In his first blog for Pulse, Dr Paul O’Reilly finds the bright side in appraisals. Dr O’Reilly won our summer writing competition with his candid and powerful piece on a patient’s final birthday. As the winner, he will be writing a blog for us every month
Every new year, I have the same resolutions – lose weight; get more exercise; and start my appraisal early. The first two I can generally manage, at least for a month or so. But the third one? Not so much.
By ‘appraisal’, I do not mean to carefully collate and reflect on the many varied forms of my continual professional development throughout the year. Of course what I mean is: anxiously scrabble around to bodge my way through some mandatory training; sign on for a Saturday update course; click through some bizarre online modules about conditions I’ve never heard of; consider which of my colleagues can be bothered to fill in a feedback form; ditto my patients; and then try to document all of that on the clunkiest website in the virtual world not under the control of NHS Digital or PCSE.
Did it really have to be this way? Yes, I know that we have to ‘prevent another Shipman’ and ‘restore public trust in the profession’. To my knowledge, there is no evidence that appraisal has done anything toward either of those worthy aims. But after so many years of jumping through the hoops with appraisals, I think we have reached the stage that we can appraise our own appraisals. For me in every instance, the only positive from them has been a chance to learn from experienced peers. They were able to give an informed and empathetic external view of my work and show me potential options for improvement.
My favourite was my first ever one. It was a two-hour masterclass with a leading local GP and medical politician. He clearly and simply articulated to me in simple acronym-free terms how exactly the local commissioning and governance structures really worked and how to get the best out of them for my patients and practice. 10 years on, I still sometimes refer to my notes of that meeting.
Since then, I have been lucky enough to have a succession of good people, all of whom wanted me to succeed and be better. Some also worked with marginalised communities and had a great deal of wisdom to share. Others ran large practices and were able to offer insights into better information processes and technological developments – which may or may not be useful for our particular homeless population. Others have been educators who have actually known exactly how to source learning truly relevant to my work and to help the professional development of our staff.
My mind fills with the memories of many such valuable meetings. I apologise to those whose experience of appraisers is different. Perhaps I have been unusually fortunate but I have heard others say the same. So, at a time when there appears to be a brief moment of opportunity with the Government seeming to value our goodwill, perhaps the GPC could ask them for an appraisal process which has more of this and less of the other paperchase.
Oh yes, and if my appraiser should happen to read this: you are definitely one of the good guys and I look forward to our meeting on Valentine’s Day.
Dr Paul O’Reilly is a GP partner in London who works for homeless people
Appraisals continue to exist because the Parasites who benefit from performing and supervising Appraisal and Revalidation are influential and vocal.
A huge waste of resources without an evidence base.
Yep, appraisals are a wholly unnecessary, useless and wasteful (of taxpayers money) exercise in over-regulation of our ethics-rooted profession, and about which our “trade union” says quiet.
While the dangerously financialised private sector (which led to 2008 crash) is being further deregulated by this Govt..
Baseball bat for doctors and a light touch cuddle for the private sector..
GPs who started way back in the last century will fondly remember those pre-appraisal years…..yes, it was the Wild West where cowboys could practice for decades without bothering with any further education, but you didn’t have that constant gnawing guilty dread knowing that the unavoidable annual colonoscopy that you try to ignore all year is creeping closer, and you’re totally unprepared.
The first few years of appraisals were glorious …..a friendly fireside chat with a senior colleague, to whom you handed over a few certificates of attendance (to show you were keeping up), a handshake, a signature, and a reassuring “keep your chin up” .
But inevitably the process mutated in a few short years, interfered with by meddling bureaucrats and well-meaning short-sighted educators, until we arrived at the miserable monstrosity of “50 hours”, SMART comments, uploading lost certificates onto crashing websites, critical incidents (“can I say I left the vaccine fridge open again this year?”), petty complaints, dredging your memory and car boot for every meaningless meds mgmt meeting memo buried there, fudging last year’s PDP, engineering next year’s PDP (to involve the least effort possible), then pray that your appraiser is a sympathetic human who knows this is all a farce, not an over-zealous witch-hunting fanatic with a God complex (I’ve had both).
The dialling back on “evidence gathering” in the wake of the pandemic has been a blessed relief, but Annual Appraisal remains an Annual Albatross that needs scrapping. The author opines for a system similar to the early glory-days, and I heartily agree. Just don’t make it annual…….
Dear Dr Banner,
Thank you very much. I think you said it better than I did.
All the very best,
Paul.