Policy Bite: having an annual review

Does this matter for our professional development and credibility?

with Prof Amanda Howe, WONCA President-elect

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I had my appraisal this week – an annual review of my work with a trained peer, and with a standardised submission of evidence that covers all areas of my work (more information here).

I prepared an electronic portfolio which:-
• Described the roles I hold as an academic family doctor (clinician, university professor, professional leader in WONCA, GP appraiser…)
• Showed the CPD activities I have undertaken (reading, conferences, clinical meetings, practice based activities, research for keynotes, other…)
• Included feedback from colleagues and patients, also information about complaints and significant events in the practice (none, but I have to answer this!)
• showed whether I fulifilled the four objectives of my last professional development plan; and what next year’s plan will be.

The portfolio also includes a set of professional statements – am I fit to practise, do I know of any risks to my health that might affect my practice, am I subject to any licensing supervision or restriction. My GP appraiser, who has already seen my submitted work, meets with me for 1.5-2 hours. At the end we have confirmed an educational plan for next year; he will have confirmed my statements, and will also have to state that he thinks I am fit to practise – or not.

This is now a requirement for all doctors in the U.K., and is the basis for continuing to hold a licence for independent practice. The appraisal is meant to be formative and professionally oriented; to help to refresh knowledge and skills, and look towards career development. The standards for the appraisal are set out by the relevant professional body – in this case, the WONCA U.K. member organisation (the Royal College of General Practitioners), who spend a considerable amount of time and energy developing guidance for GPs (see details here).

I do not know how common this model is worldwide. I do know that many countries struggle to provide and structure any career support at all – so again I think I am lucky. Early evaluation suggests added gains for patients and the service, but this is not research-level evidence and needs to be examined over a longer period.

Even if there is no national structure, I would recommend that any colleague reading this could make their own chance to sit with a colleague outside their own practice or employer once a year – use some of the headings in the documents here referenced – and reflect on what you know about your practice. It doesn’t have to be driven by others – just try it for your own learning.

Our WONCA Working Party on Education are currently drafting some standards for CPD – these do not yet include an annual appraisal, but they do suggest peer review and a variety of educational activities for full refreshment and development over a career lifetime. On a personal level, I really like once a year to have a reflective conversation with a colleague; and I also consider it a good thing to have to account for my continuing professional development. It is part of a clinical governance and accountability structure which links an encouragement for the individual doctor with a challenge to plan to do more - and better.