Appraisal: It’s all about routine


GP Karen Skinner on making appraisal easy

As a senior appraiser I have been reflecting (a word I’m sure you love), on how best to help GPs make the process less daunting.  Like everything in life, it’s about routine.   How many of us forget to brush our teeth?   You may think this is because you like clean teeth, however, I challenge you: it is not.

It’s because a routine has been instilled in you from early childhood to brush your teeth twice day.

Over this coming year, think about how you are going to make appraisal a routine like brushing your teeth.  Perhaps pick a day of the week that you know you can spend half an hour to open up your portfolio and put in all your new learning.

You may find this best at the weekend or perhaps before the children wake up on a Sunday morning.  If you feel a weekly update is too much, then go to monthly.  This is probably more than enough to keep your portfolio up to date.

The main thing is not to leave this all to the week before your appraisal and then panic and trawl through your email to see if you can extract anything useful.

Use the technology

As you know from my previous blog, I am an Apple lover.  Whenever I attend a meeting I take along my iPad or my iMac and make notes, putting my reflection in capitals throughout.

When it comes to uploading it into my portfolio I then simply have to copy and paste this into the reflective area of the toolkit.


It is a personal choice which toolkit you use (there are a few on the market now) but free ones are not necessarily the best.

They may also not be the best for your appraiser who finds they struggle to find the relevant details they need.  It’s never good to have a stressed out appraiser!

Appraisal requirements

Appraisal is not rocket science but if you don’t fulfil the requirements, you will have problems, especially when it comes to your revalidation year.

MSF and PSQ-once every cycle

Don’t leave your Patient Satisfaction Questionnaire (PSQ) and colleague Multi Source Feedback (MSF) to a week before your revalidation date and then find you can’t complete it and you have to defer.   So again, plan in advance and make a routine.

Some toolkits make this process easier.  Clarity, (amongst others), has a built in system.   The MSF is extremely easy:  just set up a new feedback cycle and input the email addresses of the people that you wish to comment on your work.

The patient one is not quite so straightforward, but again does not have to be difficult.  Simply set up the system and Clarity creates the paper questionnaires.  You then give these to the receptionist who hands them out, retrieves them from the patients and sends them off.

It is extremely important that someone else hands out and retrieves the questionnaires.  Otherwise this could bias your results as you may avoid picking patients who annoyed you that morning or felt that your approach was too firm!

Two significant events:

Each year you are required to reflect on two significant events. Significant events don’t have to be big or negative.   You don’t have to have almost killed somebody or prescribed a potentially fatal drug.  These just need to be events that stopped you in your tracks during your working day and made you think “what if?”

One of my significant events was a request for 100 codeine tablets out of hours.  On exploring further, I found that the receptionist had simply inputted the last repeat prescription that the patient had given in.  On reflection, what I learnt from this was not to make assumptions and to ensure that there is communication at all times.

CPD points:

You need to complete 50 credits a year specific to day to day general practice.  If you have other roles then of course there is overlap so you can count some of the points, but not for instance a minor ops course specific to the removal of scaly lesions that was 50 credits in itself!

Claiming impact is going soon, so don’t worry about that.

Quality Improvement Activity (QIA):

Ideally all of you should complete an all singing, all dancing, 8 point, 2 cycle audit as the gold standard of QIA.  However, the GMC and RCGP quickly realised this would not be possible for some GPs such as locums.

Thus a first cycle audit is accepted as an overall piece of work every cycle, but you also should be demonstrating each year some smaller QIA, such as case reviews, a series of PUNs and DENs, an in depth review of a significant event.


Make sure you include any significant ones - not simple a grumble to the receptionist on the way out.

Most importantly- you guessed it, write some reflection !!



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