Monday, 29 August 2011

Appraisal made simple.


Once a year as a doctor in the UK one has to reach an intellectual low point the ultimate test of medical retardation called appraisal. This we suspect to most doctors is like pulling your own teeth out with a mole wrench while being told you will look better for doing so and it won’t hurt a bit. It is like the “What I did in my summer holidays” essay at school when you were the only kid in the class who hadn’t been to Disneyland it is so painful and like the essay a complete waste of time and effort achieving nothing but happens each year.

Appraisal, although officially denied by those who missed Harold H. Shipman the multiple mass murdering GP in the UK, was introduced by the GMC as part of licensing and revalidation all of which are tools to curtail professional freedom and ensure that all doctors are dumb ar*ed Party organs. Harold H. could at least objectively quantify his achievements something that the gentlemen’s club cannot but Harold H. was of course not the GMC’s fault. How could it ever be? It is a bureaucracy that costs doctors who actually do real work dear each year.

Check the GMC website here and see how easy it is to identify a crap doctor. Can you find a dodgy doctors’ list here?

We have on several occasions identified dodgy doctors and checked the helpful GMC website and their details have been wrong. We have then informed the GMC and it takes at least two attempts per doctor to change things. Some examples of dodgy doctoring we have come across in our collective careers include such minor infringements of high professional standards like accessing highly dodgy porn while allegedly working or giving false qualifications. The initial phone calls were ignored as was a subsequent letter sent recorded delivery until someone who could read found it by chance.

We follow the individuals concerned with interest in the hope that concerns reported do not result, a quarter of century later, in the next Harold H. Shipman. We have discharged our duty as doctors in the field but has the GMC done its protecting patients bit?

The great thing about the GMC is that although it now provides licenses (not the ones we would really like) called licenses to practice if you resign from the gentlemen’s club then they have no sanction against you. We have seen this locally too and the only sanction relatives have is the legal one and so a protective GMC is a totally toothless tiger when protecting patients in contrast to its full set of armour plated nashers when savaging the profession. It has failed to protect and anyone who has failed in any NHS managerial capacity gets away with it and just carries on.

Enough of the grunts’ rants. If the officers are incompetent then the grunts will fail. Not a problem in war you just die but when patients are harmed someone may just get sued and more importantly patients get hurt due to incompetence. Hurting patients is not on but still the regulators blame and penalize all the doctors for their regulatory failings.

There are a variety of other medical bloggers who have realized the self same things about appraisal, revalidation, licensing and those in charge. Have a look here, here and here for a selective snap shot but type GMC into their blog search engines and there is plenty more to read. Remember power corrupts and absolute power (with no accountability) corrupts absolutely.

Although officially denied on its web site (Q. 8) that “appraisal”, which is part of “revalidation”, is in response Harold H. Shipman can you see anywhere a reference to Harold H. on its timeline? Neither can we but that must be because some of us haven’t yet had our annual appraisal and so will be nearing the end of the boosting charge to doctor performance that is the annual appraisal. Appraisal is that impo(r)tent to making us perform better as doctors after it just like the summer holiday essay turned us into budding Shakepeares.

You can imagine how appraisal was “thought” of as any doctor married to a nurse in the UK will have had this, or a similar, conversation in the last 10-20 years prior to doctor appraisal being brought in.

Picture the scene thus:

The Gary Grant like doctor, a member of the GMC, is cuddling up to Doris Day his wife, a caring nurse manager, in full body pyjamas in their separate single beds after they had both had their full days “work” in their respective “managerial” but hands off patient caring roles. If Gary and Doris don’t do it for you imagine the former Chief Medical officer Sir Liam Donaldson and the former Chief Nursing Officer Dame Christine Beasley instead who brought all this in. The sick bags are located in the seat in front of you if needed.

GC: Darling, the GMC have asked me to come up with something cracking to check that all doctors in the UK are all damned good chaps.

DD: Really darling? Why would they need to do that? You are all such good sports and pay for my swimming pool, Porsche and all I have to do is to lie here on my back and think of England. I get paid as well for doing absolutely nothing at one’s splendid hospital as a modern matron.

GC: Oh darling do not be so gay with these matters. I haven’t got a clue what to do but need an answer by tomorrow, my dear love.

DD: But darling that is why you work for the GMC? Oodles and oodles of money for doing absolutely nothing worthwhile!

GC: You are right as always darling, I forgot about that, but you are such a top hole sport can you help?

DD: I think I might just be able to help you. We nurses have a completely useless system called appraisal. Nobody likes it, it achieves absolutely nothing but piles of paperwork and the killers get away with it all the time. What do you think?

GC: Splendid idea Doris! I can feel one of those jiffy moments coming on and will present this as an original idea tomorrow at the GMC. Should be easy to get though as I pull a string and everyone votes yes. I am sure it will work as well as the crystal set I put into my car although the radio does go on and off over every bump but someone has to try “new” ideas despite the ups and downs.

And so appraisal may have been born for the medical profession after it had failed elsewhere and continues to do so.

If you think appraisal for GPs is quality tough stuff check out this link.

Have a read of the forms and remember all a doctor has to do is write something in the boxes. Nowhere is the care given by that doctor actually assessed. Not once in all the years that appraisal has been running have we been ever asked to show even one set of patient records. Just the filled in appraisal forms. Convinced this will ensure good quality doctors? Read on.

Check out this link for “minimum appraisal standards” here. Think Harold Shipman as you do so and substitute the word worthless for limitless in the first sentence.

We believe that he met all the then current educational “standards” and had to provide certificates of attendance at courses to qualify for educational payments called Post Graduate Educational Allowance (PGEA). That’s right to qualify for payment not to check quality of care.

We will say the word again payments so no conflict of professional interests, or of professionals maintaining their own professional standards because they think it is the right thing to do.

In summary before the more rigorous system of appraisal if you sat on your ar*e at any educational meeting and got enough certificates you were deemed a “good” or Shipman equivalent doctor. Collect your PGEA money, pay your GMC fee, no questions asked so carry on killing doctor.

Given the fact that a lot of “educational meetings” were sponsored at posh restaurants and hotels by drug companies you can rest assured that all doctors with a full PGEA payment were uninfluenced by commercial organizations only by their “love” for (money) professional advancement (and good food) which some of us have always done for nothing using the time honoured method of reading original research and doing something verboten in the current NHS thinking what is best for the individual patient not following a Party (or drug company sponsored) diktat.

We regard this as part of the job if you are a “professional” and we do this for free and do not collect “trophies” for doing so. Others however feel that keeping up to date should be paid for and rewarded with little baubles.

Check this site for it provides the “minimum” paperwork you need to comply with appraisal paperwork. You can fill it all in less than half hour. Have a read of a structured reflective template and see if you can fill them all in with something you made up that might appear real.

If you are struggling then an episode of the BBC’s Doctors soap will be more than you will need to do so. The soap is a fictional work but patient care is non fiction. Appraisal in minutes, we have done this in 20 minutes and the best bit of it was nobody read any of it but we completed our appraisal. We found this by chance (just read post #16) doing our research so it appears that others do even less than this. See how long the Party and its organs feel you spend (top of second page) on your “What I did in my summer holiday” essay here.

So current GP appraisal consists of telling a local colleague how wonderful you are in 2 hours while your colleague gets a bung of about 500 quid to sit and listen to you after a 2 day training course to become an appraiser and identify any proto Harold H.. They may even have read the sh*te you wrote on the forms but often don’t. They are getting so bored with the process, probably because no-one likes doing it and rightly so for appraisees (notice the subservient term aka trainees) are giving the Quislings a hard time so now that the whole thing takes just over an hour.

Appraisal is meant to be part of revalidation for doctors a process that is so straight forward an idea that the other great medical gentlemen’s club the RCGP have published 5 versions of the RCGP Guide to Revalidation of General Practitioners. Not over many years but between April 2009 and December 2010 so no-one is making things up as they go along are they?

Praise be to the Party for ensuring that Harold got away with murder and was educationally up to date and got paid for it. Thank God the Party and its stooges have realized this and tightened things so much up that what Harold could do in hours of education you can now do in less than 30 minutes of downloads and a 2 hour (or less) chat called appraisal.

In order to practice as a GP you have to have been appraised but before you can fail as a GP in the eyes of the GMC you have to have passed appraisal. Makes sense doesn’t it? Protecting patients guiding doctors?



6 comments:

Doctor Zorro said...

So if we all feel like that, (and most of us do) why don't we boycott the entire appraisal/revalidation process en masse. If we told them as a united profession where to stick it their only possible response would have to be to ask how far up.

Razer said...

I think we all feel it in the same way.

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Northern Doc said...

Thanks for your comments. Unfortunately Dr Z doctors are a very intelligent group of fools led by idiots so such as you suggest rarely happens even though most of us think it is a pointless waste of time.

Muhammad Shoaib said...

Top post. I look forward to reading more. Cheers
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David Harley said...

Though your post has raised a very important point to ponder but I think that GMC revalidation is still undergoing improvement by taking into account the reviews and comments from the doctors. Fr further information about appraisal and revalidation you can visit http://www.licencetopractise.co.uk/