper or application form, and it can be completed with some flexibility.

Common sense should be exercised. If you feel you are repeating yourself, or if you want to include something for which there is no apparent opportunity. And, if a section or a page really needs only a word or two there is no need to do more.

The work you put into completing this form is your main preparation for appraisal, and the value of your appraisal will largely depend on it. It will also be an important part of your appraiser’s preparation.

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The form is fairly open-ended, although some prompts and suggestions are supplied to help you. Please expand the spaces available as necessary, or attach extra sheets.

You are invited to submit documents in support of what you say in the form. You are not expected to “prove” your assertions about your work, but your appraiser will probably want to discuss them and the documents will help both of you.

The papers you assemble in support of the form should be listed in the appropriate spaces and supplied for your appraiser in a folder, organised in the same order. If the same material is listed in the form more than once, to illustrate different points, do not include it twice in the folder but explain on the form where it is to be found.

The first papers in your folder should be the summary of your last appraisal (if appropriate) and your Personal Development Plan (i.e. last year’s Form 4).

All the papers may be appropriate for inclusion in your Revalidation Folder.

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Example Form 3

Good clinical care

Commentary - what do you think are the main strengths and weaknesses of your clinical practice?

Examples of documentation you might refer to and supply: Response to quality markers and quality meetingsResponse to prescribing analysesUp-to-date audit dataPCT clinical governance reviewsRelevant clinical guidelinesResponse to significant event analysis or critical incident reportsAny complaints and records of their investigation and remedial action takenAny ‘in-house’ monitoring materials you use

Example response:Our practice has maintained the best of traditional general practice, while at the same time keeping up with developments in medical science, medical education and organisation. Our involvement in medical education (VTS and undergraduate) keeps us up to date. We have a high level of availability and accessibility (24 hour standard) and very few formal complaints: none in the last 12 months. Recent audit on Ritalin prescribing and monitoring presented to practice.

How has the clinical care you provide improved since your last appraisal?1

Refer as appropriate to your last appraisal and Personal Development Plan (it is not necessary to complete this section for your first appraisal)

Example response:Continuing development. Regular audit and significant event meetings in the practice contribute to clinical governance in the practice. Information system is improving: intranet developing and quicker links within the practice. Clearer practice protocols for smoking cessation, with loss, hypertension care.

What do you think are your clinical care development needs for the future?

This is in preparation for agreeing an updated PDP.

Example response:1. Need a general refresher type course for X clinical stuff. 2. Need to contribute more to information management in the practice. 3. Need to be more aware of new GMS contract.

1 If this is your first appraisal, look at the last year; this applies throughout the forms.

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What factors in your workplace, or more widely, constrain you significantly in achieving what you aim for in your clinical work?

It may be constructive to focus on issues that can be addressed locally

Example response:1. What feels to be less help from secondary care: this shows in increased waiting times for outpatient and inpatient appointments. Some investigations take too long to access. Secondary care less keen to help and support GPs. 2. Lack of time: we are all too busy and there is not enough time to think and reflect, either personally or as a practice.

Documents list

You will need to provide evidence

Example evidence follows:

Audit

Audit date

Topic Discussion Action/Learning Points

Review

20/05/02 Ritalin Audit meeting: all partners involved

Should be circulated to secondary care provider too

01/05/03

Significant Events

Event date

Description Discussion Action/Learning Points

20/06/02 Urgent admission of very ill baby (3 weeks old), who had been seen twice before in the previous 5 days

25/06/02 All partners, GP Registrar and Practice Manager

1. Transfer to hospital of sick small children should normally be by ambulance. (This gets oxygen and paramedics to the child quickly, and transfers responsibility for the patient appropriately). 2. Fever in a neonate is a potentially serious finding, which may merit early investigation (e.g. chest x-ray).

26/06/02 Patient given wrong dose of Warfarin by DAWN software

All partners INR results need to be checked manually too: especially when change of dose is recommended.

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Maintaining good medical practice

The last section asked about the quality of your clinical care and how it has improved; this one is about how you have kept up-to-date and achieved improvements.

Commentary - what steps have you taken since your last appraisal to maintain and improve your knowledge and skills?

Examples of supporting documentation you might refer to and attach: Your PDP and practice development planRecords of all development activity or other education/courses

e.g. PGEA meetings, clinical meetings in practice, change to practice as a resultSummary of your professional reading habits

Example response:See my learning activities table. In addition to this, I completed the decision-making module on Leeds Executive MBA course, regular audit, significant event analysis and general clinical meetings in the practice.

What have you found particularly successful or otherwise about the steps you have taken?Do you find some teaching/learning methods more effective than others? Some you enjoy more, if so, why?How will you reflect this in your future approach to maintaining good medical practice?Example response:Time spent in practice-based learning has felt to be effective, but it is very hard to arrange the time for everybody to get involved with this. There is an emphasis on education and service management in my learning at the moment.

What professional or personal factors significantly constrain you in maintaining and developing your skills and knowledge?

E.g. obstaclesExample response:Time to devote to learning and separation from service commitment.

How do you see your job and career developing over the next few years?

E.g. wish to keep up to date with new developments for effective care.

Example response:I plan to remain 50% principal. Retirement of our present senior partner is going to change dynamics in the practice and my role. Outside the practice: likely to remain busy, but possibly in different ways e.g…..

Documents list

e.g. Last PDP

Further example evidence follows:

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Education Diary

Date Title Duration Topics Covered

Reflections Further actions

05/06/02 AUDGP annual scientific meeting

2 days Conference theme was ‘working together’. Issues were multidisciplinary learning, use of IT

This is to long after the event to make this sort of record. I have been to AUDGP each of the last 4 years. Perhaps time to find a new conference, such as WONCA

Register for next year’s WONCA conference

30/10/02 How to use email

½ day How to send, receive and organise emails

Communication with colleagues much more efficient – wish I’d done this training earlier.

Continue to use email for communication, where appropriate. Register on How to use the Internet ½ day training course

Learning Needs Diary

PUN = patient unmet needDEN = doctor educational need

Date PUN Completed DEN Action02/07/02 Addressing all

needs of a self-harming patient

Mentoring/reflection on attitudes to patients of this type

Discussion with another knowledgeable practitioner: monitoring

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Relationships with patients

Commentary - what do you think are the main strengths and weaknesses of your relationships with patients?

Examples of documentation you might refer to and supply: Information for patients about your services e.g. newsletter, Patient Information LeafletsAny complaints material, including your handling of itPatient forumsAppreciative feedback e.g. complimentary lettersPatient survey data e.g. from questionnairesRelevant significant event reportsPeer reviewsProtocols e.g. for handling informed consent

Example response:1. Availability and access2. Friendly and efficient service3. See patients as people4. Availability more problematic since I have gone part time

How do you feel your relationships with patients have improved since your last appraisal?


e.g. no change

What would you like to do better? What do you think are your current development needs in this area?


e.g. more time for consultations.

Example response:Need to maintain the energy to be open to patients.

What factors in your workplace or more widely constrain you in achieving what you aim for in your patient relationships?

What can be addressed locally?

e.g. increasing demand.

Example response:Pressures of work, lack of time, increasing size of our practice workforce and also attached teams, mean that it is ever harder to maintain personal continuing relationships with patients.

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Documents list


Surveys, suggestions or feedback received from patients

Feedback date

Topic Discussed/ Circulated


Review Date

12/12/01 Thank you letter from family of recently deceased

All involved with his care

Examples of good practice or concern in your relationships with patientsPatient NewsletterGiving of Patient Information Leaflets directly to patients, as appropriate

Complaints

Complaint date

Complaint In house?

Discussed/ Circulated


Review date

30/08/02 Waiting room too hot

Yes Partners, Practice managers, Receptionists

We need regulated central heating

01/02/03

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Commentary - what do you think are the main strengths and weaknesses of your relationships with colleagues?

Examples of documentation you might refer to and supply: A description of the team structure in which you workTeam meetingsRecords of any peer reviews or systematic feedbackInformation about any problems that have arisen between you and colleagues (including consultants, pharmaceutical advisor, PCT)

Example response:Within the practice we have a very strong team of partners, and good communications helped by weekly meetings, clarity about goals and direction. Relationships with consultant colleagues have been adversely affected by NHS changes since 1990, and now that I am no longer involved in the VTS group and am a 50% principal my links with the hospital are weaker than they were. Good contact with community nursing staff, but social services are strangers.

How do you feel your relationships with colleagues have improved since your last appraisal?


Example response:Partners away days and working on Practice Development Plan have helped us with strategic agreement.



e.g. spend more time building relationships with receptionists and clerical staffe.g. more PGMC meetings with local hospital

Example response:Find a forum for some interaction with hospital colleagues

What factors in your workplace or more widely significantly constrain you in achieving what you aim for in your colleague relationships?


e.g. fitting in with usual work

Example response:Everyone is working at on or near capacity and there is not time or opportunity to properly attend to maintain professional relationships.

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Documents list


My Practice

Activity

Service My role How well is this service resourced?

Action points

Contraception Provider as practitioner, fitting iucds

Well resourced, and we are increasing the role of the practice nurses

I do not do as many coil fittings as I would like and we need to review this aspect of provision

Emergencies Partner/provider: internal rota in the practice

Well, all provision is within the practice

We need to monitor availability of phone lines when we are busy with routine work. Also, protocols for receptionist when urgent calls come in

Minor surgery Practitioner: provider of a limited range of services, cryo for warts etc.

One of my partners is more proficient and tends to do more in the way of removal of cysts etc. Basically equipped nurse room, which we share for minor surgery use

If we wanted to expand the minor surgery provision, for instance, we would have to look at our infrastructure in terms of room space, equipment and nurse time

On-call Partner/provider internal rota during working hours

Well resourced. Internal rota circulated weekly

Nil

Out of hours Partner/provider: internal rota in practice

Some partners use telephone answering service. I take phone calls at home. System works fine.

Monitor requirements in terms of logging calls, time to answer etc.

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Meetings

Type of meeting

Who attends?

How frequent?

How are action points dealt with?

How are outcomes communicated to the rest of the organisation?

Clinical meetings (inc. clinical audit/ critical events/ formulary)

Partners, practice manager, nurses as appropriate

Weekly Informally Informally

Partners evening meetings

Partners + practice manager

Monthly By nominated partner/ practice manager: minuted and reviewed at next meeting

Cascade to staff meetings where appropriate, by practice manager

Other Organisations I Work In

Organisation Type of work

My role How well is this service resourced?

Action points

Hospital work None doneAUPC Leeds Non-clinical

work in the practice

Tutor for medical students

Reasonable reimbursement for time. We have no extra consulting rooms or teaching space for this.

Need to review how many of the partners are involved with each medical student in their 10 day attachment

AUPC Leeds Other Lecturer on MMedSc and Postgraduate Certificate of Medical Education

Not well. Financial arrangements are problematic. Teaching space, academic support and secretarial support all far from optimal

Continue dialogue with the department

Northern Deanery Non-clinical work

Marker of audit projects

Well enough

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Commentary - what do you think are the main strengths and weaknesses of your work as a teacher or trainer?

This section may not apply to you, in which case just enter ‘not applicable’.

Otherwise, examples of documentation you might refer to and supply:

A summary of your formal teaching/training work and any informal supervision or mentoringRecorded feedbackPeer review

Example responseI am a very experienced teacher of GPRs, Trainers and other medical educators. The downside of this expertise is that it is hard for me to find useful educational activities for myself. The focus of my education tends to be education, which may mean that I do not spend enough time on clinical topics.

Has your teaching or training work changed since your last appraisal? Has it improved?


Example responseContinued to grow in diversity: recent role in running trainers courses in the Deanery.

Would you like to do more? What would you like to do better? What do you think are your current development needs?


Example responsePossibly extend some of the consultation skills training with GPRs to Principals in the patch.

What factors constrain you in achieving what you aim for in your teaching or training work?


e.g. arranging cover

Documents list


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Date Topic Learners Duration Outcome/ Reflection

10/10/01 VTS Trainers in Yorkshire (27)

48 hours over 3 days

Evaluations good

06/04/02 Dermatology Mixed group of primary care workers: GPs, one PCG manager, one practice nurse

10 * 3 hour seminars

In progress

Probity

What safeguards are in place to ensure propriety in your financial and commercial affairs, research work, use of your professional position etc? Have there been any problems?

You may not have undertaken any research. This section may not apply to you, in which case just enter ‘not applicable’.

Otherwise, please supply and refer to any records of concerns.

e.g. Pharmaceutical company funded research, ethical committees

Example responseMy own conscience and standards. Open relationships within the partnership.

Has the position changed since your last appraisal or in the last year?


Example responseNo change: we have become aware of the issues of third party disclosure when we send copies of medical records to solicitors etc. and set up a mechanism to deal with this.

Do you feel the position needs to change? How?

Does anything need to be included in your updated Plan? Example responseContinued vigilance.

What factors in your workplace or more widely significantly constrain you in this area?

Explain any constraints.

Example responseComplexity of modern life.

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Documents list


Probity date

Instance Concern about probity

Examples of good practice

Action

01/01/02 Informing patients about services: influenza vaccines

Target groups identified: dissemination via letter, practice newsletter, personal phone calls to non responders

10/03/02 Third party information in reports to solicitors etc. or notes viewed or summarised for legal purposes

Are we properly screening out third party references in records that we summarise or copy for solicitors?

Develop protocol: delegate task to appropriate secretarial staff: train those people: monitor effectiveness

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Management activity

Please describe any management activities you undertake that are not related to your practice or the practice in which you work. How would you describe your strengths and weaknesses?


This section may be more to identify educational needs attached to new posts.

You may already have mentioned a role in your PCT or LMC, for example, or advisory work for the Strategic Health Authority or an NHS Trust, or a national position you hold. This section is about how well you think it works.

Do you think your management work has improved?


What are your development needs?

If you have answered the first part of this section, what development needs might be included in your updated PDP?

What are the constraints?

e.g. difficulties in arranging cover

Documents list

12etc

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Research

How would you appraise any research work that you do?


This section may be more to identify educational needs attached to new posts.

You may have mentioned your research activity already but this is an opportunity to say more, and how well you think it goes. You might supply and refer to any reports or publications.

Do you feel your research skills have improved?


Do you have development needs in this area to reflect in your updated Plan?


Documents list

12etc

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Health

Do you feel there are any health-related issues for you that may put patients at risk?This section may be wholly inapplicable. It may be useful to complete and provide the health questionnaire provided overleaf.

Please mention any problems or concerns raised during the year and any steps you feel should be taken to safeguard the position.

e.g. stress in self and others mentor system now in placeopportunities for sabbatical supportmanagement activity support

Documents list

12etc

Overview of development during the year

With your Personal Development Plan in mind, please look back over the previous sections. How well have you achieved the goals agreed last year? Where you did not succeed, can you describe the reasons?

It is not necessary to complete this section for your first appraisal

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Overview of development needs

Please summarise what you think your main development needs are for the coming year. Where relevant, how will the reasons for not succeeding last year be overcome?

Aims: improve IT skillsNeeds: paperless practice

Overview of constraints

Please summarise the chief factors that you have identified as addressable constraints.

e.g. require protected learning time

Sign off

We confirm that the above information is an accurate record of the documentation provided by the appraisee and used in the appraisal process, and of the appraisee’s position with regard to development in the course of the past year, current development needs, and constraints.

Signed:

Appraisee

Appraiser

Date:

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FORM 4: SUMMARY OF APPRAISAL DISCUSSION WITH AGREED ACTION AND PERSONAL DEVELOPMENT PLAN

This form sets out an agreed summary of the appraisal discussion and a description of the actions agreed, including those forming your personal development plan. Form 4 and the PDP should be completed during and immediately after the discussion. It mirrors the major headings used in Form 3. A blank copy of Form 4 is provided in Section E.Completing Form 4 (summary of the appraisal meeting) is the responsibility of your appraiser. Completing and updating the PDP is the responsibility of you the appraisee.

Personal Development Plan

Using the template provided, the appraiser and appraisee should identify key development objectives for the year ahead which relate to the appraisee’s personal and/or professional development. They will include action identified in the summary in Form 4 but may also include other development activities agreed or decided upon in other contexts. Please indicate clearly the timescales for achievement.

In setting actions and objectives it is helpful to remember the SMART model:

Specific Measurable Achievable Relevant Timed

GPs approaching retirement age may wish to consider their retirement intentions and actions that could be taken to retain their contribution to the NHS. The important areas to cover are:

action to maintain skills and the level of service to patients action to develop or acquire new skills action to change or improve existing practice

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Personal Development Plan Template

This plan should be updated whenever there has been a change - either when a goal is achieved or modified or where a new need is identified. The original version should also be retained for discussion at the next appraisal.

What development needs have I?

How will I address them? Date by which I plan to achieve the development goal

Outcome Completed

Explain the need. Explain how you will take action, and what resources you will need? e.g. time, financial support

The date agreed with your appraiser for achieving the development goal. e.g. Timescale

How will your practice change as a result of the development activity?e.g. Review

Agreement from your appraiser that the development need has been met.e.g. what evidence?

1

2

3

4 etc

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Producing the documentation

There are three ways to produce your appraisal documentation:

1. Using the NHS Appraisal Toolkit (www.appraisals.nhs.uk)

2. Using the form templates saved on the disk – available on request. Taking the time to complete these forms electronically in the first instance will save time later on!

3. Complete paper copies of the forms, provided in Section E, and ask your secretary to type up the forms using the templates saved on the disk available on request.

Your documentation (Forms 1-3 plus supporting information) must reach your appraiser at least 2 weeks prior to your appraisal meeting. Please photocopy the originals and send the copies to your appraiser.

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The Consent Form

The consent form is optional. There are two sections to the form:

1. The first is concerned with consent for the GP Tutor to sign off your PDP. Following receipt of your consent, your PDP will be forwarded to the GP Tutor who will consider its content and sign off your plan. On signing off your plan you will be awarded 5 days PGEA.

2. The second is concerned with sharing your PDP with the Professional Development Manager. Following receipt of your consent, your PDP will be forwarded to the Professional Development Manager. In sharing your PDP you can be contacted directly regarding educational opportunities that are appropriate to your development needs. This will enable educational events to be arranged at times convenient to those practitioners for which they will be most relevant.

A copy of the Consent Form is provided at the end of Section E or electronically on the disk available on request.

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Section E: Personal Appraisal Documentation

Form 1

Form 2

Form 3

Form 4

Form 5

Consent Form

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ANNUAL APPRAISAL FOR GENERAL PRACTITIONERSFORM 1: BASIC DETAILS

Name

Registered address and telephone number

Main practice address and telephone number

Qualifications UK or elsewhere, with dates

GMC Registration Type now held, registration number and date of first full registration

Date of last revalidation If any

Date of certification JCPTGP certificate or date of starting practice if before 1981

Date of appointment to current post If different

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Main current post in general practice eg GMS Principal or PMS doctor with a patient list

Other current posts Please list any other current appointments with (1) starting dates (2) average time spent on them (3) whether public sector eg Benefits Agency, or private sector eg nursing home

Previous posts NHS and elsewhere, last five years, with dates

Other relevant personal details Please give any other brief information you wish that helps to describe you eg membership of professional groups or societies

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ANNUAL APPRAISAL FOR GENERAL PRACTITIONERSFORM 2: CURRENT MEDICAL ACTIVITIES

This form requires a brief and factual description of the work you do in the practice and in other posts. You will be able to give more detail later.

Please summarise the ‘in-hours’ activities you undertake in your practice e.g. minor surgery, child health services

Emergency, on-call and out-of-hours work

Brief details of other clinical work eg as clinical assistant, hospital practitioner etc

Any other NHS or non-NHS work that you undertake as a GP eg teaching, management, research, examiner, forensic

Work for regional, national or international organisations

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Other professional activities

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ANNUAL APPRAISAL FOR GENERAL PRACTITIONERSFORM 3: MATERIAL FOR APPRAISAL

Good clinical careCommentary - what do you think are the main strengths and weaknesses of your clinical practice?

Examples of documentation you might refer to and supply: up-to-date audit data; prescribing analyses; PCT clinical governance reviews; relevant clinical guidelines; records of any significant event audits or critical incident reports; any complaints and records of their investigation; any ‘in-house’ monitoring materials you use.

How has the clinical care you provide improved since your last appraisal?2

Refer as appropriate to your last appraisal and Personal Development Plan.

What do you think are your clinical care development needs for the future?


What factors in your workplace, or more widely, constrain you significantly in achieving what you aim for in your clinical work?

It may be constructive to focus on issues that can be addressed locally.

Documents list

12etc

2 If this is your first appraisal, look at the last year; this applies throughout the forms.

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Maintaining good medical practiceThe last section asked about the quality of your clinical care and how it has improved; this one is about how you have kept up to date and achieved improvements.Commentary - what steps have you taken since your last appraisal to maintain and improve your knowledge and skills?

Examples of documentation you might refer to and attach: your PDP and practice development plan; records of all CPD/CME activity or other education/courses . Please summarise your professional reading habits.

What have you found particularly successful or otherwise about the steps you have taken?Do you find some teaching/learning methods more effective than others? How will you reflect this in your future approach to maintaining good medical practice?

What professional or personal factors significantly constrain you in maintaining and developing your skills and knowledge?

How do you see your job and career developing over the next few years?

Documents list

12etc

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Relationships with patientsCommentary - what do you think are the main strengths and weaknesses of your relationships with patients?

Examples of documentation you might refer to and supply: information for patients about your services; any complaints material, including your handling of it; appreciative feedback; patient survey data; relevant significant event reports; peer reviews; protocols eg for handling informed consent.

How do you feel your relationships with patients have improved since your last appraisal?Refer as appropriate to your last appraisal and PDP.



What factors in your workplace or more widely constrain you in achieving what you aim for in your patient relationships?


Documents list

12etc

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Working with colleaguesCommentary - what do you think are the main strengths and weaknesses of your relationships with colleagues?

Examples of documentation you might refer to and supply: a description of the team structure in which you work; records of any peer reviews or systematic feedback; information about any problems that have arisen between you and colleagues (including consultants).

How do you feel your relationships with colleagues have improved since your last appraisal?Refer as appropriate to your last appraisal and PDP.



What factors in your workplace or more widely significantly constrain you in achieving what you aim for in your colleague relationships?


Documents list

12etc

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Teaching and trainingCommentary - what do you think are the main strengths and weaknesses of your work as a teacher or trainer?

Examples of documentation you might refer to and supply: a summary of your formal teaching/training work and any informal supervision or mentoring; any recorded feedback.

Has your teaching or training work changed since your last appraisal? Has it improved?Refer as appropriate to your last appraisal and PDP.

Would you like to do more? What would you like to do better? What do you think are your current development needs?


What factors constrain you in achieving what you aim for in your teaching or training work?

Arranging cover, for example. What can be addressed locally?

Documents list

12etc

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ProbityWhat safeguards are in place to ensure propriety in your financial and commercial affairs, research work, use of your professional position etc? Have there been any problems?

Please supply and refer to any records of concerns.

Has the position changed since your last appraisal or in the last year?Please refer as appropriate to your last appraisal and PDP.

Do you feel the position needs to change? How?Does anything need to be included in your updated Plan?

What factors in your workplace or more widely significantly constrain you in this area?

Documents list

12etc

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Management activityPlease describe any management activities you undertake that are not related to your practice or the practice in which you work. How would you describe your strengths and weaknesses?

You may already have mentioned a role in your PCT, for example, or advisory work for the Strategic Health Authority or an NHS Trust, or a national position you hold. This section is about how well you think it works.

Do you think your management work has improved?Please refer as appropriate to your last appraisal and your Personal Development Plan.

What are your development needs?What might be included in your updated PDP?


Documents list

12etc

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ResearchHow would you appraise any research work that you do?

You may have mentioned your research activity already but this is an opportunity to say more, and how well you think it goes. You might supply and refer to any reports or publications.

Do you feel your research skills have improved?

Please refer if appropriate to your last appraisal or Personal Development Plan.

Do you have development needs in this area to reflect in your updated Plan?


Documents list

12etc

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HealthDo you feel there are any health-related issues for you that may put patients at risk?Please mention any problems or concerns raised during the year and any steps you feel should be taken to safeguard the position.

Documents list

12etc

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Overview of development during the year

With your Personal Development Plan in mind, please look back over the previous sections. How well have you achieved the goals agreed last year? Where you did not succeed, can you describe the reasons?

Overview of development needs

Please summarise what you think your main development needs are for the coming year. Where relevant, how will the reasons for not succeeding last year be overcome?

Overview of constraints

Please summarise the chief factors that you have identified as addressable constraints.

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Sign off

We confirm that the above information is an accurate record of the documentation provided by the appraisee and used in the appraisal process, and of the appraisee’s position with regard to development in the course of the past year, current development needs, and constraints.

Signed:

Appraisee

Appraiser

Date:

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FORM 4: SUMMARY OF APPRAISAL DISCUSSION WITH AGREED ACTION AND PERSONAL DEVELOPMENT PLAN

This form sets out an agreed summary of the appraisal discussion and a description of the actions agreed, including those forming your personal development plan.

The form will be completed by your appraiser and then agreed by you.

SUMMARY OF APPRAISAL DISCUSSION

Good clinical care

Commentary

Action agreed


Commentary

Action agreed


Commentary

Action agreed

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Commentary

Action agreed


Commentary

Action agreed

Probity

Commentary

Action agreed

Management activity

Commentary

Action agreed

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Research

Commentary

Action agreed

Health

Commentary

Action agreed

Any other points

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Sign off

We agree that the above is an accurate summary of the appraisal discussion and agreed action, and of the agreed personal development plan.

Signed:

Appraiser (GMC Number)

Appraisee

Date:

Please record here the names of any third parties that contributed to the appraisal and indicate the capacity in which they did so

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Commentary:

PERSONAL DEVELOPMENT PLAN

This plan should be updated whenever there has been a change - either when a goal is achieved or modified or where a new need is identified. The original version should also be retained for discussion at the next appraisal.

What development needs have I?

How will I address them?

Date by which I plan to achieve the development goal

Outcome Completed

Explain the need. Explain how you will take action, and what resources you will need?

The date agreed with your appraiser for achieving the development goal.

How will your practice change as a result of the development activity?

Agreement from your appraiser that the development need has been met.

1

2

3

4 etc

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Section F : Resources

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Good Medical Practice

Third edition May 2001

ContentsGood clinical care Providing a good standard of practice and careDecisions about access to medical careTreatment in emergenciesMaintaining good medical practiceKeeping up to dateMaintaining your performanceTeaching and training, appraising and assessingMaking assessments and providing referencesTeaching and trainingRelationships with patientsObtaining consentRespecting confidentialityMaintaining trustGood communicationEnding professional relationships with patientsDealing with problems in professional practiceConduct or performance of colleaguesComplaints and formal inquiriesIndemnity insuranceWorking with colleaguesTreating colleagues fairlyWorking in teamsLeading teamsArranging coverTaking up appointmentsSharing information with colleaguesDelegation and referralProbityProviding information about your servicesWriting reports, giving evidence and signing documentsResearchFinancial and commercial dealingsConflicts of interestFinancial interests in hospitals, nursing homes and other medical organisationsHealthIf your health may put patients at risk

The duties of a doctor registered with the General Medical Council

Patients must be able to trust doctors with their lives and well-being. To justify that trust, we as a profession have a

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http://www.gmc-uk.org/standards/good.htm#Good%20clinical%20care%23Good%20clinical%20care

http://www.gmc-uk.org/standards/good.htm#If%20your%20health%20may%20put%20patients%20at%20risk%23If%20your%20health%20may%20put%20patients%20at%20risk

http://www.gmc-uk.org/standards/good.htm#Financial%20interests%20in%20hospitals,%20nursing%20homes%20and%20other%20medical%20organisations%23Financial%20interests%20in%20hospitals,%20nursing%20homes%20and%20other%20medical%20organisations

http://www.gmc-uk.org/standards/good.htm#Conflicts%20of%20interest%23Conflicts%20of%20interest

http://www.gmc-uk.org/standards/good.htm#Financial%20and%20commercial%20dealings%23Financial%20and%20commercial%20dealings

http://www.gmc-uk.org/standards/good.htm#Research%23Research

http://www.gmc-uk.org/standards/good.htm#Writing%20reports,%20giving%20evidence%20and%20signing%20documents%23Writing%20reports,%20giving%20evidence%20and%20signing%20documents

http://www.gmc-uk.org/standards/good.htm#Providing%20information%20about%20your%20services%23Providing%20information%20about%20your%20services

http://www.gmc-uk.org/standards/good.htm#Probity%23Probity

http://www.gmc-uk.org/standards/good.htm#Delegation%20and%20referral%23Delegation%20and%20referral

http://www.gmc-uk.org/standards/good.htm#Sharing%20information%20with%20colleagues%23Sharing%20information%20with%20colleagues

http://www.gmc-uk.org/standards/good.htm#Taking%20up%20appointments%23Taking%20up%20appointments

http://www.gmc-uk.org/standards/good.htm#Arranging%20cover%23Arranging%20cover

http://www.gmc-uk.org/standards/good.htm#Leading%20teams%23Leading%20teams

http://www.gmc-uk.org/standards/good.htm#Working%20in%20teams%23Working%20in%20teams

http://www.gmc-uk.org/standards/good.htm#Treating%20colleagues%20fairly%23Treating%20colleagues%20fairly

http://www.gmc-uk.org/standards/good.htm#Working%20with%20Colleagues%23Working%20with%20Colleagues

http://www.gmc-uk.org/standards/good.htm#Indemnity%20insurance%23Indemnity%20insurance

http://www.gmc-uk.org/standards/good.htm#Complaints%20and%20formal%20inquiries%23Complaints%20and%20formal%20inquiries

http://www.gmc-uk.org/standards/good.htm#Conduct%20or%20performance%20of%20colleagues%23Conduct%20or%20performance%20of%20colleagues

http://www.gmc-uk.org/standards/good.htm#Dealing%20with%20problems%20in%20professional%20practice%23Dealing%20with%20problems%20in%20professional%20practice

http://www.gmc-uk.org/standards/good.htm#Ending%20professional%20relationships%20with%20patients%23Ending%20professional%20relationships%20with%20patients

http://www.gmc-uk.org/standards/good.htm#Good%20Communication%23Good%20Communication

http://www.gmc-uk.org/standards/good.htm#Maintaining%20trust%23Maintaining%20trust

http://www.gmc-uk.org/standards/good.htm#Respecting%20confidentiality%23Respecting%20confidentiality

http://www.gmc-uk.org/standards/good.htm#Obtaining%20consent%23Obtaining%20consent

http://www.gmc-uk.org/standards/good.htm#Relationships%20with%20patients%23Relationships%20with%20patients

http://www.gmc-uk.org/standards/good.htm#Teaching%20and%20training%23Teaching%20and%20training

http://www.gmc-uk.org/standards/good.htm#Making%20assessments%20and%20providing%20references%23Making%20assessments%20and%20providing%20references

http://www.gmc-uk.org/standards/good.htm#Teaching%20and%20training,%20appraising%20and%20assess%23Teaching%20and%20training,%20appraising%20and%20assess

http://www.gmc-uk.org/standards/good.htm#Maintaining%20your%20performance%23Maintaining%20your%20performance

http://www.gmc-uk.org/standards/good.htm#Keeping%20up%20to%20date%23Keeping%20up%20to%20date

http://www.gmc-uk.org/standards/good.htm#Maintaining%20good%20medical%20practice%23Maintaining%20good%20medical%20practice

http://www.gmc-uk.org/standards/good.htm#Treatment%20in%20emergencies%23Treatment%20in%20emergencies

http://www.gmc-uk.org/standards/good.htm#Decisions%20about%20access%20to%20medical%20care%23Decisions%20about%20access%20to%20medical%20care

http://www.gmc-uk.org/standards/good.htm#Good%20clinical%20care%23Good%20clinical%20care

duty to maintain a good standard of practice and care and to show respect for human life. In particular as a doctor you must:

make the care of your patient your first concern;

treat every patient politely and considerately;

respect patients' dignity and privacy;

listen to patients and respect their views;

give patients information in a way they can understand;

respect the rights of patients to be fully involved in decisions about their care;

keep your professional knowledge and skills up to date;

recognise the limits of your professional competence;

be honest and trustworthy;

respect and protect confidential information;

make sure that your personal beliefs do not prejudice your patients' care;

act quickly to protect patients from risk if you have good reason to believe that you or a colleague may not be fit to practise;

avoid abusing your position as a doctor; and

work with colleagues in the ways that best serve patients' interests.

In all these matters you must never discriminate unfairly against your patients or colleagues. And you must always be prepared to justify your actions to them.

Good Medical Practice

1. All patients are entitled to good standards of practice and care from their doctors. Essential elements of this are professional competence; good relationships with patients and colleagues; and observance of professional ethical obligations.

Good clinical care

Providing a good standard of practice and care

2. Good clinical care must include:

an adequate assessment of the patient's conditions, based on the history and symptoms and, if necessary, an appropriate examination;

providing or arranging investigations or treatment where necessary;

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taking suitable and prompt action when necessary;

referring the patient to another practitioner, when indicated.

3. In providing care you must:

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.

4. If you have good reason to think that your ability to treat patients safely is seriously compromised by inadequate premises, equipment, or other resources, you should put the matter right, if that is possible. In all other cases you should draw the matter to the attention of your Trust, or other employing or contracting body. You should record your concerns and the steps you have taken to try to resolve them.

Decisions about access to medical care

5. The investigations or treatment you provide or arrange must be based on your clinical judgement of patients' needs and the likely effectiveness of the treatment. You must 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. You must not refuse or delay treatment because you believe that patients' actions have contributed to their condition.

6. If you feel that your beliefs might affect the advice or treatment you provide, you must explain this to patients, and tell them of their right to see another doctor.

7. You must try to give priority to the investigation and treatment of patients on the basis of clinical need. 8. You must not refuse to treat a patient because you may be putting yourself at risk. If patients pose a risk to your health or safety you should take reasonable steps to protect yourself before investigating their condition or providing treatment.

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Treatment in emergencies

9. In an emergency, wherever it may arise, you must offer anyone at risk the assistance you could reasonably be expected to provide.


Keeping up to date

10. 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 performance.

11. Some parts of medical practice are governed by law or are regulated by other statutory bodies. You must observe and keep up to date with the laws and statutory codes of practice which affect your work.

Maintaining your performance

12. You must work with colleagues to monitor and maintain the quality of the care you provide and maintain a high awareness of patient safety. In particular, you must:

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;

Teaching and training, appraising and assessing

Making assessments and providing references

13. You must be honest and objective when appraising or assessing the performance of any doctor including those you have supervised or trained. Patients may be put at risk if you describe as competent someone who has not reached or maintained a satisfactory standard of practice.

14. You must provide only honest and justifiable comments when giving references for, or writing reports about, colleagues. When providing references you must include all relevant information which has any bearing on your colleague's competence, performance, and conduct.


15. You should be willing to contribute to the education of students or colleagues.

16. If you have responsibilities for teaching you must develop the skills, attitudes and practices of a competent teacher. You must also make sure that students and junior colleagues are properly supervised.


Obtaining consent

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17. You must respect the right of patients to be fully involved in decisions about their care. Wherever possible, you must be satisfied, before you provide treatment or investigate a patient's condition, that the patient has understood what is proposed and why, any significant risks or side effects associated with it, and has given consent. You must follow the guidance in Seeking Patients' Consent: The Ethical Considerations.

Respecting confidentiality

18. You must treat information about patients as confidential. If in exceptional circumstances there are good reasons why you should pass on information without a patient's consent, or against a patient's wishes, you must follow our guidance on Confidentiality: Protecting and Providing Information and be prepared to justify your decision to the patient, if appropriate, and to the GMC and the courts, if called on to do so.

Maintaining trust

19. Successful relationships between doctors and patients depend on trust. To establish and maintain that trust you must:

be polite, considerate and truthful;

respect patients' privacy and dignity;

respect the right of patients to decline to take part in teaching or research and ensure that their refusal does not adversely affect your relationship with them;

respect the right of patients to a second opinion;

be readily accessible to patients and colleagues when you are on duty.

20. You must not allow your personal relationships to undermine the trust which patients place in you. In particular, you must not use your professional position to establish or pursue a sexual or improper emotional relationship with a patient or someone close to them.

Good Communication

21. Good communication between patients and doctors is essential to effective care and relationships of trust. Good communication involves:

listening to patients and respecting their views and beliefs;

giving patients the information they ask for or need about their condition, its treatment and prognosis, in a way they can understand, including, for any drug you prescribe, information about any serious side effects and, where appropriate, dosage ;

sharing information with patients' partners, close relatives or carers, if they ask you to do so by, having first obtained the patient's consent. When patients cannot give consent, you should share the information which those close to the patient need or want to know, except where you have reason to believe that the patient would object if able to do so.

22. If a patient under your care has suffered harm, through misadventure or for any other reason, you should act immediately to put matters right, if that is possible. You must explain fully and promptly to the patient what has

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http://www.gmc-uk.org/standards/consent.htm

happened and the likely long- and short-term effects. When appropriate you should offer an apology. If the patient is an adult who lacks capacity, the explanation should be given to a person with responsibility for the patient , or the patient's partner, close relative or a friend who has been involved in the care of the patient, unless you have reason to believe the patient would have objected to the disclosure. In the case of children the situation should be explained honestly to those with parental responsibility and to the child, if the child has the maturity to understand the issues.

23. If a child under your care has died you must explain, to the best of your knowledge, the reasons for, and the circumstances of, the death to those with parental responsibility. Similarly, if an adult patient has died, you should provide this information to the patient's partner, close relative or a friend who has been involved in the care of the patient, unless you have reason to believe that the patient would have objected.

Ending professional relationships with patients

24. Rarely, there may be circumstances, for example where a patient has been violent to you or a colleague, has stolen from the premises, or has persistently acted inconsiderately or unreasonably, in which the trust between you and the patient has been broken and you find it necessary to end a professional relationship with a patient. In such circumstances, you must be satisfied your decision is fair and does not contravene the guidance in paragraph 5; you must be prepared to justify your decision if called on to do so. You should not end relationships with patients solely because they have made a complaint about you or your team, or because of the financial impact of their care or treatment on your practice .

25. You should inform the patient, orally or in writing, why you have decided to end the professional relationship. You must also take steps to ensure that arrangements are made quickly for the continuing care of the patient, and hand over records to the patient's new doctors as soon as possible.

Dealing with problems in professional practice

Conduct or performance of colleagues

26. You must protect patients from risk of harm posed by another doctor's, or other health care professional's, conduct, performance or health, including problems arising from alcohol or other substance abuse. The safety of patients must come first at all times. Where there are serious concerns about a colleague's performance, health or conduct, it is essential that steps are taken without delay to investigate the concerns to establish whether they are well-founded, and to protect patients.

27. If you have grounds to believe that a doctor or other healthcare professional may be putting patients at risk, you must give an honest explanation of your concerns to an appropriate person from the employing authority, such as the medical director, nursing director or chief executive, or the director of public health, or an officer of your local medical committee, following any procedures set by the employer. If there are no appropriate local systems, or local systems cannot resolve the problem, and you remain concerned about the safety of patients, you should inform the relevant regulatory body. If you are not sure what to do, discuss your concerns with an impartial colleague or contact your defence body, a professional organisation or the GMC for advice.

28. If you have management responsibilities you should ensure that mechanisms are in place through which colleagues can raise concerns about risks to patients. Further guidance is provided in Management in Health Care: The Role of Doctors.

Complaints and formal inquiries

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29. Patients who complain about the care or treatment they have received have a right to expect a prompt, open, constructive and honest response. This will include an explanation of what has happened, and where appropriate, an apology. You must not allow a patient's complaint to prejudice the care or treatment you provide or arrange for that patient.

30. You must co-operate fully with any formal inquiry into the treatment of a patient and with any complaints procedure which applies to your work. You must give, to those who are entitled to ask for it, any relevant information in connection with an investigation into your own, or another health care professional's, conduct, performance or health .

31. If you are suspended from a post, or have restrictions put on your practice because of concerns about your performance or conduct, you must inform any other organisations for whom you undertake work of a similar nature. You must also inform any patients you see independently of such organisations, if the treatment you provide is within the area of concern to which the suspension or restriction relates.

32. Similarly, you must assist the coroner or procurator fiscal, by responding to inquiries, and by offering all relevant information to an inquest or inquiry into a patient's death. Only where your evidence may lead to criminal proceedings being taken against you are you entitled to remain silent.

Indemnity insurance

33. In your own interests, and those of your patients, you must obtain adequate insurance or professional indemnity cover for any part of your practice not covered by an employer's indemnity scheme.

Working with Colleagues

Treating colleagues fairly

34. 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. And you must not allow your views of colleagues' lifestyle, culture, beliefs, colour, gender, sexuality, or age to prejudice your professional relationship with them.

35. 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.

Working in teams

36. Healthcare is increasingly provided by multi-disciplinary teams. Working in a team does not change your personal accountability for your professional conduct and the care you provide. When working in a team, 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;

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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.

Leading teams

37. If you lead a team, you must ensure that:

medical team members meet the standards of conduct and care set in this guidance;

any problems that might prevent colleagues from other professions following guidance from their own regulatory bodies are brought to your attention and addressed;

all team members understand their personal and collective responsibility for the safety of patients, and for openly and honestly recording and discussing problems;

each patient's care is properly co-ordinated and managed and that patients know who to contact if they have questions or concerns;

arrangements are in place to provide cover at all times;

regular reviews and audit of the standards and performance of the team are undertaken and any deficiencies are addressed;

systems are in place for dealing supportively with problems in the performance, conduct or health of team members.

38. Further advice on working in teams is provided in Maintaining Good Medical Practice and Management in Health Care - The Role of Doctors.

Arranging cover

39. You must be satisfied that, when you are off duty, suitable arrangements are made for your patients' medical care. These arrangements should include effective hand-over procedures and clear communication between doctors.

40. If you arrange cover for your own practice, you must satisfy yourself that doctors who stand in for you have the qualifications, experience, knowledge and skills to perform the duties for which they will be responsible. Deputising doctors and locums are directly accountable to the GMC for the care of patients while on duty.

Taking up appointments

41. You must take up any post, including a locum post, you have formally accepted unless the employer has adequate time to make other arrangements.

Sharing information with colleagues

42. It is in patients' best interests for one doctor, usually a general practitioner, to be fully informed about, and responsible for maintaining continuity of, a patient's medical care.

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43. You should ensure that patients are informed about how information is shared within teams and between those who will be providing their care. If a patient objects to such disclosures you should explain the benefits to their own care of information being shared, but you must not disclose information if a patient maintains such objections. For further advice see our guidance Confidentiality: Protecting and Providing Information.

44. When you refer a patient, you should provide all relevant information about the patient's history and current condition.

45. If you provide treatment or advice for a patient, but are not the patient's general practitioner, you should tell the general practitioner the results of the investigations, the treatment provided and any other information necessary for the continuing care of the patient, unless the patient objects. If the patient has not been referred to you by a general practitioner, you should inform the general practitioner before starting treatment, except in emergencies or when it is impracticable to do so. If you do not tell the patient's general practitioner, before or after providing treatment, you will be responsible for providing or arranging all necessary after care until another doctor agrees to take over.

Delegation and referral

46. Delegation involves asking a nurse, doctor, medical student or other health care worker to provide treatment or care on your behalf. When you delegate care or treatment you must be sure that the person to whom you delegate is competent to carry out the procedure or provide the therapy involved. You must always pass on enough information about the patient and the treatment needed. You will still be responsible for the overall management of the patient.

47. Referral involves transferring some or all of the responsibility for the patient's care, usually temporarily and for a particular purpose, such as additional investigation, care or treatment, which falls outside your competence. Usually you will refer patients to another registered medical practitioner. If this is not the case, you must be satisfied that any health care professional to whom you refer a patient is accountable to a statutory regulatory body, and that a registered medical practitioner, usually a general practitioner, retains overall responsibility for the management of the patient.

Probity

Providing information about your services

48. 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.

49. The information you publish must not make unjustifiable claims about the quality of your services. It must not, in any way, offer guarantees of cures, nor exploit patients' vulnerability or lack of medical knowledge.

50. Information you publish about your services must not put pressure on people to use a service, for example by arousing ill-founded fear for their future health. Similarly you must not advertise your services by visiting or telephoning prospective patients, either in person or through a deputy.

Writing reports, giving evidence and signing documents

51. You must be honest and trustworthy when writing reports, completing or signing forms, or providing evidence in

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litigation or other formal inquiries. This means that you must take reasonable steps to verify any statement before you sign a document. You must not write or sign documents which are false or misleading because they omit relevant information. If you have agreed to prepare a report, complete or sign a document or provide evidence, you must do so without unreasonable delay.

Research

52. If you participate in research you must put the care and safety of patients first. You must ensure that approval has been obtained for research from an independent research ethics committee and that patients have given consent. You must conduct all research with honesty and integrity. More detailed advice on the ethical responsibilities of doctors working in research is published in Research - the role and responsibilities of doctors

Financial and commercial dealings

53. You must be honest and open in any financial arrangements with patients. In particular:

you should provide information about fees and charges before obtaining patients' consent to treatment, wherever possible;

you must not exploit patients' vulnerability or lack of medical knowledge when making charges for treatment or services;

you must not encourage your patients to give, lend or bequeath money or gifts which will directly or indirectly benefit you. You must not put pressure on patients or their families to make donations to other people or organisations;

you must not put pressure on patients to accept private treatment;

if you charge fees, you must tell patients if any part of the fee goes to another doctor.

54. You must be honest in financial and commercial dealings with employers, insurers and other organisations or individuals. In particular:

if you manage finances, you must make sure that the funds are used for the purpose for which they were intended and are kept in a separate account from your personal finances;

before taking part in discussions about buying goods or services, you must declare any relevant financial or commercial interest which you or your family might have in the purchase.

Conflicts of interest

55. You must act in your patients' best interests when making referrals and providing or arranging treatment or care. So you must not ask for or accept any inducement, gift or hospitality which may affect or be seen to affect your judgement. You should not offer such inducements to colleagues.

Financial interests in hospitals, nursing homes and other medical organisations

56. If you have financial or commercial interests in organisations providing health care or in pharmaceutical or other biomedical companies, these must not affect the way you prescribe for, treat or refer patients.

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57. If you have a financial or commercial interest in an organisation to which you plan to refer a patient for treatment or investigation, you must tell the patient about your interest. When treating NHS patients you must also tell the health care purchaser.

58. Treating patients in an institution in which you or members of your immediate family have a financial or commercial interest may lead to serious conflicts of interest. If you do so, your patients and anyone funding their treatment must be made aware of the financial interest. In addition, if you offer specialist services, you must not accept patients unless they have been referred by another doctor who will have overall responsibility for managing the patient's care. If you are a general practitioner with a financial interest in a residential or nursing home, it is inadvisable to provide primary care services for patients in that home, unless the patient asks you to do so or there are no alternatives. If you do this, you must be prepared to justify your decision.

Health

If your health may put patients at risk

59. If you know that you have a serious condition which you could pass on to patients, or that your judgement or performance could be significantly affected by a condition or illness, or its treatment, you must take and follow advice from a consultant in occupational health or another suitably qualified colleague on whether, and in what ways, you should modify your practice. Do not rely on your own assessment of the risk to patients.

60. If you think you have a serious condition which you could pass on to patients, you must have all the necessary tests and act on the advice given to you by a suitably qualified colleague about necessary treatment and/or modifications to your clinical practice.

This guidance is not exhaustive. It cannot cover all forms of professional practice or misconduct which may bring your registration into question. You must therefore always be prepared to explain and justify your actions and decisions.

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