Step by step of your appraisal

After your final ARCP you should be automatically revalidated. Once you complete your training and get your first job as a fully qualified GP, you will then be provided with a designated body, a responsible officer (RO) and an appraiser. How that happens varies slightly across the UK, and it's always worth checking if you're not sure, but this should all be sorted for you. There are exceptions to this, for example those working exclusively in independent practice may need to arrange their own appraisals.

Your RO will set the date of your first appraisal, which you can expect to be within the appraisal year following your ARCP revalidation. It is your professional responsibility to ensure you’re offered an appraisal in your first year. The GMC has a tool to help if you're not sure who your RO and designated body is, as well as a full list of all designated bodies and their ROs with contact details (external PDF). If you’re not given details of your first appraisal within the first few months of joining a Performers List, get in contact with your RO’s team.

You can then start thinking about what you want to get from your first appraisal. The best time to start preparing for it is as you approach your final ARCP and are thinking about which PDP items to take forward out of training. as a new appraisal year starts. That way you can ensure you are including the supporting information that best reflects your scope of work and your personal and career goals.

For revalidation the GMC requires you to engage in medical appraisal. However, appraisal is not a pass or fail assessment. Your appraiser will use the written evidence and verbal reflection from your appraisal to confirm the following (with some variation in approach between the four nations):

1. An appraisal has taken place that reflects the whole of a doctor’s scope of work and addresses the principles and values set out in Good medical practice.
2. Appropriate supporting information has been presented in accordance with the GMC Supporting information for appraisal and revalidation and this reflects the nature and scope of the doctor’s work.
3. A review that demonstrates appropriate progress against last year’s personal development plan has taken place.
4. An agreement has been reached with the doctor about a new personal development plan and any associated actions for the coming appraisal period.
5. No information has been presented or discussed in the appraisal that raises a concern about the doctor’s fitness to practise.

Appraisal is part of a formative and developmental process. It provides an annual opportunity - in protected time - to reflect on your challenges, achievements, personal and professional development and aspirations. It provides you with a peer with whom you can reflect on your supporting information, feedback, challenges and goals and help you plan steps in your career development.

Appraisal should always include support, encouragement and stimulation. At a time of great stress in general practice, appraisal has an important role in helping GPs who may be struggling and signposting them to local support services, with the aim of retaining GPs within the profession.

You should put all the supporting information you wish to provide for your appraisal in a portfolio each year.

In England, NHS GPs aligned to an NHS England Responsible Officer (RO) are required to use an electronic toolkit. There are a number of different online portfolios designed specifically for GP appraisals, and, while some ROs are happy for you to choose the portfolio tool that works best for you, others require you to use a specific one. GPs working in the Armed Forces are encouraged to use PReP. If you’re working exclusively in private practice you will usually have more flexibility in which tool you can use. Always check with your appraiser or local primary care or health organisation if you're not sure which one to use.

If you’re practising in Scotland, you must use the Scottish online appraisal resource (SOAR) (external PDF).

GPs in Wales must use the Medical appraisal revalidation system (MARS).

Those based in Northern Ireland use the GP appraisal registration and declaration form.

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. In Northern Ireland and England you are encouraged to use an up-to-date electronic toolkit with the MAG 2022 embedded. The MAG22 has not been approved by the GMC as a standalone document so you should use an updated appraisal toolkit to submit your supporting information. 

The FourteenFish and Agilio Clarity portfolios are submitted directly to your appraiser who will be linked to you via their platform. 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. We recommend you use secure NHS email addresses if you want to, or are asked to, send anonymised versions, rather than share during your meeting. They can then be referenced anonymously by the appraiser in the summary.

Your RO could potentially ask to view supporting evidence, and we recommend it is kept electronically and securely until revalidation.

Your appraisal portfolio is normally only available to you and your appraiser (or appraisal lead) and RO (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. We do not, therefore, recommend uploading minutes from meetings attended by other identifiable staff or complaints identifying colleagues by name.

We don't recommend that you upload complete complaint letters or replies. Instead: note that a complaint occurred; summarise it in non-identifiable ways; reflect on whether you apologised; whether you or the practice applied your duty of candour; whether you wrote an apology and explanation; and whether the complaint is settled. Your appraiser may seek more information and ask you to read a document at the meeting or email it to them at a secure email address. This is for you to demonstrate that you've reflected on the complaint as feedback, learning and change if needed. Your appraiser is trained to be supportive and non-judgemental. You should come away from your appraisal discussion feeling you've had a valuable discussion with a kind peer rather than feeling worse.

The GMC will not require or request any details of an appraisal when conducting a fitness to practise inquiry, although you may wish to share these with the GMC to show your engagement in the appraisal process.

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 that maintains confidentiality as far as possible.

If you are employed in other roles, ROs have the ability to communicate governance information between themselves. However, you should check or have your contract checked by a trade union or Local Medical Committee if you are uncertain about its meaning, as you may have signed a contract to say you would either share your whole appraisal portfolio or the outputs. 

Your medical appraisal is a professional responsibility. We recommend that you set aside three hours for your appraisal, though the discussion time may be less than that. It should 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 unless you and your appraiser agree otherwise.

When appraisal was introduced in primary care in the NHS it was resourced for a full day – half a day to prepare and half a day to have the appraisal meeting. Sessional and locum GPs in parts of the UK are still entitled to a payment equivalent to one session. However, for GPs in England, 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 have 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.

We recommend that you seek advice and support from your RO if you feel that your appraisal is not being supported appropriately. They are responsible for the quality assurance of the appraisal process.

PDP

All GPs in training in the UK must have a PDP for their final ARCP (Annual Review of Competence Progression) and this is the PDP that should be brought forward to your first medical appraisal for revalidation. You can ask for your post-CCT personal development plan which you discussed with your trainer to be emailed to you at your final educational supervisor's review. If you can't access it, discuss this with your appraiser who may agree that you can summarise it 'as best remembered'.

It is possible that some doctors arriving from overseas may not have been part of any managed system that would generate a PDP. In such cases we recommend that the appraiser uses a “disagree” statement as one of the outputs of appraisal and explain in the comments that there has been no progress with the previous PDP because there was no previous PDP.

Statements

There are some key aspects of the appraisal process that your appraiser needs to agree have taken place. For example, in England there are five key sign-off statements for your appraiser to review. For most appraisals, the appraiser will be able to ‘agree’ all five statements. If an appraiser is unable to confirm one, or more than one, statement, it simply draws something relevant to the attention of the responsible officer. Any ‘disagree’ statements should be appropriately explained in the comments sections provided, to assist the responsible officer in understanding the reasons for them.

The doctor and the appraiser can both comment on the output statements made. For example, the appraiser may explain that they have disagreed with statement three because there was no previous PDP to review, or because a major change in circumstances affected the appropriateness of the former goals, or with statement five because a doctor presented an ongoing investigation into a complaint that had been discussed but was not yet resolved. A doctor newly arrived from overseas might comment that the previous system within which they worked did not include a PDP process which is why there was no PDP to review.

In all cases, you have the opportunity to comment, although you do not have to if you have nothing to add to the appraiser’s explanation.

You can expect your appraiser to offer a range of times and dates for your appraisal meeting about three months before your appraisal month. Depending on your contractual arrangements, this may be within your usual working days. There should be times within a normal working day, except in exceptional circumstances, that are acceptable to you, your appraiser and the appraisal service.

In some areas, appraisers may offer the choice of a face-to-face or virtual meeting, in others, only a virtual meeting. The venue, whether in-person or virtual, needs to be professional, private and uninterrupted. If it is arranged virtually, there should be good connectivity with both of you visible and there should be a backup arrangement agreed.

Your appraiser needs time to prepare for your meeting, and we recommend you share your portfolio at least two weeks before the meeting. Any information should be carefully anonymised by you. The appraiser may request that the meeting is postponed if they have not had long enough to prepare and consider your needs.

The meeting is likely to be set at three hours, but generally, about two hours is long enough. You should be offered and feel able to ask for a comfort break during the appraisal.

The meeting should be held under GMC confidentiality rules, with good information governance maintained.

Your appraiser will draft a Summary of the discussion. They'll then either help you to craft your PDP or formulate it for you based on the discussion. Your PDP should be SMART (specific, measurable, achievable, relevant, time-bound) or SMARTER (including economic and reflect impact). Your appraiser should then give you a timeframe for when you can expect to receive the typed draft summary in your portfolio.

When you receive your summary and PDP it's important that you read through them carefully and update any inaccuracies. Edit anything you would not want in your professional record, either directly through your appraisal toolkit or contacting your appraiser with suggested changes. You can expect your appraiser to agree to all or most of your changes. Only rarely they might specify when something needs to remain as originally written. Remember the first version they send you is a draft. It is common for you to edit it between you before it's signed off, sometimes more than once.

Your appraisal is not complete until both you and your appraiser have signed off the summary and PDP. We'd recommend you then download your portfolio, appraisal summary, and PDP and save them separately from your appraisal toolkit for your safe keeping.

Your PDP and appraisal summary are shared with your RO and their nominated deputies and, occasionally, your RO may examine some or all your portfolios as evidence for revalidation recommendations (though this is not the case in Northern Ireland). Once your appraisal has been completely signed off, your appraiser won't keep a copy of it themselves.