Navigating the appraisal process as a locum GP

There are six types of supporting information to collect and reflect on. Adapted from the GMC’s supporting information:

• Continuing professional development (CPD)
• Quality improvement activity (QIA)
• Significant events
• Feedback from patients or those to whom you provide medical services
• Feedback from colleagues
• Compliments and complaints

Describe what you have done to keep up-to-date across the whole of your scope of work. Examples include:

• reading the BJGP and doing RCGP online learning modules, watching webinars, listening to podcasts
• being part of a sessional GP peer group and meeting online, or in person, regularly
• doing a BLS update.

Questions to ask yourself:

• What are the two or three most significant things you have learned this year then describe how or where you learned them (e.g. in Practice/in a peer learning group/from the BJGP/BMJ/Pulse/Red Whale). Can you illustrate this by implementing the learning in practice with patients, which might become a brief anonymised case-based reflection that you could share with peers or reflect on with your appraiser.
• Have you identified any learning needs that you need, or want, to address, or key learning to be shared? This might be the identification of PUNS (patient unmet needs) and DENS (doctors educational needs) in a consultation that you then researched.   
• Can you illustrate this addressing your learning need by drafting a brief anonymised case-based reflection that you could share with peers or reflect on with your appraiser?

We recommend you open a new electronic appraisal portfolio as soon as your previous appraisal is agreed and signed off so that you can upload significant learning as you complete it rather than having to set aside many hours near your next appraisal date.

You should be able to demonstrate that you review the quality of your work by showing you have done at least one quality improvement activity (QIA) for your GP role.

These could include:

• Reflection on case discussions: If you go back to a practice, look back to your previous referrals or two-week wait referrals and reflect on the outcomes.
• PUNS and DENS: make a note whenever you see a patient where you are not sure how to manage the problem and subsequently read up on the management of this condition.
• Consultation Analysis: If you do two shifts or regular shifts at the same Practice, review your consultations - either face-to-face or telephone or both - from one session and look up the outcomes or learning from these.
• Telephone Appointment Analysis: looking at all telephone appointments done in a session, check whether you felt that the patient needed a face-to-face appointment and were correct in that, or whether you felt that they were dealt with over the phone but then proceeded to come in about the same thing then identifying any potential learning from that.
• Time Analysis: look at the session you did and whether you ran late or kept to time. Are there any alterations you might request for a future shift, for example, asking for fifteen-minute consultations or a break.
• Practice Development: Are there improvements from other practices you have worked in that you can signpost to the partners or practice management?
• Set up or join a peer-learning group and use it to discuss tricky cases, safeguarding referrals, learning events, significant events, key learning, and keep a record of the case-based discussions shared.

Your appraiser will be keen to hear that you know how to identify a learning event or a significant event (the latter is where harm occurs) and that you take part in the process of learning from when things go wrong or even when they work well.

Questions to ask yourself:

• Do you know in each practice you work in how significant events are identified and ask whether any will share their learning with you?
• If you identify a learning event, how do you inform the practice, and can you share this with a GP there, and do you have a peer group where learning can be shared?

Every year, you should reflect on any informal feedback you have had from patients or carers.

If the practice where you work passes on any informal patient feedback, upload the anonymised feedback to your electronic portfolio. This may be a scanned anonymised card but could be kept simple by you summarising.

Once per revalidation cycle, you will need to do a formal patient survey. You may find this easier to do with a longer locum, such as a maternity locum or where you have a regular booking. All GPs are required to do this, and practices should have a ‘hands-off’ approach for their partners and salaried GPs, so approach the practice manager and ask.  Training practices are likely to be accustomed to the frequent surveys needed in training.

We recommend starting your patient survey early in a new revalidation cycle in case it takes a while to get enough responses from successive patients. You can mix your requests from consecutive in-house telephone, face-to-face and out-of-hours NHS general practice. Discuss how to do your surveys with your appraiser at your first appraisal in a new revalidation cycle to ensure your survey will meet the RO’s requirements.

If you are struggling to get replies from patients as a locum, you should contact your RO to explain, as they may be able to approve surveys with fewer responses.

Every year, you should reflect on any informal feedback you have had from colleagues.  Try to aim for the majority, but not all, of the respondents to be clinical colleagues whom you are working with or have worked with recently.

As with patient feedback, we recommend you discuss how to do your surveys with your appraiser at your first appraisal in a new revalidation cycle to ensure your survey will meet the RO’s requirements.

Every year, you should reflect on any feedback in the form of compliments or complaints. If the practice where you work passes on any informal patient feedback, upload the anonymised feedback to your electronic portfolio, this may be a scanned anonymised card, but could be kept simple by you summarising the compliment.

We can all expect to get complaints over the course of our careers, and the GMC asks that we reflect on them to try and identify any learning, address it, and change our practice as a result of the complaint. We do not encourage you to upload original complaint letters or replies, but to be able to describe the complaint, any learning and subsequent change of practice in your electronic portfolio or at your meeting. Even if you do not reflect in writing in advance, you must answer the declaration about significant events and complaints truthfully because a false declaration in your portfolio casts doubt on your probity, an important part of professionalism and maintaining your GMC registration.

You may be asked whether you apologised and practised the duty of candour.

Be clear with your appraiser whether the complaint is resolved or ongoing, and whether you were supported by the practice, sought advice from your MDO or LMC, and whether you needed any emotional support.

Complaints can be very distressing. Your appraiser may ask for more details, which you may be able to share by secure NHS email, onscreen at your virtual meeting, or read out loud, but they should be there as a supportive peer familiar with the impact of complaints on confidence and wellbeing and extracting any learning themselves.  A supportive discussion may be able to reframe a negative experience into a valuable piece of professional development.  

If you’ve moved to a different region, it is likely your designated body will have changed, and it is a good idea to check it has been updated on GMC online. This is also the most reliable way for you to check when your next revalidation recommendation is due.