Guide to independent sector appraisal for doctors who are not employed, but have practising privileges with one or more provider
An agreement between the British Medical Association and the Independent Healthcare Forum
March 2005
During 2005 the General Medical Council (GMC) will require all practising doctors to hold a "Licence to Practise" (Licence to Practice and Revalidation for doctors', GMC publications, April 2003). Through the process of 'revalidation' it will help to ensure that doctors are up to date and fit to practise medicine throughout their careers.
[Update - March 2005: Following publication of the Fifth Report of the Shipman Inquiry in December 2004, the Department of Health announced a review of the Inquiry’s recommendations, including arrangements for the revalidation process. The GMC has therefore postponed the launch of revalidation until the outcome of the review is known. However, under the National Minimum Care Standards for Independent Healthcare Providers, annual appraisal remains a requirement for all doctors working in the independent sector.]
The GMC believes that "full participation in annual appraisal, with completed supporting documentation, during the revalidation cycle is a powerful indicator of a doctor's current fitness to practice" (Licence to Practice and Revalidation for doctors', GMC publications, April 2003) (provided it is undertaken on their principles of "Good Medical Practice" (Good Medical Practice, GMC publications, May 2001) and operated within a quality assurance system).
Appraisal is a positive process to provide feedback on performance, chart continuing progress and identify development needs. The outcome of appraisal will provide documentation for doctors which they will subsequently present for GMC revalidation. In addition, appraisal is now a requirement of the National Minimum Care Standards for Independent Healthcare Providers (regulation 19 (1), standard A.3.2.). A similar requirement exists in Scotland, Wales and Northern Ireland.
- Doctors who are not employed, but have practising privileges with one or more private providers will be expected to complete annual appraisal documentation in order to gain renewal of those privileges.
- Forms 1, 2, 3, 4 and 5 apply, (form 6 is optional).
- Doctors will be required to carry out a renewal of their practising privileges every two years.
- Appendix 'A' is an example model for the renewal of practising privileges (as agreed between the BMA and the Independent Healthcare Forum). It details advice for the collection and type of data that is required. Appendix 'A' should be signed by independent sector providers for retention by consultants as part of information kept within their revalidation folders.
- Appendix 'B' is an example certificate for the renewal of practising privileges and should be signed by independent sector providers for retention by doctors, as part of information kept within their revalidation folders.
The list attached specifies which Royal Colleges and Faculties have produced documentation on appraisal and revalidation for consultants in the independent sector. The Independent Doctors Forum also has an approved appraisers scheme.
Appraisal process
The appraisal process should be based on models agreed between the Department of Health and the BMA for the NHS, which were subsequently modified for private sector use by the IHF and the BMA (in agreement with the DoH). Doctors may be appraised through the NHS system, even when undertaking only a small amount of work contracted in the NHS.
The appraiser must be a registered medical practitioner who will normally, though not necessarily, be from the same speciality as the doctor to be appraised. They will need to be quality assured, either from doing appraiser work in the NHS or through a Royal College Scheme or other quality approved scheme, e.g. the Independent Doctors Forum.
If a doctor does contracted private work for the NHS, they may be able to obtain appraisal through the NHS whole practice appraisal system, covering all of their NHS and private work (the appraisal would be through the NHS; ask contracting organisations if any schemes apply).
Both appraisee and appraiser should agree the data to be provided and the timetable to complete these forms in a preparatory discussion at least two months before the formal appraisal discussion. They should agree on the information and activity to be included and on the time, place and length of the appraisal discussion.
The appraisee should complete and submit Forms 1 to 3, at least two weeks before the discussion, accompanied by the best available supporting evidence and documentation. The appraiser may complete the forms immediately after the appraisal, and will complete Form 4 (and Form 5 for employed doctors); the finalised version should be agreed before signing and added into the appraisee’s revalidation folder. The appraiser and appraisee should retain copies.
An exit appraisal should normally be arranged on resignation, retirement, or cessation of practising privileges, this would be helpful for any future revalidation.
Renewal of practising privileges
Doctors will be required to carry out a renewal of their practising privileges every two years. This guidance includes a list of data to be collected for the practising privileges process against the headings of 'Good Medical Practice', laid down by the General Medical Council, model appraisal forms for completion with the independent sector provider, (this summarises data provided to the consultant in relation to their private practice).
Consultants are encouraged to use the model checklist in Appendix A as the private practice component of their whole practice dataset, as well as to gain practising privileges.
Practising privileges documentation should be available from hospital management.
Royal Colleges and Faculties information
The following Royal Colleges and faculties have produced documentation on appraisal and revalidation for consultants in the independent sector. We strongly advise doctors to check with the relevant Colleges and Faculties for up to date information.
Faculty of Occupational Medicine (Go to the website here - www.facoccmed.ac.uk)
The Faculty of Occupational Medicine together with the Society of Occupational Medical Practice have developed a set of guidelines for appraisal in Occupational Medical Practice. Their aim has been to encompass the practice of most occupational physicians and to make it clear to their appraisers some essential differences between occupational medical practice and that of other disciplines. The focus is on the content of appraisal, rather than the process or its documentation.
A list of appraisal and identified learning needs are:
- good occupational practice
- working with individuals
- working with groups
- working with organisations
- maintaining a knowledge base
- auditing activity
- relationships with patients
- acting as a Medical Manager
- general managerial competency
- special responsibilities of managing in a medical setting
- working with colleagues
- teaching, training, appraising and assessing
The Royal College of Ophthalmologists have issued a practical guide to doctors on keeping a portfolio for the purposes of revalidation by the GMC. They have recommended that consultants keep a record of the following information:
- maintaining good medical and ophthalmological practice
- collecting letters of appreciation and letters of complaints
- evidence of how working relationships have been improved
- providing feedback and training
- adopting the habit of filing relevant documents in a portfolio ready for the GMC revalidation
Clinicians are individually responsible for demonstrating their fitness to practice and are advised by the College to collect a folder of information. This folder will need to satisfy those acting for the GMC/GDC that the information provided demonstrates fitness to practice.
Royal College of Physicians (Go to the website here - www.rcplondon.ac.uk)
The Royal College of Physicians, with extensive experience of consultant appraisal training, is developing a service whereby trained appraisers will be available to independent practitioners requiring peer appraisals. The College has developed a programme to train selected doctors to become skilled appraisers through informative and practical workshops designed specifically to provide the knowledge and skills required to conduct effective appraisal of independent practitioners.
The Royal College of Physicians proposes that the appraisers should be nominated, and possibly sponsored, to the programme by their parent Colleges and that the Colleges should subsequently act as the intermediary between the person requesting an appraisal and the nominated appraiser. Discussions have indicated that an appraisal fee of the order of £800 should be charged and it is for consideration that this fee should be divided equally between the College and the appraiser.
(A workshop has been arranged for those interested in becoming trained appraisers, contact the Royal College of Physicians for more information: winnie.wadw@rcplondon.ac.uk, telephone: 020 7935 1174).
Royal College of Surgeons in England (Go to the website here - www.rcseng.ac.uk)
It has been agreed that the College will consider providing both appraisal training and appraisers to undertake the appraisal of surgeons working in the independent sector. The College has run appraisal workshops over the past few years and developed supporting materials. Although these courses are not specifically marketed at the independent sector these will form the basis of any further developments.
Generic and speciality specific criteria, standards and evidence for use by surgeons when preparing for appraisal and revalidation are currently being developed by the College and Specialist Associations and this guidance will be relevant to surgeons working both in the NHS and the independent sector. This document will hopefully be available for consultation.
Royal College of Surgeons in Ireland (Go to the website here - www.rcsi.ie)
Structures in Ireland are somewhat different than in Britain. Almost all surgeons are involved in private practice. The Medical Council are in the process of introducing mandatory appraisal which will include elements of Continuing Medical Education (CME) and Continuing Professional Development (CPD). Government legislation is about to enforce this very shortly.
Currently, surgeons have been enrolled in the CME Appraisal Programmes at their Colleges during the last year. CME activities are recorded electronically and Fellows have an individualised code number for electronic recording of CME activities retained in their associated Colleges.
That process is now complete and there will be an official appraisal of the CME activities on an annual basis by the Colleges. At the end of five years the RCSI will issue a certificate of compliance with CME (and later CPD) activities.
The London Consultants’ Association (Go to the website here - www.london-consultants.org)
The London Consultants’ Association is administering a system with approved consultant appraisers for members and other consultants who wish to have appraisal of their private practice. For more information contact their office by post at 14 Queen Anne’s Gate, London SW1H 9AA, or telephone 0207 222 0975 or email info@london-consultants.org
The Independent Doctors Forum (Go to the website here - www.independentdoctorsforum.net)
The Independent Doctors Forum has a number of trained appraisers and suggested appraisal documentation.
The following Royal Colleges and Faculties do not have a specific mechanism or guidance for consultants working in the independent sector. This is mainly because they have very few members left working in this area:
- The Faculty of Accident and Emergency
- The Royal College of Anaesthetists
- The Royal College of Paediatrics and Child Health
- The Royal College of Psychiatrists
- The Faculty of Public Health
- The Royal College of Radiologists
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Form 1 - appraisal folder background details
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Form 2 - details of your current medical activities
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Form 3 - record of reference documentation supporting the appraisal and report on development action in the past year
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Form 4 - summary of appraisal discussion with agreed action and personal development plan
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Form 5 - personal and organisational effectiveness
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Form 6 - detailed confidential account of appraisal interview
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Appendix A - checklist for completion by the independent sector provider
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Appendix B - Certificate of renewal of practising privileges
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