Desperate times call for annual patient appraisals 

On the theme of ‘My big idea’, Dr Anya Heywood contemplates turning the tables by introducing annual appraisals for patients

My Big Idea? Well, being a dyed-in-the-wool-GP-till-I-die (or retire, whichever happens first), I’m more about team working, active listening and gentle guidance. I’m an offering options and shared decision-making sort of person. Bumbly and genial to one and all. 

But then, sometimes out of the blue, GPs surprise themselves by having Dynamic Big Ideas. And I have one. It is genius and brilliant and needs, like Covid, to be implemented ASAP. I’m not going to discuss the pros and cons – these are desperate times. We need decision makers, and I’ve made one. 

So the Big Idea is to roll out annual patient appraisals. Hear me out. 

You know how useful and formative our own appraisals are? And how we can’t sort of continue to work until we’ve filled in the form and had a meaningful chat with an eager peer? And the appraiser doesn’t need/want to know the first thing about you, but it’s a handy income stream? 

Well, imagine the same thing for patients. I’d make it mandatory that they can’t be registered as a patient in the NHS without an annual appraisal. They’d have to prepare for this by filling in a 10 page online form which changes slightly every year to keep it fresh. Then (and this is the genius bit): they don’t send it to a GP. They send it to another patient who is their peer, i.e. same age and gender. They might even have the same medical complaints as each other; in our area that’s more than likely, as all our patients have all the complaints. 

They can list their qualifications to be a patient, and where they graduated. They should include a bit of blurb about the sort of patient they are (chronic, intermittent, dangerous, private when it suits, etc). There’ll be a section on medication, which they’ll have to spell themselves. Points for originality will be awarded. 

Patients can reflect on their greatest achievements and challenges over the previous 12 months, and any complaints or compliments they were involved with. It’ll be like the Christmas ‘round robin’ letters from your cousin Louise. 

Then, a review of last year’s PDP will be done with the usual sections: have you achieved your goals? If not, (in a passive-aggressive tone of voice) why not?  Do you want the option of carrying this forward? Patients’ PDPs might be health related or not. I predict the upper middle classes will engage massively with appraisals and will list: ‘Do triathlon; learn Spanish; go vegan’ – it will become a huge ‘health-off’ with their peer appraiser. 

Other people might prefer something more along the lines of returning those library books, moving house, getting divorced or tap dancing. We just won’t (ever) know. 

Then patients set their PDP for the next year. Again, it’s completely up to them, but it could be a life changing idea for many; that you can in fact decide what to do with your own life. If no goals come forth easily, I’m willing to bet hard cash that their peer appraiser can come up with some excellent ideas. 

You know, the more I think about it, the better it gets. People love talking about themselves and I think a solid two hours would be needed for every appraisal. This would relieve pressure on counselling and GP appointments. All the retired teachers can be the appraisers, as they can mark the results and send them back with corrections. 

It’s hitting social connection, life coaching, and competitive heath comparison in a formal way. And it doesn’t involve me. 

Dr Anya Heywood is a GP in Middlesbrough, North Yorkshire