NHSE/I agreed position on the provision of appraisal for doctors in England

A letter from Alastair Henderson, Chief Executive of the Academy of Medical Royal Colleges, outlining new guidance on the appraisal process for doctors.

The message has below been sent out today from Maurice Conlon at NHSE/I (acting on Steve Powis’s behalf) through the Responsible Officer Networks in England:-

Dear Colleague

Further to my message on Tuesday, and following discussion at the Professional Standards Delivery Group this morning, I am sharing the following as our current agreed position on the provision of appraisal:

Key lines:

• Doctors: ‘It’s fine to decline’ your appraisal. Remember the Appraisal 2020 model is primarily for your support but don’t press ahead if you need to focus on other things right now.
• Doctors and organisations: If pressing ahead, use the 2020 model, and remember preparation requirements for the doctor are minimal (30 min prep as standard).
• NHS England ROs and teams: keep the situation under active review. A decision to reduce or suspend appraisal processes will be supported, though please maintain the option for doctors who need/want it and please keep the professional standards community informed. Our consistency will come from doing the right thing in each location, even if this means variation across the country.
• Non-NHS England ROs: you must make your own decisions but NHS England higher level ROs will support these and stand by to advise if needed.

Context and rationale for key lines above

With pressure rising rapidly across the system, questions are arising again about the role of appraisal. Indications are that the Appraisal 2020 model is helping to support doctors during the pandemic. This supports the view that appraisal has a role in the overall Covid effort.

However, as the above pressures intensify, coping with daily workload will inevitably take priority over appraisal for a significant number of doctors for now. Also, in several sites appraisal staff are being deployed to direct Covid priorities. Finally appraisers themselves may need to reduce their availability, for example so that they can support the vaccination programme. This has already led some regions to decide to reduce or suspend their appraisal programme.

The Professional Standards Delivery Group met today to air this issue, with the following agreed position. This is appropriate to the current situation and equally consistent with the letter from Professor Powis of 3 September 2020 (attached).

For NHS England responsible officers, their teams, appraisers and doctors:

• A doctor connected to NHS England is free to decline their appraisal invitation without any negative implication.
• A doctor agreeing to proceed with their appraisal should follow the simplified Appraisal 2020 model, and spend a very limited amount of time preparing (around 30 minutes).
• An NHS England responsible officer who decides to reduce or suspend appraisal activity will be supported by the national responsible officer and the professional standards community in NHS England and Improvement. Please confer with the central Professional Standards Team and/or your higher level responsible officer about this if circumstances permit. You are also asked to continue to make appraisal available for individual doctors who will benefit from it if at all possible.

Responsible officers in other designated bodies in England:

• are encouraged to engage with the Appraisal 2020 model as a way to support their doctors’ professional development in the context of the pandemic.
• hold the statutory duty to fulfil the responsible officer regulations in that body, so any decision on reduction or suspension rests with them.
• Regional responsible officers are asked to support their responsible officers in other designated bodies, both to use the Appraisal 2020 model and in decisions around reduction or suspension of appraisal processes.

The balance in this discussion is between the need to make space for a doctor to get on with their professional workload and the benefit of taking time out for appraisal to help manage that workload. There is no single answer to this that will work for all doctors and all teams in all situations, so this flexible approach allows for maximum local discretion.

Alastair