Appraisal and Revalidation in General Practice on the Isle of Man

An annual appraisal and supporting evidence are key to demonstrating your fitness to practise whatever your branch of practice. A medical appraisal is also a key opportunity to focus on your professional development needs.

A medical appraisal is a process of facilitated self-review supported by information gathered from the full scope of a doctor's work.

Medical appraisal can be used for a number of purposes, including:

To reflect on an individual's practice and performance with their appraiser in order to demonstrate that they remain up to date and fit to practise

To help doctors plan their professional development

To identify learning needs

To ensure doctors are working in line with the organisational priorities

The appraisal process is an important source for agreeing and monitoring personal development objectives.

Whilst it interacts with the job planning process, the two should be kept separate in order to mitigate any conflicts of interest.

The Appraisal process like General Practice is always developing and changing.

The Isle of Man appraisal team changed during 2016/17 with a new Appraisal Lead heading up the team and a new Administrator supporting. During 2017/18 new and robust systems have been put in place and include:

1. Appraiser workload monitoring
2. Quality Assurance development
3. New training/update resources
4. Annual Appraiser Feedback Meetings.

There is a growing and positive partnership between Primary Care and Secondary Care Appraisal Teams.

Regular meetings are held in the form of the Responsible Officer Support Group, where issues and challenges are discussed with the Suitable Person.

What is a suitable person?

A suitable person is a licensed doctor who we have approved as suitable to make a revalidation recommendation about a doctor's fitness to practise. A suitable person performs the same revalidation functions as a Responsible Officer and is responsible for:

• overseeing the evaluation of fitness to practise, and monitoring the conduct and performance of doctors
• ensuring that there are systems and processes in place locally to support doctors in their revalidation, such as annual appraisals
• Making recommendations to the GMC about the revalidation of doctors who have an approved connection to them.
• If we approve you as a suitable person, all our revalidation guidance and instructions for Responsible Officers will apply to you also.

Responsible Officers have an important, wider role in medical regulation, helping to make sure a doctor who has restrictions on their practice is appropriately and safely managed. Suitable Persons are not responsible for approving the work place arrangements which must be put in place for doctors with restrictions on their practice. This function is carried out by a person who has the necessary expertise, and who has agreed to undertake the role when a doctor does not have a connection to a Responsible Officer who would otherwise be required to make sure such arrangements are in place.

Why do we have ‘suitable persons’?

Most licensed doctors have a connection with a designated body. The Responsible Officer of this designated body will make a recommendation to us that the doctor is up to date, fit to practise and should be revalidated. However, under the current Responsible Officer regulations, because we are based on the Isle of Man some doctors do not have a connection.  Revalidation regulations, allow us to accept recommendations for doctors made by suitable persons on behalf of doctors who do not have a Responsible Officer. This will allow some doctors who do not currently have a connection to engage in local systems and revalidate.

Who is the suitable person on the Isle of Man?

Dr John Snelling

As Responsible officer is professionally responsible for all the doctors on the Isle of Man. The main objectives of his role are to improve patient safety and maintain the highest quality of care for the people of Isle of Man, along with enabling the development of a joined up integrated health and social care system.

Dr John Snelling FRCGP, Lead Appraiser

Dr Snelling is a GP in Peel, although he also works for the DHSC in other leadership roles (he is Clinical Lead for MEDS and Mental Health Services).

He has been an appraiser in the UK since the appraisal development process began in the 1990s, and was an appraisal lead in the Midlands for several years.

He has been GP Appraisal Lead for the island since 2016. Dr Snelling says

'Appraisal, for me, is all about encouraging and enthusing colleagues to achieve their potential. Done properly, appraisal can help GPs manage workload, develop best practice, learn effectively, and manage change well. Perhaps more importantly than any of those things, good appraisal is an unthreatening, protected, confidential environment where GPs can take a step back and put their practice into perspective.'

Dr Snelling is happy to answer any questions or challenges you have with the appraisal process.

He can be contacted via the appraisal administrator, or by email on john.snelling@gov.im

Isle of Man Appraisers for General Practice:

This section will support you as you prepare for your appraisal. It is important to remember that the appraisee and the appraiser both have to prepare for an appraisal meeting. Your appraisal must be submitted at least 2 weeks prior to the agreed meeting date. 

When preparing for your appraisal it is recommended that:

• You Keep It Short and Simple Appraisal preparation should not be time consuming, but does need to meet the requirements of the General Medical Council (GMC)

• You get your appraisal date booked in your appraisal month at least 3 months before the due date – this will give you something to work towards rather than rushing at the last minute.

• It should be personal to you and about your work. If you keep a learning log throughout the year then preparation before your appraisal may take less than a couple of hours.

• The evidence and supporting information that you present should be lean and meaningful, and work related.

• Reflections are essential – required by the GMC and Royal College of General Practitioner (RCGP) Review your last Personal Development Plan (PDP) and reflect on achievements.

• If you have recently completed the Vocational Training Scheme (VTS) then use the plan you established with your trainer at your final review.

 Things to include in your appraisal:

• Continuing professional Development (CPD) – with brief reflections (the RCGP benchmark is 50 hours) – what (if anything) was learned, and how it has been applied to practice. If you have significantly less CPD for a good reason e.g. maternity or sick leave, point this out to your appraiser.

• Learning log - consider keeping this on a simple word document, recording brief reflections and updating every couple of weeks.

• Quality Improvement – you only need one good piece per year – e.g. a reflective case review, or an audit with reflections.

• Don’t forget everyday quality activities (meetings, reviewing prescribing data, planning) will do, so long as they are accompanied by reflection, so keeping a log, a bit like for CPD, works for some doctors.

• A note of any complaints (whether or not resolved) with reflections, and any compliments

• Any patient or colleague feedback.  – This can include thank you cards and letters.

• Full MSF and PSQ are needed at least once every 5 years, with reflections. This needs to be administered independently from your practice.  Any GMC-approved feedback tool will do this for you, Here on the Isle of Man the tool on Clarity or Fourteen Fish if you are using their platform are both approved. Please check with the appraisal administrator first if you are thinking of using anything else.

• All Significant Events (that meet the GMC threshold - i.e. did or could have caused harm) (if any) with reflections

• Achievements, Challenges and Aspirations – reflect back on the year, and look forward to where you might want to be developing. Spend time on this one – it is your chance to emphasise what is important to you.

Finally Remember, The most important part of appraisal process should be the meeting and discussion with your appraiser. It is your one chance in the year to be able to talk about you and your work with a colleague who will listen to you and help you reflect on the quality of your work and where your career is going. It should be supportive and constructive, and this is made much more likely if you have prepared well, with meaningful and relevant supporting information. If you have any queries or concerns contact your appraiser, the appraisal lead or the appraisal administrator.

The Importance of Quality Assurance in Appraisal

On the Isle of Man we want to ensure that all of our Doctors receive a good quality appraisal, there is a standardised Quality Assurance (QA) policy within the general DHSC Appraisal Policy. In General Practice we have a robust QA strategy for appraisal. The appraisers meet at least twice each year to reflect and be updated on appraisal skills; Quality Assurance discussions take place each time. Each appraiser also meets with the appraisal lead annually to discuss the quality of their appraisals. These meetings are structured around the Agreed Appraisal Summary Guidelines.

General Practice is known to be one of the most stressful occupations.

There are various support mechanisms in place for GPs who are struggling with workload, and personal physical or mental health issues.

The Department is very understanding of this, and wants to support GPs at an early stage, before their work becomes affected by any of these things.

• Initially please do speak to your appraiser, if you feel able to do so
• All GPs should be registered with a GP of their own, who should not be in your own practice; if you feel able, they are your best local ‘first step’.

But it is well-recognised that sometimes GPs may need a more                    confidential level of support.

• In this Instance please contact Annmarie Cubbon, Manager, Primary Care Commissioned Services. Annemarie.cubbon@gov.im  or Dr John Snelling, Appraisal Lead, who will both be happy to give confidential advice about services that can be put in place locally and discreetly.

The following are also reliable independent sources of support:

• Occupational Health Service

Department of Health and Social Care, Garaghyn Glass Strang Braddan Isle of Man IM4 4RJ 642150, Occupationalhealth.dhsc@gov.im 

A link to Self-referral - /lib/docs/hr/Forms/selfreferralform.pdf

• Island GPs can now access the NHS GP Support Service – a comprehensive and entirely confidential service set up recently by NHS England – see https://www.england.nhs.uk/gp/gpfv/workforce/retaining-the-current-medical-workforce/health-service/ Funding for this is assessed for this on a case by case basis, if you feel you will benefit from this service please contact Annemarie.cubbon@gov.im

Full Multi Source Feedback and PSQ are needed at least once every 5 years, with reflections. This needs to be administered independently from your practice. On the Isle of Man we support the tool on Clarity or Fourteen Fish. However Any GMC-approved feedback tool can be used though please check with the appraisal administrator first if you are thinking of using a different tool.

Revalidation is the process by which doctors demonstrate they are up to date and fit to practise. Appraisal is a major resource in ensuring that GP’s achieve a successful revalidation.

Any Doctor with a licence to practice is legally required to revalidate, usually every five years, by having a regular appraisal based on The GMC core guidance for doctors.

When a Doctor successfully revalidates, this means they continue to hold a licence to practise. Revalidation aims to give your patients greater confidence that you are up to date in General Practice.

Getting Ready for Revalidation

• Have a regular appraisal
• Collect your supporting information for appraisal
• Set up your GMC online account
• Know your Designated Body and Suitable Person/Responsible Officer 

If you need extra support preparing for revalidation, your appraiser or Lead Appraiser will be able to assist you.

General Practice Appraisers are invited to attend any of the following local training/support groups.

If you require any further information please contact GP Appraisal Administrator Claire.newall2@gov.im

Approved Appraisal Toolkits for General Practice on the Isle of Man: