The GMC says

Quality not quantity: It is important that your supporting information covers your whole scope of practice, is of sufficient quality to support your learning and development, and helps you reflect to identify areas for improvement and strengths in your practice. We do not set a minimum or maximum quantity of supporting information you must collect.

The GMC and RCGP recommend that, as a GP, you maintain a focus on the quality rather than the quantity of supporting information in your appraisal and revalidation portfolio by demonstrating:

  • An appropriate level of detail in describing your scope of practice.
  • Reflection on the probity and health statements and the domains of Good medical practice (GMC, 2013).
  • Annual reflection on continuing professional development (CPD) learning activities across a balanced programme appropriate to your scope of practice:
    • If you undertake the full range of general medical services in undifferentiated primary care (normal general practice), the RCGP recommends that you demonstrate at least 50 CPD credits per twelve months in work, covering the whole breadth of the RCGP curriculum over the five-year revalidation cycle, irrespective of how many sessions you work.
    • If you no longer provide the full range of general medical services, or have exceptional circumstances to declare, you may sometimes record fewer than 50 credits, provided that you document appropriate explanation and reflection, which is discussed with your appraiser and agreed with your responsible officer.
    • One CPD credit = one hour of learning activity.
    • All your learning activities, including learning arising from quality improvement activities (QIA), significant events (SE), feedback from colleagues and patients, and compliments and complaints, as well as personal reading and professional conversations, are eligible for CPD credits providing that you document your reflection on your learning from them appropriately.
    • Learning activities should normally be a mixture of consolidation (things you already know), targeted learning (for example, triggered by a case or a learning event, or an area of interest or need) and opportunistic exposure to new learning (to ensure you keep up-to-date with 'unknown unknowns').
    • There is no need to document or write reflective notes on every learning activity you underta
    • ke (prioritising reflection on your key learning from the past year is recommended).
    • In order to avoid professional isolation, the RCGP recommends that over the five-year cycle, you should provide evidence of some learning activities taking place with colleagues outside your normal place of work, or reflect on why this is not possible and discuss it with your appraiser.
  • Annual reflection on ongoing review of your work across your whole scope of practice:
    • The RCGP recommends that you include representative quality improvement activities (QIA) every year to demonstrate how you review the quality of your work and reflect on the standard of care you provide by reflecting on cases, data, events and feedback
    • You should provide a balance of different types of QIA over the five-year cycle, including reflection on your personal outcome data, where available, and examples of initiatives that have led to quality improvements in practice.
    • Normal GP learning event analysis (LEA) (formerly called significant event analysis (SEA)) should be included as a form of quality improvement activity, and include learning from positive events and good practice, as well as events where things could have been done better, with the phrase 'significant events' reserved for adverse patient safety incidents as defined by the GMC in their guidance:
    • It is important that you consider the impact of your quality improvement activities and review whether changes you made have made a difference to the quality of your practice.
  • Reflection on the analysis and review with colleagues of all significant events (SE) as defined by the GMC, in which you have been personally named or involved since your last appraisal
    • If you have not been involved or named in any significant events, you must declare this.
  • Reflection on feedback from patients and those to whom you provide medical services using a feedback tool compliant with the GMC requirements at least once in every five-year cycle:
    • It is important to ensure that you choose, from the ever-increasing range of feedback tools, a GMC-compliant tool that is appropriate for your scope of practice and accessible to the whole range of respondents / patients.
  • Reflection on feedback from colleagues using a feedback tool compliant with the GMC requirements at least once in every five-year cycle:
    • It is important to ensure that there are appropriate respondents from across your whole scope of practice, over the five-year cycle, whether they are all included in your one formal GMC compliant feedback, or whether you seek and reflect on feedback separately for a specific role (eg an appraiser seeking feedback from appraisees).
  • Reflection on other sources of feedback from patients, whether formal or informal, solicited or unsolicited, where appropriate, on an annual basis.
  • Reflection on all complaints in which you have been personally named or involved, as and when they arise:
    • If you have not been involved or named in any complaints, you must declare this.
  • Reflection on any compliments you have received.
  • Reflection on anything else you have been specifically asked to bring to the appraisal
    • If your responsible officer has asked you to bring specific information to the appraisal, such as routine clinical governance information provided by your organisation, or the outcomes of an investigation or complaint, then you must do so, so that you can discuss your reflections on it with your appraiser, and your appraiser can record it in the summary of the appraisal.

Next: Reflection and professionalism >

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