General Note
NHS Fife acknowledges and agrees with the importance of regular and timely review of policy/procedure statements and aims to review policies within the timescales set out.
New policies/procedures will be subject to a review date of no more than 1 year from the date of first issue.
Reviewed policies/procedures will have a review date set that is relevant to the content (advised by the author) but will be no longer than 3 years.
If a policy/procedure is past its review date then the content will remain extant until such time as the policy/procedure review is complete and the new version published, or there are national policy or legislative changes.
1. FUNCTION
1.1 Licensed doctors are required by the GMC to revalidate their license to practice every five years and this process is based on comprehensive appraisals undertaken over that five-year period.
1.2 The annual appraisal process is designed to allow doctors to reflect on their practice and to improve the quality of patient care they provide by ensuring that licensed doctors remain up to date and continue to be fit to practise.
1.3 This procedure document states NHS Fife’s requirements and the approach to appraisal for revalidation to ensure that licensed doctors remain up to date and fit to practise. It is also to support all those involved with appraisals of medical staff.
1.4 This procedure is not exhaustive and is not intended to contain information on all aspects of appraisal and revalidation.
2. LOCATION
2.1 This policy applies to all non-training grade medical and dental staff (GPs, Consultants, Specialty Doctors, Associate Specialists, Salaried GPs, Clinical Fellows and any other non-training grades) contracted by NHS Fife (this includes locums, substantive employees, linked i.e. with honorary contracts / joint contracts or employed temporarily) irrespective of age, disability, race, colour, nationality, ethnic origin, religion, gender, sexual orientation or marital status, domestic circumstances, social and employment status, HIV status, gender reassignment, political affiliation or trade union membership.
2.2 NHS Fife will make arrangements for seamless appraisal for any doctors who have been on maternity leave in any five-year period, and for any doctors who have had a break in service, as appropriate.
3. RESPONSIBILITY
3.1 Revalidation of Doctors in Training
3.1.1 The respective Deanery / NES are responsible for the revalidation of doctors in training.
3.2 Responsible Officers
3.2.1 Within NHS Fife the Responsible Officer (RO) is the Executive Medical Director of the NHS Board.
3.2.2 The Deputy Responsible Officers (DRO) are the Associate Medical Director – Acute Services Division and the Associate Medical Director – Health & Social Care Partnership.
3.2.3 When a medical practitioner is subject to conditions imposed by, or undertakings agreed with, the GMC, the RO will monitor compliance with those conditions or undertakings.
3.2.4 The RO is responsible for ensuring that a robust appraisal system is in place.
3.3 GP Appraisal Adviser
The GP Adviser:
3.3.1 Is the first line of enquiry for local GPs on the appraisal process and links with Revalidation.
3.3.2 Is the first line of enquiry for issues that arise locally between GP appraisers and their appraisees and who provides support for appraisers in their role.
3.3.3 Ensures that local appraisers effectively carry out the responsibilities expected of a GP appraiser.
3.3.4 Conducts an annual meeting with each local GP appraiser to give feedback on their performance as an appraiser and to identify any development needs.
3.3.5 Co-ordinates training initiatives in the local area related to GP appraisal.
3.3.6 Produces a report for the NHS Board Medical Director (RO) and the Director of Medical Education from the anonymised summary of the appraisals conducted by local appraisers in the preceding year.
3.3.7 Reports to NES on progress with appraisal in the local area.
3.3.8 Attends regular meetings with Local Appraisal Advisers in Scotland.
3.4 Appraisers
3.4.1 Appraisers will be appointed by the Appraisal Lead on behalf of the Medical Directors, Associate Medical Directors, Director of Public Health, or Clinical Directors, in line with the numbers of appraisals that are required:
3.4.2 They will adhere to NHS Fife’s Medical Revalidation and Appraisal Policy and Procedure:
3.4.3 NHS Fife Appraisers will:
- Have the agreed time allocated within their job plan to undertake appraisals.
- Organise all their appraisals within the appraisal timeframe.
- Review appraisal documentation and evidence one month before the appraisal interview takes place, identifying key areas for discussion.
- Ensure all paperwork is processed as required on completion of the appraisal interview, including the signing off of the Form 4/PDP by both parties.
- Report via Form 4s on the outcome of appraisals to the Responsible Officer and on progress with appraisals via their respective Medical Director, Associate Medical Director, Director of Public Health, Clinical Director or Local Appraisal Adviser.
- Undertake appraisal training and attend period updates as required.
- Take part in a performance review of the appraisal process, including feedback on performance in their role.
- Ensure their statutory and mandatory periodic training is up to date.
3.4.4 If an Appraiser has concerns about the fitness to practice of the doctor that they must stop the appraisal and inform the RO.
3.4.5 NHS Fife Appraisers will receive appropriate accredited NES training and support to undertake their role.
3.5 Appraisees
3.5.1 Are responsible for making sure that they are aligned to an RO. For direct employees and independent contractors of NHS Fife, the Executive Board Medical Director is the RO.
3.5.2 Are responsible for ensuring that they participate in the annual appraisal cycle to meet the requirements of revalidation.
3.5.3 Are required to maintain a professional portfolio including feedback from each of their employers (whole practice review) including the independent sector, records of their training, reflective practice and additional documentation as specified by the GMC. This evidence must be available to their appraiser one month before the date of the appraisal.
3.5.4 Doctors who are subject to professional performance, capability, disciplinary or remediation procedures should continue to have an annual appraisal. The appraisal will be used to support the individual and their PDP should reflect the training and development needs identified.
3.6 The Medical Appraisal and Revalidation Co-ordinator
3.6.1 Co-ordinate and provide administrative support to the appraisal and revalidation process.
3.6.2 Maintain the records / electronic data system and ensure that the systems in place are held securely.
3.6.3 Undertake regular quality control checks to ensure the appraisal documentation submitted meets the agreed standards.
3.6.4 Maintain a database of trained Appraisers to identify and ensure that there are sufficient numbers to meet the needs of the Medical Workforce and allocate trained Appraisers to the appropriate level of doctor to be appraised.
3.7 Medical Appraisal and Revalidation Group (MARG)
Membership is as follows:
- Medical Director / RO, NHS Fife (Chair)
- Associate Medical Director, Acute Services Division (DRO)
- Associate Medical Director, Health & Social Care Partnership (DRO)
- Director of Public Health
- GP Appraisal Lead
- Secondary Care Appraisal Lead
- Primary Care Manager
- Head of Human Resources
- Business Manager to the Medical Director
- Clinical Directors, Acute Services Division and Health & Social Care Partnership
- Medical Appraisal and Revalidation Co-ordinator
- BMA Representation
The Medical Appraisal and Revalidation Group are responsible for:
3.7.1 Overseeing the arrangements for Medical Appraisal and Revalidation for all GPs, Consultants, SAS Doctors and any other Non-Training Grade posts across NHS Fife.
3.7.2 Updating the Medical Appraisal to support Revalidation Policy.
3.7.3 Overseeing the quality assurance of the appraisal and revalidation process and its outcomes.
3.7.4 Providing assurance to the Fife NHS Board against the GMC and Royal College guidance on appraisal and revalidation by way of an annual report.
3.7.5 Overseeing the selection, allocation and training of appraisers.
4. OPERATIONAL SYSTEM
4.1 Medical Appraisal
4.1.1 Medical Appraisal differs fundamentally from Appraisal in other settings due to its elemental link with external profession regulation and revalidation.
4.1.2 Medical Appraisals are based on a Doctor’s performance and in compliance with the General Medical Council’s Guidance:
The areas covered by Appraisal are:
- Improvement activity
- CPD
- Feedback from patients
- Feedback from colleagues
- Complaints, clinical incidents and significant events
- Probity
- Health
4.2 Appraisal Protocol
4.2.1 The Appraisal process comprises of five elements:
- Preparatory work and information gathering by both appraiser and appraisee in secondary care and by the appraisee only in primary care. Appraisals for revalidation are made up of a review of the whole practice of the individual; and therefore appraisees must provide information from all organisations that employ them, where applicable, including private practice.
- Appraisal discussion including a review of the previous year’s PDP.
- Notification and return of papers and agreement of a new PDP going forward.
- Reporting by issue of a completed Form 4 signed off by both parties within 28 days of the appraisal meeting.
- Feedback from appraiser and appraisee.
4.3 The Appraisal Cycle
4.3.1 In Primary Care, the appraisal process occurs throughout the year. Each GP usually has their appraisal annually on the anniversary of their date of commencement within the NHS Fife Board area.
4.3.2 Within Secondary Care, the appraisal cycle will run on an annual basis and the following flowchart sets out the process to be followed by individual members of medical staff.
ANNUAL APPRAISAL CYCLE FOR APPRAISEE WITHIN SECONDARY CARE
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Preparation |
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Appraisal / Personal Development planning |
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Recording / Personal Development |
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4.4 SELECTION, TRAINING, RETENTION, REVIEW AND REMUNERATION OF APPRAISERS
4.4.1 Selection of Appraisers
- In Primary Care, the Primary Care Manager’s Department invites GP Principles and Host Locums to apply for the post(s) of part time Appraiser as and when vacancies arise. An interview panel comprising Associate Medical Director, H&SCP, GP Appraisal Adviser and Primary Care Manager recruit appraisers. Prior to undertaking appraisals, appraisers are sent on NES training. On completion of the training the appraiser is then allocated appraisees by the Primary Care Manager’s Department. Details of the allocation are recorded on SOAR.
- In Secondary Care, an advert seeking trained medical staff to become appraisers is issued on an adhoc basis. Successful appraisers must participate in accredited NES training and are then allocated appraisees by the Medical Appraisal & Revalidation Coordinator. Appraisers are trained by NES to conduct cross specialty appraisals and may be allocated appraises from any specialty. Specific time is allocated within job plans to support this.
- The offices of the Primary Care Manager and Directorate Manager to AMD – Acute Services Division will maintain a list of approved appraisers which is filed in the “T” drive under “Medical Appraisal – NHS Fife”.
4.4.2 Training of Appraisers
- National Education Scotland (NES) provides training for appraisers.
- In order that appraisal is delivered to a uniform high standard across the country all appraisers must attend the NES National Appraiser training scheme and are expected to attend any subsequent meetings.
- NES have been providing such training for GP appraisers for a number of years.
- In addition to the initial training, appraisers are required to attend ongoing training as appraisal develops.
4.4.3 Retention of Appraisers
- When there is a GP Appraiser vacancy, the Primary Care Manager’s office sends out a letter of invite to all Principal GPs and Host Locums. Candidates are interviewed by the Associate Medical Director, H&SCP, GP Appraisal Adviser and Primary Care Manager. Following appointment, appraisers are asked to go on NES training before being allocated any appraisees.
- When there are insufficient Appraisers within Secondary Care, an advert is issued seeking trained medical staff to become appraisers. The content of adverts is agreed via the Medical Appraisal and Revalidation Group.
- Interested parties must be approved by the Appraisal Lead and their Clinical Lead / Clinical Director, to ensure they will have a review of their job plan in terms of time to be allocated for appraisal, before being asked to submit a training form to NES who then allocate a training slot.
4.4.4 Review of Appraisers Performance
- Feedback from appraisees is sent to appraisers and discussed when appropriate.
4.4.5 Remuneration of Appraisers
- In Primary Care, NHS Fife currently employs the appraisers and allows one session per week to provide 18 appraisals per annum
- In Secondary Care each appraiser has identified protected time within his/her job plan to fulfil the required responsibilities. This is 0.5 PA (2 hours) per week for undertaking up to a maximum of 10 appraisals per annum.
5. RISK MANAGEMENT
5.1 NHS Fife will ensure that effective and supported systems of clinical governance arrangements are available to enable doctors’ continuous professional development. Doctors will be able to monitor their practice through performance information, including clinical indicators relating to patient outcomes and through feedback from patients and colleagues, etc.
5.2 Doctors in Difficulty
5.2.1 In the event that the appraisal process indicates that a doctor is “in difficulty”, the appraiser must escalate this to the relevant Medical Director, Associate Medical Director, Director of Public Health or Clinical Director without delay, who will deal with the issues in accordance with NHS Fife’s current arrangements and Remediation Policy.
5.2.2 However, NHS Fife needs to deal with performance issues as they arise, and not to wait until the appraisal. It may be appropriate to delay an appraisal under such circumstances, but a doctor’s appraisal for revalidation has to take place annually within the financial year. Arrangements should be made as quickly as possible for the appraisal to be rescheduled. Where this is not possible records relating to the delayed appraisal, (including the reason for delay), must be kept and timescales clearly documented.
5.3 Quality Assurance for Appraisals and Revalidation
5.3.1 The responsibility for development, implementation and operation of the system of Medical Appraisal is discharged through the Medical Appraisal and Revalidation Group which is chaired by the Medical Director / Responsible Officer, NHS Fife.
5.3.2 The quality of appraisals and revalidation will also be assured through regular reports to the Medical Appraisal and Revalidation Group.
5.3.3 The Local Appraisal Adviser within Primary Care meets with each appraiser for a performance appraisal on an annual basis, starting twelve months after the appraiser has been undertaking the role. The General Practitioner Appraisers group meets three times per year at which appraisers can exchange ideas and discuss scenarios from their own experiences and from cases provided. GP Appraisers also attend the yearly national conference which is run by NES.
5.3.4 Primary Care also has a Local Appraisal Group which meets once a year. Its remit is to oversee the GP appraisal process. Membership comprises, Associate Medical Director, H&SCP, GP Appraisal Adviser, Primary Care Manager, Local Medical Committee and Clinical Health Partnership Clinical Director.
5.3.5 Appraiser drop in sessions are held bi monthly and are chaired by either the Associate Medical Director, H&SCP or Associate Medical Director, Acute Services Division. The purpose of these drop-in sessions is to ensure that all are up to date and to share best practice.
5.3.6 Both General Practitioner Appraisal Adviser and the Secondary Care Appraisal Lead provide feedback to the Responsible Officer.
The tool for:
5.3.7 Report to Committees of the Board are to provide assurance on progress provided by MARG.
5.3.8 Medical Revalidation: Assessing Readiness in Scotland Self Assessment Tool is submitted to NHS Health Improvement Scotland on an annual basis (July of each year).
5.3.9 NHS Fife Board also receives an annual report in July of each year, based on NHS Health Improvement Scotland’s (HIS) Medical Revalidation: Assessing Readiness in Scotland Self Assessment Tool.
5.4 Records and Confidentiality
5.4.1 The details of discussions during the appraisal interview will be considered as confidential to the appraisee and appraiser. However, within the context of appraisal for revalidation, the appraiser will be reporting to the Responsible Officer on the progress with their appraisals. The appraiser will need to escalate any concerns about performance that arise during the appraisal discussion, in line with NHS Fife’s policy.
5.4.2 Both NHS Fife and the appraisee need to retain copies of the appraisal documentation over a five-year period. The appraisee should retain and add to their supporting documentation in an appraisal folder.
5.4.3 The Scottish On-Line Appraisal Resource (SOAR) is available to trained medical staff within Secondary Care. Use of this system will ensure copies of documentation are held securely. However paper or electronic presentation of appraisal documentation is still accepted within Secondary Care, but the intention is to move to an electronic web-based submission in the future.
5.4.4 The Responsible Officer has overall accountability for ensuring systems for appraisal are in place for all doctors for whom they are responsible and for securely holding copies of all relevant documentation.
6. RELATED SYSTEMS
6.1 Scottish On-Line Appraisal Resource (SOAR)
6.1.1 The Scottish On-Line Appraisal Resource (SOAR) is available to trained medical staff within both Primary and Secondary Care. This is NHS Fife’s preferred method of appraisal.
6.1.2 This database collects interview details such as date/location/appraiser, etc and is used to aid the appraisal process for all trained doctors within Primary and Secondary Care. It is maintained by Appraisers and Local Admin Teams.
6.1.3 Appraisees also access this database where they can upload and share/store supporting evidence material for their appraisals; as well as signing off the Online Form 4. The link to the database is: https://online.appraisal.nes.scot.nhs.uk/Login.aspx?ReturnUrl=%2
6.2 Feedback
6.2.1 NHS Fife will ensure that effective and supported systems of clinical governance arrangements are available to enable doctors’ continuous professional development. Doctors will be able to monitor their practice through performance information, including clinical indicators relating to patient outcomes and through feedback from patients and colleagues, etc.
6.3 Patient Feedback
6.3.1 It is a requirement of appraisal for revalidation that feedback is obtained (where doctors have direct patient contact) from patients at least once every 5 years.
6.3.2 If a doctor feels that he/she is unable to obtain patient feedback due to the patient group then they need to discuss with their Appraiser.
6.3.3 Feedback from patients will be collected using questionnaires that comply with GMC or other relevant guidance. The purpose of the feedback is to provide doctors with information about their work through the eyes of those they treat and it is intended to inform further development.
6.3.4 Doctors should receive questionnaire feedback prior to the appraisal to ensure time to consider and reflect upon it.
6.3.5 Questionnaires should be administered independently of the doctor and appraiser. The range of patients should reflect the doctor case mix. It is in the doctor’s interest to have as many completed responses as possible to ensure the feedback reflects the totality of their works.
6.3.6 In cases where there is no alternative, doctors can issue the questionnaire to patients but must not collect them directly.
6.3.7 It is recommended that a minimum of 25 completed patient questionnaires should be obtained in a 12-month period.
6.3.8 See Guidance on Use of Patient Questionnaire (Appendix 1)
6.4 Colleague Feedback (MSF)
6.4.1 It is also a requirement of appraisal for revalidation that feedback is obtained from work place colleagues at least once every 5 years using an MSF tool which complies with GMC guidance.
6.4.2 A questionnaire is available as a web resource and is free to use for doctors registered with the Scottish Online Appraisal Resource (SOAR).
6.4.3 If an appraisee does not wish to use SOAR to obtain colleague feedback then he/she can use the paper version of the GMC Colleague Questionnaire. However, if the appraisee does use this questionnaire then it is their responsibility to make arrangements for:
- Issue and collection of questionnaires;
- Analysis of the feedback
- Payment of any costs involved.
Completed questionnaires must to be returned to an independent third party. The appraisee will need to have a discussion and reach agreement with their appraiser on this, in advance, of any questionnaires being issued.
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