If you have read our article ‘Do I need to do an appraisal as an F3 or Locum doctor’ then you should now understand who does (essentially every non-training UK doctor) and who doesn’t (a few people with mitigating circumstances) need to do an annual appraisal in the UK. 

You probably fit into the ‘requires annual appraisal’ category, right?

Now you need to understand what you need to prepare for your annual appraisal because the GMC guidance on this is confusing and to put it delicately, rather dry. 

Luckily for you (for us it was rather tedious and exhausting), we have gone through all the GMC guidance for you and have created a nifty set of resources, templates, guidance, and tools for you to use when preparing for your appraisal.

For a summary of what appraisal evidence the GMC requires of you - keep reading here, but if you want to explore the other articles and resources in our appraisal and portfolio series, click any of the links below:

👉  Top tips for acing your appraisal
👉  Do I need to do an appraisal as an F3 or locum doctor?
👉  How to build an incredible medical portfolio in 3 easy steps
👉  How investing in your portfolio will help you prepare for appraisal
👉  Meet our Portfolio Companion - your ultimate guide to medical portfolios

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🩺  What is the GMC’s Good Medical Practice guidance?

This topic is pretty confusing, so we will start slow and simple… 

The GMC created a document called Good Medical Practice. This document defines what it means to be a good doctor. This definition is central to your career as a doctor, and you will eternally be required to show how you are working towards this ideal doctor. 

They break down this definition into four domains, and in each domain, they list a series of statements describing a good doctor. 

They call these the ‘Duties of a Doctor’, and they are:

Domain 1: Knowledge, skills and performance 

👉  Make the care of your patient your first concern. 
👉  Provide a good standard of practice and care by keeping your professional knowledge and skills up to date and recognising and working within the limits of your competence. 

Domain 2: Safety and quality 

👉  Take prompt action if you think that patient safety, dignity or comfort is being compromised. 
👉  Protect and promote the health of patients and the public. 

Domain 3: Communication, partnership and teamwork 

👉  Treat patients as individuals and respect their dignity by being polite, considerate, and respectful of a patient’s right to confidentiality. 
👉  Work in partnership with patients by listening to and responding to their concerns and preferences, giving them the information they want or need in a way they can understand, respecting their right to reach decisions with you about their treatment and care, and supporting them in caring for themselves to improve and maintain their health. 
👉  Work with colleagues in the ways that best serve patients’ interests. 

Domain 4: Maintaining trust 

👉  Be honest and open and act with integrity. 
👉  Never discriminate unfairly against patients or colleagues. 
👉  Never abuse your patients’ trust in you or the public’s trust in the profession

✅  Key point: Your appraisal aims to demonstrate your ongoing commitment to being the doctor described in these statements. 

🥼  How can I demonstrate my commitment to these principles?

This is where things start to get a little more complex… 

The GMC further breaks down each of these duties into a series of statements you must or should meet.

For example, some of the statements from Domain 1: Knowledge, skills and performance are:

👉  You must be competent in all aspects of your work, including management, research and teaching.
👉  You must keep your professional knowledge and skills up to date.
👉  You must regularly participate in activities that maintain and develop your competence and performance.
👉  You should be willing to find and participate in structured support opportunities offered by your employer or contracting body (for example, mentoring). You should do this when you join an organisation and whenever your role changes significantly throughout your career.
👉  You must be familiar with guidelines and developments that affect your work.
👉  You must keep up to date with, and follow, the law, our guidance and other regulations relevant to your work.
👉  You must take steps to monitor and improve the quality of your work.

To put this into context, these are the statements from one sub-section of domain 1. Domain 1 comprises three sub-sections in total and is one of the smaller of the 4 domains. In summary, the list of statements is huge. You can see the full list here.

When you attend your appraisal, your appraiser may go through each of the duties of a doctor in turn and ask you to show evidence for each one, but it is more likely they will simply infer it from the conversation that you have together. 

✅  Key point: There is a long list of statements for what you must or should do to show your commitment to each section of the Good Medical Practice Duties of a Doctor. However, you are not required to provide unique evidence for every single one at your appraisal. 

💼  What do I need to show at appraisal?

In order to show you are committed to being the doctor described above, you must collect ‘evidence’, reflect on it, and discuss it with your appraiser at each appraisal meeting. 

For the most part, the GMC doesn’t specify what constitutes ‘evidence’ for meeting these principles and instead puts the responsibility on you and your appraiser to decide whether you have ‘done enough’ in each area each year. 

This means that for the most part, you can tailor your appraisal evidence to match your interests and fit with your own schedule. You may need to ‘demonstrate that you are keeping up to date with national guidance and improving your knowledge’, but how you do that is up to you. You could attend conferences, lectures or online courses, read textbooks or journals, take exams, watch films or even reflect on your own experiences. Our Portfolio Companion has tips, tricks, and templates for collecting evidence however best suits you.  

However, there are certain things that the GMC does require you to show evidence of each year or each revalidation cycle. They are:

👉  Continuous Professional Development
👉  Quality Improvement Activity
👉  Significant Events or Serious Incidents
👉  Feedback From Patients and Colleagues
👉  Compliments And Complaints
👉  Probity and Health Statements 

We go into each one in a little more detail below, but if you want the comprehensive overview of each, then visit our Portfolio Companion by clicking each subject above.  

✅  Key point: It is mainly the responsibility of the appraiser and doctor to decide what evidence will be needed to show that the doctor is meeting the principles listed. However, there is some evidence that the GMC states you must collect. 

📝  What evidence is mandatory?

Continuous Professional Development

Continuing Professional Development (CPD) is the term used to describe the ongoing learning activities that professionals do to develop and enhance their abilities. 

Engaging in CPD activity shows that you are working to improve your medical knowledge and skills. 

The GMC does not mandate a specific number of CPD points (aka hours) you need to do each year, but generally, a full-time doctor would aim for around 20. 

You can read more about what is considered CPD, how to find CPD opportunities, and how to log it and evidence it at appraisal by clicking here. 

Quality Improvement Activity

Quality improvement involves looking at systems that affect patient outcomes and making and measuring the impact of incremental changes on a system. 

Engaging in QI activity shows that you are actively working to improve your workplace and the NHS as a whole. 

You can read more about quality improvement and how to evidence it at appraisal by clicking here. 

Significant Events or Serious Incidents

Significant events are known by many names (i.e. Significant Incidents, Serious Incidents, Serious Untoward Incidents, or Serious Incident Requiring Investigation). Still, essentially, they are any unintended or unexpected event that could or did harm one or more patients. 

The GMC mandates that you declare and reflect on your involvement in any significant event at every appraisal to recognise trends, identify areas for learning, and discuss whether any change in practice may be needed. 

You can learn more about Significant Events, what to do if you are involved in one, and how to discuss it at appraisal by clicking here.

Feedback From Patients and Colleagues

The GMC mandates that all revalidating doctors must have collected and discussed feedback from patients and peers at least once in each revalidation cycle (every five years).

Collecting and reflecting on feedback is part of the GMC’s expectation around Probity. You should not only be open to receiving feedback from your colleagues and patients, but you are expected to share that feedback and reflect on your learnings from it.

Read more about collecting feedback for an appraisal by clicking here. 

Compliments And Complaints

The GMC mandates that each year you must declare and reflect on any complaints that you are named in and demonstrate learning and any necessary change in practice. This is similar to your obligation to declare any serious incidents or events that occurred in the last year. 

If you are named in any complaints, then it is best to save a record of it as evidence, and use the ‘collect, reflect, discuss’ model to present it at your appraisal. You won’t be punished for having a complaint against you - it is not unexpected that patients who are scared, unwell, confused, and overwhelmed will make complaints. The idea here is to use it as an opportunity for self-reflection and learning and to identify trends that need to be addressed.

You aren’t obliged to share compliments you have received – it is just a nice way to balance any positive and critical feedback you have received in the last year. 

Health and Probity Statements 

You must make an annual declaration confirming that you are fit to practice. This is simply a tick-box exercise and relates to your ‘fitness to practice’ declarations. 

You can read more about probity and health statements here. 

✅  Key point: Some of the evidence you must collect is simply a tick-box exercise, and some takes much longer to collect. You can learn more about each section in our comprehensive Portfolio Companion. 

🖥  How do I submit my appraisal evidence?

In England we use the MAG (Medical Appraisal Guide). It’s a document that can be populated with your evidence to provide a comprehensive overview of your work and progression over the last year. You must open the document in adobe acrobat reader. However you have collected your evidence (i.e. PDF, excel, word document, scanned documents, photos, screenshots, etc), it can be uploaded to the MAG in the relevant section. 

We explore this in more detail in the Portfolio Companion, including pictures of each page of the MAG and an explanation of how to upload your evidence. 

There are different appraisal processes in Wales, Northern Ireland, or Scotland.

✅  Key point: If you are in England, you will upload your evidence to the MAG form in the relevant section. The process is similar in Wales, Northern Ireland, and Scotland but uses different forms and processes. 

📑  In Summary

👉  The purpose of your appraisal is to demonstrate your ongoing commitment to being the doctor described in the GMC’s Good Medical Practice ‘Duties of a Doctor’. 
👉  There is a long list of statements for what you must or should do to show your commitment to being that doctor. However, you are not required to provide unique evidence for every single one at your appraisal. 
👉  It is mainly the responsibility of the appraiser and doctor to decide what evidence will be needed to show that the doctor is meeting the principles listed. However, there is some mandatory evidence that the GMC states you must collect. 
👉  Some mandatory evidence you must collect is simply a tick-box exercise, and some take much longer to collect. You can learn more about each section in our comprehensive Portfolio Companion. 
👉  The Portfolio Companion is a compendium of useful information and guides for getting through your appraisal, including tips on collecting evidence and how to upload it. 
👉  If you are in England, you will upload your evidence to the MAG form in the relevant section. The process is similar in Wales, Northern Ireland, and Scotland but uses different forms and processes. 

We hope all of this information has cleared up the mystery and confusion around the GMC’s good medical practice document and how it relates to appraisal. However, if you still have questions, then you can either check out the rest of the articles in this series or get in touch with us at support@messly.co.uk.

Explore the other articles and resources in our appraisal and portfolio series:

👉  Top tips for acing your appraisal
👉  Do I need to do an appraisal as an F3 or locum doctor?
👉  How to build an incredible medical portfolio in 3 easy steps
👉  How investing in your portfolio will help you prepare for appraisal
👉  Find out what actually happens in an appraisal meeting
👉  Meet our Portfolio Companion - your ultimate guide to medical portfolios

This article is part of a wider series of resources designed to support doctors through the process of building great portfolios. The heart of this is Messly’s Portfolio Companion, which is a detailed set of guides, templates and tools to help you build and manage your portfolio with confidence. For other articles and discussion on the topic, click here.

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