2. Appraisal organisation and documentation March 2019

• 2.1. Myth: I must use a portfolio defined by my responsible officer to revalidate
• 2.2. Myth: My appraisal portfolio is entirely confidential
• 2.3 Myth: I do not need to provide examples of my reflective practice in my portfolio as long as I bring them to my appraisal
• 2.4. Myth: My appraiser has the choice of appraisal venue
• 2.5. Myth: I should do my appraisal outside working hours
• 2.6. Myth: My appraisal has to be face to face
• 2.7. Myth: I am only allowed to have three appraisals with the same appraiser (England)
• 2.8. Myth: I am a GP working in (any particular scope of practice e.g. a secure setting) so I must have my appraisal with someone who has experience of this setting

2.1. Myth: I must use a portfolio defined by my responsible officer to revalidate

The format of the portfolio of supporting information is not prescribed by the GMC, so having an electronic portfolio is not a requirement for revalidation. We recommend that your portfolio of supporting information should include all the core elements required by the GMC in a format that is professionally presented, typed so that it is legible, and capable of being transmitted electronically. Some other items of supporting information, such as original complaint letters or compliment cards, which may be hand-written, are usually best kept in paper form and shared privately with your appraiser to maintain confidentiality. They can then be referenced anonymously by the appraiser in the summary.

The medical appraisal guide model appraisal form (MAG4.2) is a free interactive pdf available from the NHS England website. This provides the template for all other toolkit providers and its use is not restricted to England. In some areas, responsible officers (ROs) have commissioned bespoke IT solutions for their doctors to encourage them to use a single system. In Scotland and Wales there are national appraisal and revalidation platforms used by all doctors. Scotland uses SOAR and Wales uses MARS. Your RO may have expressed a preference among the available options, which they are entitled to do under RO regulations. You should check your designated body requirements and variations with your RO. For example, special arrangements might need to be made to solve an issue of accessibility for a GP with a protected characteristic. If you move to a new area of the UK you should check if there is a preferred local choice of portfolio.

If your RO has not determined that a specific electronic portfolio should be used locally, you should choose a solution that suits you. Remember that your portfolio, with all the GMC required supporting information, needs to be available to your RO, potentially at short notice.

2.2. Myth: My appraisal portfolio is entirely confidential

Your appraisal and revalidation portfolio is normally only available to you and your appraiser or appraisal lead and responsible officer (or designated deputy). It should follow all relevant information governance and data protection laws. It is inappropriate to include any third party identifiable information, whether about patients or colleagues, without their explicit permission, unless the information is already in the public domain.

Your portfolio is a professional document and reflective notes included in it should be written in a professional way. It could be subject to a request to disclose by a court of law just as clinical notes can be. If they are appropriately written, your reflective notes can demonstrate your learning and insight into any incident or complaint under investigation. Your appraiser should be able to support you in ensuring that you have demonstrated your reflective practice in a professional way, that is proportionate and maintains confidentiality as far as possible.

2.3 Myth: I do not need to provide examples of my reflective practice in my portfolio as long as I bring them to my appraisal

There has been a lack of understanding about the necessity of meeting the GMC requirement to demonstrate that you are a reflective practitioner working in line with Good Medical Practice. It is not appropriate to avoid demonstrating your reflective practice in your appraisal portfolio. The GMC requires you to demonstrate that you are working as a reflective practitioner by collecting appropriate supporting information, reflecting on it and discussing it at your appraisal. In other words - collect; reflect; discuss. You should demonstrate your professionalism and your engagement with appraisal by including appropriate examples of your professional reflective practice in your appraisal portfolio. It is not sufficient to provide them separately and expect your appraiser to summarise them for you - there has to be some evidence of your reflective practice. You can expect your appraiser to help you to ensure that what you include in your portfolio is appropriate, and proportionate. Original, non-anonymised information, such as the details of complaints and compliments, should be shared separately and cited by your appraiser in the appraisal summary of discussion.

Reflection is a subjective analytic process that seeks to learn and make improvements as a result of thinking about CPD, cases, data, events or feedback. Think quality not quantity of reflection. The factual details are best captured elsewhere, and contemporaneously as far as possible, but your reflection should focus on capturing any lessons that you have learned and any changes that you have made as a result. Your appraiser will help you to ensure that what you include in your portfolio of supporting information is appropriate.

2.4. Myth: My appraiser has the choice of appraisal venue

There is good evidence that the most valuable appraisals take place when the environment is private, confidential and provides a ‘safe space’ for reflection and discussion. The appraisal venue should be mutually agreed between the appraisee and the appraiser and you should not feel pressured into meeting at a venue that does not suit you. If you do not have a suitable professional venue to offer, or you prefer to meet away from your workplace, it may be appropriate for you to travel to the appraiser or to meet in some alternative professional venue. Some designated bodies may set out specific arrangements in their medical appraisal policy for the appraisals of doctors connected to them and you should be aware of any such local requirements. Wherever you meet, it should still meet the requirements of a professional venue.

A professional venue is private, free from interruptions and has full access to the internet and other necessary facilities. In exceptional circumstances, it may be appropriate to hold an appraisal meeting in an unusual venue, such as a home office, if it can be demonstrated that the venue is appropriately professional and there is good reason for such a choice.

The RCGP recommends that any decision to hold the appraisal meeting in an unusual venue should be agreed in writing with the appraisal lead or responsible officer (according to the appropriate appraisal policy) before the proposed meeting takes place, and that the agreement should be attached to the appraisal documentation for transparency. This provides protection to the individuals concerned and assurance to the responsible officer.

2.5. Myth: I should do my appraisal outside working hours

Your medical appraisal for revalidation is a professional responsibility. The RCGP recommends that the appraisal meeting should take up to half a day and be done when you are alert and able to give it your full energy and concentration, and ideally when you will have time to relax and reflect afterwards. It should take place in your normal working hours.

When appraisal was introduced in primary care in the NHS it was resourced (funded) for a full day – half a day to prepare and half a day to have the appraisal meeting. Although the money is now in the global sum and not paid to individuals, this supports professional appraisals in working hours.

There should be no pressure on you to have your appraisal outside your normal working hours. If you choose to do your appraisal in your own time, for example on your half day, because it is mutually convenient for you and your appraiser, then you should be entitled to time in lieu.

The RCGP recommend that you should seek advice and support from your responsible officer (RO) if you feel that your appraisal is not being supported appropriately. The RO is responsible for the quality assurance of the appraisal process.

2.6 Myth: My appraisal has to be face to face

Although it is considered best practice to have your appraisal face to face (particularly for the first appraisal in a new appraiser-appraisee pairing) many doctors have satisfactory remote appraisals with the prior permission and agreement of their responsible officer and appraiser. The Medical Appraisal Policy for your designated body will have clear guidance on the circumstances in which a remote appraisal may be appropriate and how to get prior agreement from your RO. The expectation is that within the NHS, and for GPs, it will remain exceptional to have a remote appraisal.

2.7 Myth I am only allowed to have three appraisals with the same appraiser (in England)

There may be exceptional circumstances where it would be appropriate for you to have a fourth appraisal with the same appraiser, providing that you have the prior permission and agreement of your responsible officer and appraiser. For example, a doctor approaching retirement may get more value from a fourth appraisal with the same appraiser in celebrating their career and planning for their retirement than trying to form a relationship with a new appraiser when they have very little time left in practice. The RCGP recommends that you think about what will enable you to have the most meaningful and valuable appraisal and take action if you feel that you would benefit from an additional year for continuity. You will need the agreement of your responsible officer and appraiser and to demonstrate how you will fulfil the strong recommendation that it is good practice to have at least two different appraisers in a five-year revalidation cycle.

Myth 3.8: I am a GP working in (any particular scope of practice e.g. a secure setting) so I must have my appraisal with someone who has experience of this setting.

Medical appraisal for revalidation, by definition, is the forum to reflect on and discuss the whole scope of your practice. It is inappropriate for a medical appraiser to fail to appraise any part of your scope of work. Doctors working in roles that may be quite isolated need their generic appraisal as a chance to have appropriate support and challenge. All appraisers should feel competent and supported to appraise the whole scope of practice and if they have any concerns, the RCGP recommends that they take them up with their RO

There is no requirement for you to have your appraisal with someone who has experience of your setting. The scope of work of general practitioners is so broad that it would be impossible to match the experience and backgrounds of all appraisers and appraisees. There is good evidence that GPs value having an appraisal with someone from outside their own setting because of the objectivity that this allows and the perception of being able to speak in confidence. 

In order for your appraisal to be valuable to you and to your patients, the training and support for the medical appraiser must give them sufficient credibility to appraise your whole scope of practice. You are entitled to request a reallocation, after you have been appraised for the first time by a new appraiser, if you do not find them credible as there is good evidence that appropriate rapport is essential to a productive appraisal discussion.