NHS Education for Scotland

The submissions for the 2018/2019 MARQA review indicated that there was significant variation in the levels of support the Medical Appraiser workforce received from their local health boards. The Medical Appraisal Team at NES was keen to explore this further to increase our understanding of this issue and consider what actions we could take to improve the situation. We ran a survey which was sent out to all Medical Appraisers working in NHS Scotland in November 2019. It was similar to the RCGP Appraiser Survey¹ also run in 2019. We decided to include questions on the Appraisers’ experience, overall workload, cross-specialty practices, their experience of Appraiser support, and their views on the impact of Appraisal.

We received 281 replies (equating to 14% of the Appraisers on SOAR), of which 205 were working in secondary care, 70 were working in primary care and 6 were working in other areas. Appraisers were mostly senior clinicians with 84.2% having been qualified for more than 20 years. Around two thirds of appraisers had other roles in addition to their clinical roles as well, mostly in education, leadership and management or committee work. In secondary care 75.2% of appraisers worked full-time, in primary care only 31.9% did. In secondary care the vast majority (82.2%) of appraisers were doing cross specialty appraisals with over half of the appraisers responding that at least 50% of their appraisals were cross specialty. In primary care only 18.6% of appraisals were cross specialty. Some primary care appraisers appraise colleagues in secondary care. The 2019 Scottish Medical Appraisers Survey Report – which we hope to publish later on in the year – gives further details about the demographics of our appraiser cohort.

The results showed significant differences between primary and secondary care in many areas. The numbers in the ‘other’ category were very small making it difficult to draw any conclusions from the results for these respondents. While the majority of appraisers responded that appraisals have a positive impact, just over a fifth of secondary care appraisers feel that is not the case as the tables below demonstrate.

Free text comments showed that the opportunity to reflect on the current practice and development with a peer in a confidential discussion is seen as valuable, providing both personal and professional support to the appraisee. Several appraisers pointed out that making most use of this opportunity depended on the engagement of appraisees as well as the support they received from the Health Board to implement any changes to their practice. The most commonly cited reasons why appraisal did not have a positive effect were that improvements would happen anyway, and that revalidation has contributed to a more tick box approach to appraisal which has hindered reflections.

We asked appraisers how they calibrated their practice as an appraiser. The most common means were reflection on appraisee feedback and local meetings. Just over 10% of secondary care appraisers replied that they either did not do this or did not understand the question.

Looking at the appraiser’s own appraisal, the most commonly used pieces of supporting evidence for the appraiser role were Form 6 feedback and reflective templates in the appraiser role. Summaries of 1-2-1s with the appraisal lead were used by just over 40% of primary care appraisers but only 5% of secondary appraisers.

This may be a reflection of the different levels of support appraisers receive in primary and secondary care. Primary care appraisers feel more supported in their role and have accessed 1-2-1s with their appraisal lead in 72.5% of cases. In secondary care this only happened for 8.8% of appraisers. Across all areas appraisers sought support and advice mainly from appraisal leads and fellow appraisers.

All primary care appraisers had accessed some resources to develop in their appraiser role. We asked for comments where appraisers had not accessed developmental resources. This showed that the majority of the 34 people who replied to this question did not have the time or were not aware these resources existed.

Overall, these results show most appraisers see appraisals as beneficial. A higher proportion of secondary appraisers do not think it has a positive impact and there were many comments that it is seen as too burdensome, and that revalidation has led to an increase in a tick-box approach to appraisals. There is also a significant difference in the support provided to appraisers between primary and secondary care. The NES team will explore this further and consider how we can update and improve the training and ongoing support for appraisers as well as supporting the appraisal leads and responsible officers to make local improvements.

References:

¹ Caesar S, Hellewell C. RCGP Appraiser Support Survey, 2019. Royal College of General Practitioners; 2019.

Dr Christiane Shrimpton
Associate Postgraduate Dean for Appraisal and Revalidation