Monday, 28 May 2018

Appraisal Appraised

Not long ago I posted on the utter waste of time that is "Mandatory Training". I pointed out that the obsession with this bollocks takes doctors away from their patients for a not insignificant period of time, to learn stuff, much of which is of no relevance to their profession whatsoever.

In similar vein I thought I'd look at that universally reviled, ridiculed and disrespected process of annual appraisal.

As Doctors we are used to the concept of examining potential therapies for our patients on the basis of how the potential benefit balances against the potential downsides. We look not only at the  expectations of therapy, but also the possible adverse effects, and, ideally, present these facts to the patient, to ensure truly informed consent. We also consider cost.

So how does appraisal stack up using this approach?

1. Benefits of annual appraisal.
This of course is going to be difficult to objectively assess. The GMC approaches this difficulty by not even trying. Their concept of "success" seems to rest heavily on compliance rates. Almost all doctors are now participating in the process and that alone is considered success. But participation is not enough. There is little reason to believe that this man should not have been able to comply and retain his license to practice. The GMC would have considered that a success

 Although it is claimed that there is evidence that the profession has a very positive attitude to the process, this appears to be based entirely on surveys. Try getting research published where the database consists entirely of surveys and see how far you get.
The claim is that appraisal and revalidation will identify underperforming doctors and thus raise the standard of practice. Really?

So how come that, as the GMC admits, complaints made to the GMC about doctors have doubled in the last 4 years? Doesn't speak of a raising of standards does it?
How about claims against the NHS for clinical negligence? In 2004/5 there were 5609 such claims, in 2015/16 there were 11000, and in 2016/17 a staggering 17338. The numbers are rising steadily and apparently inexorably. That doesn't support the idea that standards have risen since appraisal came along either does it?
Excess hospital deaths show the same trend.
Let's face it, the assertion that appraisal and revalidation improves standards is not supported by evidence.
So Benefits?   Zero!

2. The downsides.

GMC propaganda would have you believe that doctors are warming to the concept of appraisal. Odd... I have yet to meet a single doctor who has any respect or regard for the process at all. Indeed there is evidence that most find the process demoralising to the point where it is a significant cause of  doctors taking early retirement. Or deserting the UK altogether.
The BMA estimates that annual appraisal takes the typical doctor about 40 hours, a full working week, to prepare for and endure. There are approximately 250,000 fully registered medical practitioners in the UK, so that means that total doctors time spent with patients is reduced by 250,000 weeks every year to accommodate appraisal. Assuming 6 weeks annual leave a year, plus 2 weeks study leave a full time doctor will work 44 weeks per year. So appraisal causes the effective removal from the NHS of 5681 full time doctors..............and a part timer. Put another way, if appraisal was abolished tomorrow the NHS would benefit with an effective rise in clinician numbers of 5681, without cost!

Whichever way you look at it, appraisal and revalidation for doctors is a failed experiment. One that virtually no other country has sought to emulate.

An utter bag of shit tied up with string.

1 comment:

  1. I don’t doubt your words at all Dr Z, but surely you must realise that doctors MUST be controlled for the idiots they are presumed to be….?

    Doctors have no place in medicine unless they are regulated to the point where being so interferes with their practice, meaningless though this regulation might be. But you must agree that boxes are ticked, and hell, that is so important!

    Appraisal and revalidation affecting the moral of doctors – who cares – certainly not the GMC in their mighty (controlling) tower, for as we all know, patients will be safer then. Dr Shipman (or his ilk) has passed the test, so all bodes well…

    I left nursing eighteen months ago for many reasons, but particularly as the NMC had jumped on the revalidation bandwagon and desired that I must prove myself fit to practice. I resented this and would not go through it, so left and have never regretted it.

    Anna :o]