Quality assurance of appraisal summaries.

Objective assessment of whether doctors meet the General Medical Council (GMC) standards for revalidation1,2 is a new challenge. In Hertfordshire GP senior appraisers started to quality assure appraisals in January 2013 with the aim of ensuring that they were up to sufficient standard to enable the responsible officer to base revalidation recommendations on their outcomes. A quality assurance form was developed, and all appraisal summaries were allocated to one of seven senior appraisers to be checked against the form. After 3 months the senior appraisers were sent (without knowing it) the same appraisal summary to ascertain whether this process was accurate and objective. The results showed surprising lack of unanimity. In some areas there was total agreement, for example: whether last year’s personal development plan had been reviewed; whether it covered the scope of the doctors work; whether a balance of different types of educational activity was maintained; and whether patient and colleague surveys with reflection were present. However there were complete splits on issues that we had expected to be cut and dried. There were 5:2 splits on whether learning credits were discussed and verified, whether complaints/ audits with review and reflection were present, and whether statements were objective and supported by evidence. There were 3:4 splits on whether last year’s appraisal summary had been reviewed and discussed, and whether two significant events were present with reflection and learning points. This is a work in progress. We have discussed these results and revised the wording and the statements on the QA form. Furthermore this is a tiny sample, of one appraisal summary and seven senior appraisers’ views of it. However, revalidation is now with us, and our findings suggest that application of the GMC minimum standards for revalidation decisions may be problematic.