The implications of enhancing appraisal to meet the requirements of revalidation, as perceived by appraisers: a qualitative study in Scotland.

This paper describes a qualitative study which explored the possible impact of enhanced appraisal and the requirements of revalidation upon GP appraisers in Scotland. So far there has been little research examining the impact 'enhanced' appraisal may have on the appraisee or appraiser population. Key objectives were to identify potential benefits and problems with the introduction of enhanced appraisal for the appraiser population and to explore what they perceive its impact will be on the GP workforce more generally. Three focus groups were held with a purposive sample of 17 highly experienced GP appraisers from across Scotland between February and April 2010. The results showed that this group of appraisers perceived that they would need to become more prescriptive about the standard of basic paperwork and evidence that is submitted by an appraisee. This created some anxieties about taking on a more judgemental role. They were concerned about a possible need to inform a high-achieving GP that their evidence was insufficient. Concerns were also raised about appraisees becoming less open and candid during appraisal once the links to revalidation are in place. Uncertainty was expressed about the relationship between the appraiser and responsible officer (RO) and how appraisers should decide which appraisees ought to be flagged up to the RO. The need for clear, standardised summary forms (known as GP Scot 4 in Scotland) to be passed to the RO was highlighted. Some of the appraisers were unsure about the value of new types of evidence which will be required--notably MSF and continuing professional development (CPD) credits. However, a few appraisers noted that some early adopters of CPD credits liked this way of recording their learning whilst MSF could be valuable and was seldom controversial. Potential benefits of 'enhanced appraisal' were highlighted--particularly increased engagement from some GPs who have hitherto been reluctant appraisees. The appraisers in this study wanted further training for their role, particularly training and calibration in delivering MSF feedback and in verifying CPD credits. They were frustrated by delays to revalidation and concerned that enhanced appraisal might be implemented without sufficient support (remediation and IT systems) being in place. However, they remained cautiously optimistic that some of the formative elements of appraisal can be maintained and were content to continue as appraisers provided they receive appropriate training and support and provided adequate remediation systems are in place for those GPs requiring help.