Registrar Appraisal at the end of training

Guidance from COGPED suggests that the final ES report and ARCP panel at the end of ST3 year constitutes an appraisal within the terms of the NHS. However, this does not help the doctor prepare for life beyond training, an area in which Trainers are skilled and experienced. Severn School of Primary Care therefore recommend  that GP Trainers carry out an NHS style appraisal at the end of each trainee’s three year scheme. Some trainers have been concerned that they may not have the knowledge and skills to complete this and that it will take up extra time. This guide is intended for trainers, to help clarify what is being suggested and how it can be achieved. Please note it is no longer a requirement to submit the summary and PDP to the patch AD. This should be retained by the trainee, and uploaded onto their e portfolio as supporting evidence in their log.

AIMS

The aims of this appraisal are

1.       To assist the trainee to plan lifelong learning strategies

2.       To offer career advice and development

3.       To improve awareness of the requirements of appraisal and revalidation, and the evidence required.

4.       To ensure their PDP is appropriate for the post CCT environment.

5.       To ensure they meet the registration requirements of independent practice.

This appraisal is intended to supplement and not replace the e portfolio. While the portfolio looks backwards to ensure training has been fully completed, this appraisal will look forward to the planning of future career and learning strategies.

BACKGROUND

Newly Qualified GPs are a mobile and vulnerable group. 50% will move to a different area, where they may have few contacts and little support. Many will be working as locums or in out of hours services. Even as assistants or long term locums such as maternity cover, they may have little support from their practices. Their career structure is poorly defined, and time for learning may not be easy to protect.

GUIDANCE TO TRAINERS

This appraisal should not be approached as a separate event from the normal teaching programme. It should be built in to your tutorial programme, and take about an hour. As with any appraisal, encourage the registrar to modify their PDP themselves after the appraisal and run it past you later. The appraisal can take place at any point in the last two months, but is easier to do once the application for CCT has been made, and the e portfolio formalities completed. The e portfolio may provide a basis for the discussion, and many of the form 1-3 sections will not be necessary, so avoid them slavishly repeating themselves.

PROCESS

The registrar should be encouraged to use the English appraisal toolkit. The new toolkit being developed in Severn is not suitable for this year.

·        When they register on the toolkit, at www.appraisals.nhs.uk , they can select the PCT where they are on a performers list, or the “virtual” PCT called “GP registrar PCT”.

·        As a trainer, you can add your name to the appraisers list of GP registrar PCT, which enables full sharing of files. Go to “my profile” on the toolkit, and choose GP registrar PCT from the drop down menu of PCTs.

·        If using the local PCT as host, you will not be able to register as appraiser, but the registrar can show you their paperwork using their own logon. Consult your local PCT lead about this, but if no appraiser is selected, they can still use the tools and advice on the site which is very helpful and accustoms them to this for the following year. In this case, you will only be able to view their paperwork jointly, but this should be possible in the context of a normal tutorial, on their desktop. Otherwise they can download the completed forms and e mail them to you.

·        At the end of the appraisal, or shortly afterwards, agree the summary and PDP. On the toolkit these can be downloaded using the “Preview” icon.These should then be kept by the qualifying doctor for their future revalidation portfolio, and may be requested by their appraiser next year.

·        The trainee then creates a log entry for the appraisal, and attaches the summary and PDP as supporting evidence at the foot of the log page.

·        If the trainer wishes to keep a copy, they must seek the agreement of the trainee to do so.

CONTENT

If you think about your own appraisals, and then apply the principles to this situation, you will not go far wrong. Much of the fact finding part of the appraisal process will be unnecessary, as you already know them well, and will have helped them develop a PDP over the last few years. The e portfolio and PDP contains many of the pieces of evidence required, such as patient and colleague feedback and a learning log, and will also help to define their areas of learning need for the future, through the GP Curriculum links. The RCGP Revalidation guide is useful for this and is available on the Severn school website, along with many other resources. You have probably encouraged them to use online resources during the previous years, and to plan their own learning. You will have a good idea of their strengths and weaknesses.

1.  Lifelong learning.

·     You need to ensure that after they leave your protection, they have the skills and means to access information and services. Help them to plan this.

·        In the Severn region they should be advised to join an educational trust; the subscription is tax deductible.

·         The RCGP is rolling out its own learning scheme called Essential General Practice, and the BMJ and other organisations offer online resources.

·         Encourage them to contact their local GP Educator team, usually based at Postgrad centres; many areas now have newly qualified GP schemes, or self directed groups.

·         Many prefer to meet up in the evenings, quite informally, so the postgrad centre may be able to put them in touch with a suitable group for this.

·         Some areas may also have mentorship, and in Severn a praeceptorship is proposed.

·         Do they have any special areas they wish to develop, such as coil fitting, or a specialist diploma like dermatology or geriatrics? How do they plan to achieve that? In any event, the registrar needs to plan how they are going to continue to learn.

2.  Career development. What are their job plans?

·         Do they aim to find a partnership, in which case they may need advice on how to achieve this. For example what to put in their CV, how to approach practices, what skills may be marketable.

·         How can they use their last few weeks in your practice to gain survival skills for the future? Visits to the type of practice where they want to work, or practice swaps, may be useful.

·         They may want to “be a partner” for a week, and experience the attendant workload.

·         They may need to gain experience in management and accounts, where the practice manager may be able to help. Help them to use the last few weeks to full advantage.

3.  Appraisal and Revalidation.

·         Give a brief overview of the requirements; they may have had a session in their course about this

·         Direct them to School appraisal pages for more resources e.g. RCGP guide

·         Help them to understand the need to continue to gather evidence in a portfolio-this should not be hard as they have been doing so for three years already!

4.  Future Status.

·         If planning to work as a locum or freelance OOH doctor, do they understand the implications of being self employed?

·         Have they considered joining a locum group, or getting involved in a virtual practice or locum chambers?

·         How will they charge and run their business?

·         They may need advice on locums collecting evidence for future appraisals, which is available from www.nasgp.co.uk or the northern deanery toolkit.

·         The area’s LMC may also be helpful, and the BMA and NASGP give guidance to locums.

As you have had some appraisals, you can help them identify the key pieces of evidence they will require in the future. These include

·         Keeping case studies, and significant events, having discussed them and reflected on them.

·         Doing simple audits or data collections, for example following up referrals or emergencies sent to A/E.

·         Keeping a learning log, with reflections on what they learned from each event, much as they have been doing on the portfolio.

·         Ensuring they have up to date CPR training-their local PCT should be able to help with this, or the practice where they work.

·          Ensuring they undertake patient surveys is important, and multi source feedback should be planned within the next two years.

·         They must keep records of any complaints personal to them, and how these were dealt with.

·         Revalidation will not be an immediate worry for them, as long as they keep up their appraisal annually.

·         Review their PDP, and ensure it is realistic and achievable in the real world. Timings need to be sensible as well.

Finally, you need to make sure they have all the paperwork they need to continue working. This includes

·         defence cover,

·         getting PMETB approval in time,

·         updating their performer list details and status,

·         ensuring they are registered with any relevant professional bodies.

·         They may need legal advice to review contracts or partnership agreements, and accounting and pension advice.

·         Discuss references and who to ask as referees- including yourself!

Many of these aspects are familiar from past registrar’s last months I am sure. However, the appraisal helps to formalise and encapsulate these discussions, and give them a reference for future planning. As ever, we are aiming to launch them into independent practice with confidence and understanding of what that involves.

Alongside this document, you can encourage registrars to read the sister document for them, entitled “Surviving Independent Practice”. Both will be regularly updated and placed on the deanery website.