Medical appraisal policy

1 Introduction

Medical appraisal was first introduced for NHS consultants in 2001 and has been generally well regarded by doctors and provides organisations with an opportunity to align individual professional development with service and organisational development.

The White Paper (21 February 2007) Trust Assurance and Safety, the Regulation of Health Professionals in the 21st Century has positioned strengthened annual medical appraisal as the cornerstone of revalidation. This model of appraisal will involve quality assurance and effective supporting clinical governance systems. Current appraisal systems and content are based on the General Medical Council’s (GMC) good medical practice as a framework.

The broadly formative theme of appraisal will be retained but in addition objective summative judgements will be made about the supporting information provided by the appraisee on performance and whether the doctor is progressing satisfactorily towards revalidation. Key definitions are provided below.

2 Purpose

This policy adheres to the principle that all appraisees will undertake annual appraisal in keeping with the process agreed at the time by the General Medical Council, British Medical Association, Department of Health and NHS England. It describes requirements for doctors in the role of both appraiser and appraisee.

3 Scope

This policy applies to all consultants, specialist, specialty, staff grade and associate specialist (SAS) doctors, other trust doctors and physician associates, employed or contracted by the trust, that is those that have a prescribed connection to the trust as the designated body. This policy and its associated procedures will be overseen by the trust revalidation support group.

The trust Revalidation Support team will provide supporting information to doctors who do not have a prescribed connection to the trust at their request for their appraisal with their designated body.

The policy does not cover the annual review and assessment process for doctors in formal training grades. This is undertaken by the Health Education England (HEE) as part of the formal annual review of competence progression (ARCP) procedures for assessing progress in training. Issues related to health, conduct and behaviour of doctors in training grades will be dealt with under the normal employer policies and procedures for that employee in liaison with Health Education England.

Appraisal should be a positive process that gives doctors feedback on their past performance, to chart their continuing progress and to identify their development needs. It is a forward-looking process, essential in identifying the developmental and educational needs of individuals. Appraisal is at its heart a reflective process allowing the appraisee to review his or her development professionally with a trained colleague as appraiser, involving challenge where necessary.

The primary aim of appraisal is to help appraisees consolidate and improve on good performance, aiming towards excellence. In doing so, it should identify areas where further development is necessary or useful; the purpose is to improve performance right across the spectrum. It can help to identify concerns over performance at an early stage and also to recognise factors, which may have led to performance problems, such as ill health.

Appraisal is underpinned by continuing professional development and if used properly can help to develop a reflective culture within service and training. It is expected that regular successful annual appraisal will provide the foundation stone upon which a positive affirmation of continued fitness to practice can be made every five years by the doctor’s responsible officer (RO).

In relation to the whole scope of work, the aims of medical appraisal are to:

• review personal and professional development needs and agree plans for these to be met
• regularly review and reflect upon an appraisee’s work and performance, utilising relevant and appropriate comparative operational data from local, regional and national sources
• consider the doctor’s contribution to the quality and improvement of services and priorities delivered locally
• optimise the use of skills and resources in seeking to achieve the delivery of general and personal medical services
• identify the need for adequate resources to enable any service objectives in the agreed job plan review to be met, this then supplies the baseline information to be submitted to the separate but related job planning process
• provide an opportunity for doctors to discuss and seek support for their participation in activities for the wider NHS
• utilise the annual appraisal process and associated documentation to meet the requirements for General Medical Council revalidation as aligned to good medical practice

3.1 Confidentiality

This section aims to clarify issues of confidentiality on appraisal documentation and outcome namely who will see both the summary of discussion from appraisal, the output of the personal development plan process and the wider portfolio of information.

While there is a need to have an explicit link between successful participation in and outcome of annual appraisal and General Medical Council re-licensure through revalidation the outcome of the appraisal discussion, as specified by General Medical Council guidance, will need to be shared with the responsible officer. It should be understood that the appraiser will need to escalate any significant concerns that arise during the appraisal discussion to the responsible officer.

The appraisal process serves a number of purposes which influence the circumstances in which appraisal information may be viewed by individuals other than the appraiser and the appraisee. These include:

• providing an accurate record for those involved (appraiser and appraisee)
• quality assurance of appraisers which may include sampling of appraisal information
• addressing concerns highlighted in the appraisal interview
• capacity to highlight continuing professional development (CPD) themes that might need to be addressed by the trust as a whole
• responsible officer, appraisals staff and central electronic storage

3.2 Newly appointed doctors

There is a requirement under the Medical Profession (Responsible Officers) Regulations (2010) that pre-employment information is made available to the responsible officer before a doctor starts work. This information is references, qualifications and experience, details of their current responsible officer and designated body, their revalidation due date and date of last appraisal and any General Medical Council conditions or restrictions.

Responsible officer or fitness to practice information also needs to be available to the responsible officer for all new doctors within three months of the doctors starting date. This includes a record of previous appraisals, any relevant performance monitoring information, records of patient and colleague feedback and records of any fitness to practice investigations, disciplinary procedures, conditions or restrictions, and unresolved concerns.

All consultants, staff grade and associate specialist doctors and other directly employed doctors appointed by the trust and who are connected to the trust as a designated body will be allocated an appraiser within two months prior to their appraisal due date where possible. The trust Revalidation Support team will decide on how to align the appraisee with the appraisal cycle. This will also involve a decision on whether there should be an interim or priming appraisal pending a full appraisal. Doctors who have just completed training should have their first medical appraisal no less than 6 months and not more than 12 months since their final annual review of competence progression.

All newly appointed doctors will still be expected to meet with their relevant line manager to agree service related objectives within the first job planning meeting.

Directly employed doctors connected to other designated bodies, who have their annual appraisal with that body, must provide the trust with a statement confirming that they have completed and signed off a satisfactory annual appraisal and confirm the relevant dates.

3.3 Deferment of appraisal

The trust policy requires all consultants, staff grade and associate specialist doctors and other directly employed doctors to undergo an appraisal annually and this is a formal requirement for revalidation. There are, however, exceptional circumstances when a doctor may request that an appraisal is deferred such that no appraisal takes place during one appraisal year.

Instances when a doctor may request a deferment:

• breaks in clinical practice due to sickness or maternity
• breaks in clinical practice due to absence abroad or sabbaticals

Doctors who have a break from clinical practice may find it harder to collect evidence to support their appraisal, particularly if being appraised soon after their return to clinical practice. An appraisal, however, can often be useful when timed to coincide with a doctor’s re-induction to clinical work to help plan their re-entry.

A doctor who is seeking to return to practice after a period of absence should discuss their circumstances with their responsible officer at the earliest opportunity. The timing of their first appraisal will be determined to some extent by their individual circumstances, including whether they can demonstrate that they have maintained fitness to practise in the relevant areas during their absence and hence whether a bespoke re-training programme or period of supervision is required prior to resuming practice.

The first appraisal should take place between 6 and 12 months after re-entry to practice. The responsible officer may also exercise discretion whether, within this range, it occurs earlier to support the doctor’s return to practice, or later to facilitate the accrual of supporting information. Where possible and practical, if the doctor had a previously agreed appraisal month this should be reinstated. Also, if the doctor has had an appraisal previously and circumstances permit, their first appraisal should be undertaken within 15 months of the last one.

Appraisers will use their discretion when deciding the minimum evidence acceptable for these exceptional appraisals or agree with the responsible officer or appraisal lead that an interim or priming appraisal may be more appropriate.

As a general rule it is advised that doctors having a career break:

• in excess of 6 months should try to be appraised within 6 months of returning to work
• less than 6 months should try to be appraised no more than 15 months after the previous appraisal and wherever possible so that an appraisal year is not missed altogether

Each case can be dealt with on its merits and the trust is mindful that no doctor must be disadvantaged or unfairly penalised as a result of pregnancy, sickness or disability. Doctors are likely to have to produce the required total amount of continuing professional development credits stipulated for the five-year revalidation cycle, even if they have had some periods of leave during these five years.

The trust has a requirement that a doctor should undergo an annual appraisal. This policy aims to ensure that if there are good reasons for not undertaking an appraisal then these circumstances are dealt with in an appropriate, timely, and consistent manner, minimising bureaucracy and ensuring that all doctors benefit from appraisal at a time which meets their professional needs.

Doctors who think they may need to defer their appraisal should discuss their deferment with their appraiser in the first instance prior to the responsible officer formally agreeing the request.

Appraisals may also be deferred at the specific request of the responsible officer where a doctor is already under investigation for concerns that have been raised.

3.4 Non completion of appraisal within the appraisal year

The trust will ensure that all doctors within the trust are adequately supported to complete their annual appraisal. In the event that a doctor breaches the 12-month limit they will be requested by the responsible officer to identify the reasons why the appraisal has not been completed. A formal investigation may be carried out if necessary and a report on the investigation will be submitted to the responsible officer and appropriate action will be taken. In addition to this there is a requirement to report any such instance to the board of directors.

Doctors who have not completed an annual appraisal will not be eligible for routine pay progression or local clinical excellence awards unless deferment on exceptional grounds has been agreed with the trust.

3.5 Links to job planning

Job planning is the main process supporting the alignment of individual doctor, team and service objectives. This process also identifies the types of activities (programmed activities or sessions) required on a weekly basis to deliver these objectives. The appraisal process offers a platform for identifying personal objectives, and understanding the key personal development areas required to deliver job plans more effectively.

4 Responsibilities, accountabilities and duties

The trust recognises that an effective appraisal system is dependent on both organisational clinical governance support and an appropriately challenging appraisal. Organisational support includes clinical and managerial leadership, high-level administrative support, and partnership working with the Royal College of Psychiatrists, Health Education England, the Department of Health and NHS England. Clear accountabilities of both the organisation and individual roles are crucial in order to achieve this.

4.1 Chief executive

Is accountable to the board of Rotherham, Doncaster and South Humber NHS Foundation Trust for ensuring the resources and systems are in place for robust medical appraisal for employed or contracted doctors. They are accountable for ensuring that appraisal and clinical governance systems are integrated and co-ordinated at both strategic and operational level and that a responsible officer is appointed and provided with sufficient support to enable them to deliver on the role requirements.

4.2 Responsible officer

Is accountable to the chief executive and the board for implementing and managing the appraisal process including appraisal outcomes. The responsible officer (or nominee, for example, appraisal lead) will receive, review, act upon appropriately the outcomes of the appraisals. They will also be responsible for preparing an annual report on appraisal for the board of directors and for any actions arising from this. They will ensure that appraisers are properly recruited, trained and regularly assessed to carry out their role. They will ensure that all necessary administrative and managerial systems are in place to manage the appraisal system effectively. The responsible officer will ensure appraisees have an understanding of the trust appraisal process, including supporting information. This should include delivering an induction to appraisals for new appraisees and identifying those that may require more in depth support, for example, via a priming appraisal. In conjunction with the trust Revalidation Support team the responsible officer will be responsible for the allocation of appraisers to appraisees across the trust and for making decisions on appraiser re-allocation if there is any perceived or actual conflict of interest between an appraisee and an appraiser. They will also be responsible for arranging joint appraisals where this is appropriate, for example doctors with mixed academic or service roles and for leading on the development and monitoring of standards and performance in relation to appraisal and revalidation.

4.3 Medical directorate and education manager

Is responsible for identifying, in conjunction with the responsible officer and the lead for patient safety, what relevant information needs to be provided to support medical appraisal, for example, patient data, clinical governance data (complaints, serious incidents), workload, operational and performance information for inclusion in the appraisal portfolio. They will monitor appraisal coverage generally across the trust for individual doctors and report on this to the responsible officer.

4.4 Appraisal administrator

Is responsible for the provision of administrative support, supplying information and guidance in relation to systems and processes to the responsible officer, trust Revalidation Support team, appraisers and individual doctors.

4.5 Deputy director of safety and quality

Is responsible for working with the responsible officer and medical directorate to ensure that relevant supporting information in relation to incidents, complaints and serious incidents can be made available to those involved in the medical appraisal process.

4.6 Appraiser

Is responsible for carrying out appraisals to the standards laid out in this policy. All appraisers will receive formal training, have a job description and fulfil the criteria set out in the competency framework (appendix A). Appraisers will assess the portfolio of supporting information provided by the appraisee against the attributes in good medical practice and the current speciality standards set by the Royal Colleges, with a view to identifying weaknesses and gaps so that these can be addressed in the appraisee’s personal development plan. A review of the previous year’s personal development plan will also take place and where this has not been completed satisfactorily the reasons for this are understood. The appraiser is responsible for ensuring that the appraisal is fully signed off and available for the responsible officer to view.

4.7 Appraisee

Is responsible for collating and preparing supporting information for the appraisal meeting using the appropriate Royal College and trust checklists and requirements. The burden of preparation can be reduced by regarding verbal reflection facilitated during the appraisal discussion as having equal weight with recorded reflection prior to the meeting.

The portfolio of supporting information provided by a doctor should reflect the breadth of all of the doctor’s professional practice, including indirect patient care activities such as clinical audit, management and advisory roles across all healthcare organisations (including private practice). The General Medical Council emphasises the quality rather than the quantity of supporting information required. The appraisee is responsible for submitting their portfolio or electronic access to their appraiser at least two weeks prior to the appraisal. The appraisee is responsible for raising any concerns about the appraisal process in accordance with this policy. They are responsible for completing the appraisee survey as feedback at the end of the appraisal process. The onus is on the appraisee to seek to agree a date for the appraisal meeting with the appraiser in accordance with the timescales set out in section 5.

5 Procedure

The content of appraisal is based on the General Medical Council guidance good medical practice (GMP) framework. The General Medical Council’s core headings or domains, which cover the spectrum of medical practice are:

• knowledge, skills performance
• safety and quality
• communication partnership and team working
• maintaining trust

Each domain is described by three attributes. The attributes define the scope and purpose of each domain. These attributes relate to practices or principles of the profession as a whole. The principles and values have been pared down from the full advice in good medical practice and they are examples of the professional behaviours expected of all doctors.

Supporting information should be routinely sought and collected during the Appraisal year. The supporting information will fall under four broad headings:

• general Information: providing context about what you do in all aspects of your work
• keeping up to date: maintaining and enhancing the quality of your professional work
• review of your practice: evaluating the quality of your professional work
• feedback on your practice: how others perceive the quality of your professional work

There are six types of supporting information that appraisees will be expected to provide and discuss at the appraisal at least once in each five-year cycle. They are:

• continuing professional development
• quality improvement activity
• significant events or serious incidents
• feedback from colleagues
• feedback from patients or those they provide medical services to
• review of complaints and compliments

The process for appraisal will be as follows:

• the appraisal year will run from 1 April one year to 31 March the next year
• it is expected that all appraisals will be completed within that year, that is, the appraisal will review a complete year’s activity and conducted between 1 December and 28 February or 29 February utilising the trusts’ appraisal system
• the appraiser and the appraisee should ensure that the appraisal is booked at least 6 weeks in advance of the date of the appraisal to allow for adequate preparation time
• the doctor being appraised should prepare for the appraisal by ensuring they are familiar with the trust appraisal system
• by building their portfolio of supporting information and mapping information to the good medical practice attributes
• providing self-reflection and identifying any issues to raise with the appraiser and by preparing a personal development plan (PDP)
• the appraisee is then responsible for submitting the portfolio of evidence a minimum of two weeks in advance of the meeting
• the appraisal meeting must be held in an appropriate environment, which can include a virtual meeting. This will involve a quiet room and both the appraiser and appraisee must ensure that they are not disturbed during the appraisal meeting. It is advised that access is available to stored information that may be used with the appraisal system at the time of the appraisal discussion, but this is not mandatory
• on completion of the appraisal summary of discussion and the personal development plan production, both the appraiser and the appraisee must provide sign off to the content of the appraisal portfolio. The outputs should be signed off by the appraiser and appraisee within 28 days of appraisal meeting and within the appraisal year
• failure to participate in the appraisal process will place a doctors’ employment status and potentially their General Medical Council licence to practice at risk

5.1 Use of the appraisal system

The trust appraisal system is the mandated process for producing and managing the appraisal portfolio and delivery of the completed appraisal and outcomes including the personal development plan.

The appraisal system contains guidance relating to the structure and requirements for Supporting Information.

5.2 Selection and recruitment of appraisers

Appraisees will be appraised by a trained appraiser and appropriate training will be made available to ensure compliance with revalidation and this policy.

The core competencies for the appraiser role have been identified and these are included at appendix B, prospective appraisers will be assessed against these competencies.

Following appointment, a probationary period of 12 months will follow during which the new appraiser will seek to undertake a minimum of 3 appraisals. After these a review will be undertaken with the responsible officer, or nominee, to assess progress, deal with any new learning needs identified, and confirm whether the appraiser is competent to continue.

Established appraisers will have access to ongoing support through the responsible officer. An appraiser meeting will be held each year to provide refresher skills training, group feedback and updates on appraisal policy changes. In addition, appraisers will be expected to include relevant learning objectives for developing their appraisal skills in their personal development plans as a result of their own annual appraisal and to attend other appraisal meetings locally or regionally, as necessary.

All those undertaking appraisals will be expected to discuss formalising their workload on appraisals within their annual job plan review.

Doctors working as appraisers on behalf of the trust will be indemnified for their actions in pursuance of their work as part of the usual indemnity arrangements with the trust as their employer.

In normal circumstances an appraiser should aim to undertake between 5 and 20 appraisals a year. Where appraisers fall below this activity there will be further scrutiny and consideration as part of the quality monitoring process.

An appraiser should not undertake more than two appraisal meetings on the same day.

An appraiser should not maintain or keep personal records about a doctor’s appraisal and all copies electronic or otherwise of the doctor’s appraisal held by the appraiser are required to be destroyed or deleted no later than one month following the appraisal.

5.3 Joint appraisals

Joint appraisal may be arranged for doctors who are employed by other trusts or Universities. A lead employer will be identified with an appraisal lead from that organisation. A representative appraiser from the other organisations can be invited following discussion with and agreement between all parties.

5.4 Management of constraints, conflict of interest and doctors Subject to performance management measures

To avoid collusion and ensure objectivity in appraisal a number of constraint rules will apply in guiding the allocation of appraiser:

• no doctor will be appraised by the same appraiser for more than three consecutive years and must then have a period of at least three years before being appraised again by the same appraiser
• in any five-year cycle, a doctor will have a minimum of two different appraisers
• an allocated pairing of a doctor with an appraiser should normally be for three consecutive appraisals
• a doctor should not act as appraiser to a doctor who has acted as their appraiser within the previous five years. Similarly, a doctor who has entered the trust appraisal process from a training programme should not be allocated their educational or clinical supervisor as their appraiser for the first three years after exiting training

The NHS England medical appraisal policy allows flexibility to extend the allocation to additional appraisals provided the reasons are documented. While there should be a clear reason for extending the allocation of an appraiser this should be more than simple personal preference. Examples are varied but may include where:

• the additional appraisal will allow the doctor and their appraiser to conclude a complex issue
• maintaining the doctor-appraiser connection will support retention of a doctor in the workforce
• the additional appraisal will be the last before revalidation and it is judged that maintaining the allocation will help this to proceed smoothly
• the additional appraisal is the last appraisal before the doctor retires
• the doctor is returning from abroad and it will be helpful for their next appraisal to be with an appraiser who knows them even if this takes them beyond the third appraisal.

Extending to additional appraisals will normally be by mutual agreement between the doctor, their appraiser and the responsible officer, within the terms of what is described in the NHS England medical appraisal policy about appraiser allocation.

The appraiser should record in the appraisal documentation that the appraisal is in addition to the normal allocation of three, describe the reason for this and confirm that approval has been given by the responsible officer via their team.

Notwithstanding this flexibility, a doctor is expected to have at least two appraisers in each revalidation cycle, to demonstrate objectivity within the process.

Where there are concerns expressed on given appraisal pairings in any one year, a final decision on appropriateness of the pairing will be taken by the medical director or responsible officer and recorded.

The nature, conduct and frequency of annual appraisal for doctors that are currently subject to investigation and, or disciplinary action following health, conduct and, or clinical performance concerns that have been raised (including any doctors on restricted duties, excluded by the trust or suspended by the General Medical Council) will be decided on an individual basis by the responsible officer. The responsible officer will be responsible for keeping an accurate record of these decisions for future reference by either employer or the doctor concerned.

5.5 When an appraisal interview should be adjourned

Where it becomes apparent during the appraisal process that there is a potentially serious performance, health or conduct issue (not previously identified through clinical governance processes or other means) that requires further discussion or investigation, the appraisal meeting must be stopped. The matter must be referred by the appraiser immediately to the responsible officer to take appropriate action. The responsible officer will discuss with human resources about the applicability of maintaining high professional standards and relevant trust policies and guidelines. Performance issues should be dealt with as they arise and should not be held in abeyance pending the appraisal process.

5.6 Completion of appraisal

Following completion of the appraisal discussion, the appraisal summary (including an agreed personal development plan for the forthcoming year) will be signed by both parties within 28 days. The signed appraisal document will be made available to the responsible officer. The date of the signed appraisal summary will be regarded as the date of completion of the annual appraisal. Any late sign off will be recorded with reasons and, where necessary, investigated.

A completed satisfactory appraisal is where the appraisal meeting occurs between 9 and 15 months since the previous appraisal meeting and sign off within 28 days of the appraisal discussion, with the appraisal meeting taking place in the relevant appraisal year (1 April to 31 March).

Definitions of completed medical appraisal, approved incomplete or missed appraisal and unapproved incomplete or missed appraisal are provided in NHS England medical appraisal policy version 2 April 2015.

Any doctor failing to provide a satisfactory portfolio of supporting information or failing to attend their appraisal discussion within 28 days of their scheduled appraisal without prior agreement may be considered as failing to engage, and the responsible officer will be informed.

5.7 Disagreement with the content or outcomes in appraisal

Where there is disagreement on the wording of the appraisal content or feedback or scoring by the appraiser or within the personal development plan, which cannot be resolved between appraiser and appraisee, this should be recorded and advice should be sought from the responsible officer who will consult with that appraiser, appraisee and any other individual that they think appropriate before reaching a decision on the most appropriate way forward.

Where the doctor continues to disagree with the content of the appraisal, and, or the process that has been followed, and, or satisfactory completion of appraisal documentation such that satisfactory completion of appraisal cannot be confirmed then they will be advised of his or her right to raise their concern formally in accordance with the grievance procedure.

It is envisaged that with the application of these appraisal processes there will be a greater understanding of the outcomes of appraisal and any such “differences of opinion” can be assessed through structured evaluation of the process.

5.8 Multi source feedback (MSF)

All of the trusts medical staff are required to use the Royal College 360-degree appraisal system which currently takes place once every 3 years. New starters will be enrolled after 6 months in post. There is an expectation that this is completed in a timely manner. For doctors who are not psychiatrists, the responsible officer will provide access to an equivalent system.

6 Training implications

All employed consultants, staff grade and associate specialist doctors and other trust employed doctors will need to be up-to-date with staff induction and mandatory training including generic training on appraisal and the operation of the trusts’ appraisal scheme specifically.

The trust will provide a structured programme of training for all of its doctors comprising:

• generic training of appraisal and revalidation for all appraisees (ad hoc)
• training on the appraisal system with all appraisees, where appropriate
• appraiser training with all existing and proposed appraisers

7 Monitoring arrangements

This policy has specific internal linkages to a number of existing organisational strategies, policies and procedures to ensure that appraisal systems locally are integrated fully and appropriately and are listed in section 9. The overall monitoring and quality assurance in relation to the delivery of appraisal and revalidation will be of primary importance.

The internal quality assurance (QA) of appraisal comprises:

• assurance of the process
• assurance of the work of appraisers
• assurance sampling of appraisal information carried out by the responsible officer

7.1 Assurance of the process

Assurance of the process will be carried out as part of the annual report to the board of directors produced by the responsible officer.

Regular review of the appraisal system, policy and supporting guidance will be undertaken each year. The review will follow the annual NHS England return and in addition there will be regular formal feedback from both appraisers and appraisees on the management of the appraisal system as a whole. For appraisees this will be achieved through the use of the routine appraisee feedback questionnaire within the trust appraisal system. Appraisers will be asked for feedback as part of their annual review process.

7.2 Assurance of the work of appraisers

Quality assurance of appraiser work is delivered through:

• recruitment and selection, through the responsible officer
• review of probationary appraiser performance after their initial three appraisals, through mandatory appraisee feedback
• review of established appraisers’ performance through regular feedback questionnaires from appraisees to ensure the appraiser remains suitable to continue in the role
• annual appraiser review, using analysis of summary of discussion completion or personal development plans produced, and other relevant appraisal information conducted by the responsible officer on an annual basis
• annual appraiser updates (formal group training and appraiser support)
• appraisers should bring their role of appraiser to their own annual appraisal and manage any development needs through their own personal development plan

External assurance of appraisal systems will be undertaken as and when agreement is reached nationally on mechanisms for conducting this in line with relevant regulations and inspectorate responsibilities.

7.3 Unsatisfactory appraisal

Guidance is given in the appraisal system on what is considered to be essential and optional documentation that should be detailed in the portfolio.

If any part of the essential documentation is not identified in a portfolio (unless a satisfactory explanation can be offered by the appraisee) then this must be brought to the attention of the appraisee prior to the appraisal meeting. This should provide an opportunity for the appraisee to produce the relevant piece of information. If the information is not forthcoming and there is no satisfactory explanation offered, then the appraisal meeting should not go ahead, and the responsible officer should be informed.

An unsatisfactory outcome of appraisal may also arise from:

• failure to address issues that have been previously raised about clinical performance or personal behaviour
• the appraiser’s judgement that there is inadequate evidence in any section of the appraisal domains
• failure to complete the previous years personal development plan without adequate explanation.

Part of the developmental approach to appraisal should be in supporting the appraisee in improving the quality of evidence year on year in the appraisal portfolio. It is only when there has been a clear failure to respond to actions outlined in previous appraisal discussions and, or responsible officer specific information for inclusion could be considered as being unsatisfactory. If the issues cannot be resolved with the appraisee then the matter should be referred to the responsible officer.

7.4 Complaints arising from the appraisal process

Complaints and grievances arising from the appraisal process should be addressed in the first instance to the responsible officer, or, if they concern the responsible officer, to the chief executive.

Receipt of complaints will be acknowledged within seven days. Complaints will be investigated and where possible resolved by the recipient within twenty eight days. A written reply will be provided to the complainant at this time.

Complaints and grievances may be discussed with the director of people and organisational development, with the agreement of the complainant, if necessary to determine the best course of action or to assure the complainant of the integrity of the process.

Complainants who remain dissatisfied with the outcome may utilise the trusts grievance procedure.

An anonymised report of complaints will be included in the annual report.

8 Equality impact assessment screening

This policy applies to all doctors (excluding training grade doctors) employed by the trust, irrespective of age, race, colour, religion, disability, nationality, ethnic origin, gender, sexual orientation or marital status, domestic circumstances, social and employment status, HIV status, gender reassignment, political affiliation or trade union membership.

All employees will be treated in a fair and equitable manner and reasonable adjustments will be made where appropriate.

The trust will ensure that this policy and procedure is monitored and evaluated on a regular basis by the People Sub Committee with information on key aspects being submitted to the board of directors.

The equality impact assessment screening is held in appendix C.

9 Links to any other associated documents

• Clinical governance policy.
• Handling of formal complaints procedure.
• Raising concerns.
• Policy for the management of serious incidents.
• Maintaining high professional standards (2005).
• Clinical excellence award procedures.
• Sickness and absence management process.
• Positive management of stress.
• Grievance procedure.
• Medical appraisal policy NHS England Version 2 April 2015.
• Responding to concerns.
• General Medical Council (2013) The good medical practice framework for appraisal and revalidation.
• General Medical Council (2013) Supporting information for appraisal and revalidation, latest version 2018.
• A guide to consultant job planning (2011) British Medical Association, NHS Employers.
• Medical profession (responsible officers) regulations (2010) and the Medical profession (responsible officers) (amendment) regulations (2013).
• Medical appraisal guide 2022, Academy of Medical Royal Colleges.
• Fair to Refer (2019), General Medical Council.

10 Appendices

10.1 Appendix A competency framework for appraisers

The core appraiser competencies can be summarised as follows:

10.1.1 Professional responsibility

Competency: high standards of professional responsibility, personal Integrity, effectiveness, and self awareness

Behaviour:

• maintains high professional credibility
• acts as a champion and role model for appraisal and revalidation
• demonstrates insight and self awareness
• reflects on feedback
• declares conflicts of interest

Competency: develops professional competence as an appraiser

Behaviour:

• undertakes appropriate development in all professional roles including as an appraiser, reflecting development needs in their personal development plan
• supports efforts to evaluate and improve local systems and processes

10.1.2 Knowledge and understanding

Competency: understands the purpose of appraisal and revalidation, and the role of appraisal in revalidation

Behaviour:

• demonstrates understanding of the purpose of appraisal and revalidation
• explains the difference between processes of appraisal, revalidation and performance management

Competency: understands the role and responsibilities of the appraiser

Behaviour: undertakes appropriate roles and responsibilities of appraiser.

Competency: understands healthcare organisations and quality and safety systems and relates this to the context within which the appraisee is working

Behaviour:

• applies knowledge of quality and safety systems to appraisal
• adapts approach to the work context of the appraisee

Competency: understands relevant legislation and guidance in areas including equality and diversity, bullying and harassment, data protection and confidentiality

Behaviour:

• maintains knowledge of relevant policies and legislative frameworks and applies the principles in practice
• demonstrates fairness and equality and makes allowance for differing backgrounds
• deals with confidential data in accordance with data protection policies and guidelines

Competency: understands the principles of adult education sufficiently to inform the appraisal discussion and the design of professional development objectives

Behaviour:

• demonstrates a learner-centred approach to the appraisee’s personal and professional development.
• understands and supports the role of professional development in quality improvement
• facilitates reflection
• facilitates reflection on patient and colleague feedback

Competency: understands the relevant specialty specific context and portfolio requirements

Behaviour: demonstrates awareness of specialty specific requirements.

10.1.3 Professional judgement

Competency: maintains and applies skills in evaluating the portfolio of supporting information

Behaviour:

• applies General Medical Council standards and specialty specific guidance appropriately
• demonstrates ability to evaluate the quality of supporting information

Competency: ability to judge whether the supporting information shows that the appraisee is on track to revalidate

Behaviour:

• makes judgements about the accumulating quantity and quality of supporting information presented at different stages of the revalidation cycle
• demonstrates ability to support the doctor in developing an appropriate revalidation portfolio which relates to the full scope of the doctors practice

Competency: ability to judge whether there is a patient safety issue or emerging performance concern

Behaviour:

• is alert for early signs of emerging performance, conduct or health concerns and responds appropriately.
• identifies patient safety issues and responds appropriately
• demonstrates the ability to suspend the appraisal process where necessary and take appropriate further actions

Competency: ability to judge whether the appraisee has appropriately engaged in the appraisal process and the review of their whole practice

Behaviour:

• makes appropriate judgements about the participation of the appraisee in appraisal
• promotes reflection on and in practice
• communicates concerns about the appraisee’s participation in the appraisal process to the appraisee appropriately
• communicates concerns to the responsible officer (or an appropriate deputy) appropriately

Competency: ability to evaluate achievement of the previous years personal development plan objectives and confirm that the current personal development plan is appropriate following the appraisal discussion

Behaviour:

• reviews outstanding items in previous personal development plans with the appraisee
• ensures that the new personal development plan addresses the doctor’s development priorities arising from the appraisal and gaps in the accumulating portfolio

10.1.4 Communication skills

Competency: ability to manage an effective appraisal discussion

Behaviour:

• prepares effectively for the appraisal discussion
• sets the context and agrees the priorities for the appraisal discussion
• demonstrates the ability to facilitate a well-structured and focused appraisal discussion that is centred on the appraisee’s needs
• demonstrates appropriate time keeping within the appraisal discussion

Competency: develop, maintain, and apply good communication skills

Behaviour:

• builds rapport
• employs active listening, questioning and summarising
• provides effective feedback and constructive challenge
• demonstrates good verbal and written communication skills

Competency: ability to manage a difficult appraisal

Behaviour:

• understands the factors that might contribute to a difficult appraisal.
• demonstrates a range of strategies in managing a difficult appraisal

Competency: ability to produce high quality written appraisal records and outputs

Behaviour: completes appraisal documentation to a high standard.

10.1.5 Organisational skills

Competency: management of time, workload and prioritisation

Behaviour:

• completes appraisal caseload and documentation in a timely manner
• responds in a timely way to appraisees, managerial staff and the responsible officer (or their deputy)

Competency: familiarity with computerised support systems for appraisal and revalidation

Behaviour: demonstrates effective use of computerised support systems for appraisal and revalidation.

Competency: sufficient information technology skills to perform the role of appraiser

Behaviour: demonstrates sufficient information technology skills to perform the role of appraiser.

10.2 Appendix B exception audit, missed or incomplete appraisals

Refer to appendix B: exception audit, missed or incomplete appraisals (staff access only).

10.3 Appendix C equality impact assessment template

Refer to appendix C: equality impact assessment template (staff access only).

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Document control

• Version: 1.
• Unique reference number: 1108.
• Approved by: people and teams group.
• Date approved: 10 June 2025.
• Name of originator or author: revalidation appraisal and support officer.
• Name of responsible individual: director of people and organisational development.
• Date issued: 29 July 2025.
• Review date: 31 July 2028.
• Target audience: all medical staff, medical human resources staff, clinical governance staff and anyone else involved in medical appraisal.

Page last reviewed: August 13, 2025
Next review due: August 13, 2026

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