Appraisals for well-being and resilience of GPs
Appraisals for well-being and resilience of GPs
We are writing to share our disappointment with the latest decision to call for suspension of GP Appraisals during COVID-19 and to ask the RCGP Council to reconsider its stance. We outline our experience of appraisals since restoration of appraisal process, to demonstrate why we believe it has become more important than ever to offer appraisals during COVID-19.
It is our firm belief that to take a doctor out of practice for 3 hours - 30-40 minutes preparation and 2-3 hours of meeting - is a tiny portion of their working time and a huge investment in their sanity and working future. Informal feedback following appraisals has been very positive and suggests that this small window of “me-time” has been both productive and appreciated. Framing appraisal as a burden as opposed to a supportive process is not a helpful view to progress and may deprive GPs of support they really need and might otherwise not access.
Pre-Covid appraisals were already described as one time when doctors get to talk about themselves and express their vocation rather than “holding back their own needs in order to support others”. Since the pandemic, doctors have allowed their own needs to be supressed more than ever. GPs we have met feel distressed and demoralised, particularly by negative press about GPs leading to some patients taking it as a licence to fling abuse our way. Overwhelmingly, GPs have had distress or trauma to deal with, not necessarily due to specific patient care, but often to do with working in such strange times. They report having to deal with sick and dying patients, in a way that has not been usual practice or, more uncomfortably, that has called upon us to interpret our roles against the grain of usual practice. All the things we usually rely on going well - home life, family support, leisure time - have been under pressure and for some doctors,work-life balance has gone under.
Appraisal was re-started in October with the expressed intention of providing support to GPs working under the pressure of Covid-19. Appraisers have all been trained to use the appraisal discussion to focus on the GPs’ health and well-being, and personal and professional development at this very difficult time. Sign-posting GPs who are struggling to a range of sources of support is a key function of the 2020 appraisal model, and there is clear evidence that this is already happening. A significant effort has been made to reduce the preparation to a maximum of 30 minutes, and if a GP cannot even manage this amount of time in preparation, the guidance we have received is still to go ahead with the appraisal meeting and provide whatever support is needed for the individual GP.
Those of us who are senior appraisers have received feedback from our appraiser locality groups that their appraisees have not found the appraisal preparation onerous. Their appraisees have reported meetings to be supportive and for the ones facing difficulty (personal or work) a safe space to offload. Some appraisers were, perhaps like Council members, initially reluctant to restart appraisal with their own practice workload. They were concerned about managing to do appraisal related work amongst mounting clinical work. However, they have found it a welcome opportunity to meet with colleagues, provide support with the stresses they are experiencing and find facilitating these discussions enormously satisfying.
We have reflected on Council’s decision in great detail and carefully considered whether our testimony is conflicted or less valid, just because we are paid to appraise. Our concerns are not financially motivated. We were drawn to the appraiser’s role having experienced great benefit from appraisals. We are convinced that having delivered appraisals since the suspension was lifted, we are seeing a real need for them in a professional group of doctors who can be too busy to recognise the need for help or seek it out until their personal situation has deteriorated significantly.
We believe that Council’s decision is a retrograde step in terms of offering important support to GPs via appraisal at this very stressful time. It has been our usual experience that college has stood up for positive and supportive actions for GPs, while political and bureaucratic institutions may take actions that undermine the profession. On this occasion, when GPs need the College most, disappointingly Council has chosen to vote for a measure that would deny vulnerable GPs much needed support, if appraisals were suspended again.
We would like to urge the RCGP Council to reconsider its decision and listen to our feedback, as GPs who know and understand the appraisal system processes and its enormous benefits.