Guide to independent sector appraisal for doctors employed by the NHS and who have practising privileges at independent hospitals – whole practice appraisal
An agreement between the British Medical Association and the Independent Healthcare Forum
March 2005
During 2005 the General Medical Council (GMC) will require all practising doctors to hold a "Licence to Practise" (Licence to Practice and Revalidation for doctors'). Through the process of 'revalidation' it will help to ensure that doctors are up to date and fit to practise medicine throughout their careers.
[Update - March 2005: Following publication of the Fifth Report of the Shipman Inquiry in December 2004, the Department of Health announced a review of the Inquiry’s recommendations, including arrangements for the revalidation process. The GMC has therefore postponed the launch of revalidation until the outcome of the review is known. However, under the National Minimum Care Standards for Independent Healthcare Providers, annual appraisal remains a requirement for all doctors working in the independent sector.]
The GMC believes that "full participation in annual appraisal, with completed supporting documentation, during the revalidation cycle is a powerful indicator of a doctor's current fitness to practice" 'Licence to Practice and Revalidation for doctors', (provided it is undertaken in their principles of "Good Medical Practice" and operated within a quality assurance system). In parallel, the Healthcare Commission requires doctors to renew their practising privileges every two years National Minimum Care Standards, Standard C10.
This document was drawn up by the British Medical Association and the Independent Healthcare Forum (IHF) in agreement with the Departments of Health, England, Wales and Northern Ireland in order that the principles of whole practice appraisal can be implemented. The Health Department in Scotland is currently being consulted. The GMC has also been consulted on this document and is in agreement with its contents.
Appraisal is a common gateway to both processes: a positive process to provide feedback on performance, chart continuing progress and identify development needs. The outcome of appraisal will provide documentation for doctors, which they may subsequently present for GMC revalidation. In addition, annual appraisal is now a requirement of the National Minimum Care Standards for Independent Healthcare Providers, (regulation 19 (1), standard A.3.2).
- Doctors employed by the NHS and who work privately, are recommended to participate in whole practice appraisal within their NHS appraisal, to cover all elements of their practice.
- Appraisal will take place in the NHS using NHS appraisal forms together with data provided in appendices A and B (models of forms) available from private hospitals.
- For the initial whole practice appraisal, appendix A will be required by the NHS for its appraisal process. Once the first appraisal has been completed, form 4 should be sent to the private practice provider and appendix B completed.
- Forms 1, 2, 3, 4 and 5 apply, (form 6 is optional).
- Appendix 'A' is an example model for the common data set provided by the private hospital for the purpose of whole practice appraisal and renewal of practising privileges (as agreed between the BMA and the IHF). It details advice for the collection and type of data that is required. Appendix 'A' should be signed by independent sector providers for retention by the consultant, as part of information kept within their revalidation folders.
- Appendix 'A' should be requested by the consultant from the private provider in good time before the appraisal.
- Appendix 'B' is an example certificate for the renewal of practising privileges and should be signed by independent sector providers for retention by the consultant, as part of information kept within their revalidation folders.
- If a consultant has practising privileges with more than one independent provider, the same information (i.e., appendices A and B) will need to be provided from each independent hospital. They will be considered together in the NHS appraisal.
The appraisal process should be based on models agreed between the Department of Health (DoH) and the BMA for the NHS, which were subsequently modified for private sector use by the IHF and the BMA (in agreement with the DoH). All doctors holding NHS contracts are required to be appraised through the NHS system.
The appraiser will usually be the Clinical Director. The appraiser must be able to cover clinical aspects and matters relating to service delivery. If the Clinical Director is not on the medical register, the medical director should conduct the appraisal or select a suitable lead consultant or other appropriate consultant to do so. The appraiser should have received appropriate training in appraisal skills.
Both appraisee and appraiser should agree the data to be provided and the timetable to complete these forms in a preparatory discussion at least two months before the formal appraisal discussion. They should agree on the information and activity to be included and on the time, place and length of the appraisal discussion.
The appraisee should complete and submit Forms 1 to 3, at least two weeks before the discussion, accompanied by the best available supporting evidence and documentation. The appraiser may complete the forms immediately after the appraisal, and will complete Forms 4 and 5; the finalised version should be agreed before signing and added into the appraisee’s revalidation folder. The appraiser and appraisee should retain copies. A copy of form 4 will be sent to the Chief Executive of the NHS Trust and the private provider Hospital Manager(s).
An exit appraisal should normally be arranged on resignation, retirement, or cessation of practising privileges; this would be helpful for any future revalidation.
Renewal of practising privileges
Doctors will be required to carry out a renewal of their practising privileges every two years. This guidance includes a list of data to be collected for the practising privileges process against the headings of 'Good Medical Practice', laid down by the General Medical Council and model appraisal forms for completion with the independent sector provider(s) (this summarises data provided to the consultant in relation to their private practice).
Consultants are encouraged to use the model checklist in Appendix 'A' as the private practice component of their whole practice dataset, (to be included within their whole practice appraisal to be undertaken in the NHS) as well as to gain practising privileges.
Practising privileges documentation should be requested from independent hospital providers.
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Form 1 - appraisal folder background details
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Form 2 - details of your current medical activities
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Form 3 - record of reference documentation supporting the appraisal and report on development action in the past year
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Form 4 - summary of appraisal discussion with agreed action and personal development plan
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Form 5 - personal and organisational effectiveness
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Form 6 - detailed confidential account of appraisal interview
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Appendix A - checklist for completion by the independent sector provider
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Appendix B - certificate of renewal of practising privileges
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