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Birthdays, appraisals and Harold Shipman

This summer our anonymous GP didn’t spend her birthday celebrating. She spent it preparing her annual appraisal, and it’s all because of a prolific serial murderer.

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Illustration of a GP trying to jump over an oversized appraisal document with a calendar on the other size flagging up her birthday coming up soon.
The Secret GP. Source: Pui Yan Fong for Wellcome Collection. © Pui Yan Fong.

Most jobs involve a fairly simple yearly appraisal. My partner is a professional, and he prepares for his in half an hour the night before. He writes a few ambitions for the year, ticks the boxes to say how wonderful he is and then the following day his boss does likewise. Job done.

Not so for GPs, and mostly because of Harold Shipman. Shipman killed over 200 of his patients between the 1970s and 1990s, and in 2000 was sentenced to life imprisonment with no chance of release. He hanged himself in his cell in 2004.

His crimes led to many changes within medicine, including a process of rigorous annual appraisal and recertification every five years for UK doctors.

Weeks of preparation

The idea was that a thorough system would identify underperforming doctors and maintain standards within the GP workforce. It would also keep an eye on those with potential mental health problems. Hopefully, if there ever was another Harold Shipman, he would be much less likely to get away with his crimes for so long.

Of course, most GPs are not mass murderers. I like to think that we are generally caring and hardworking! And nobody can really argue that it isn’t a good idea to check on doctors’ performance and address any concerns early.

You might think – why the fuss? It’s only an appraisal, after all.

But the lasting effect of the post-Shipman changes on the GP appraisal system in England has caused us hours of additional work and stress. It has even resulted in the early retirement of many GPs who just did not want to do the extra work on top of everything else.

My appraisal takes weeks of preparation. I dread it all year round. I’m given one half-day of paid ‘appraisal leave’ to prepare for it, but then spend multiple evenings on it as well.

One study showed GPs, on average, spend 55 hours preparing. This is generally in their own time, on top of the 12-hour days I mentioned last time.

Complaints, compliments and feedback

The appraisal document is most certainly not a tick-box exercise. I need to list which teaching sessions I’ve attended, and include information about audits, mistakes and interesting cases, as well as detailing complaints, compliments and feedback from patients and colleagues.

All the entries made then require ‘reflection’ – or personalised thoughts – on how what I have learned has improved patient care or contributed to the development of our practice.

This year I need to collect patient satisfaction questionnaires also, which feels wrong. How do you ask at the end of the consultation for an email address and would they please fill in a questionnaire about the way I cared for them?

Some of my patients have been in tears during the consultation, and others may have been annoyed because they didn’t get the sleeping pills or antibiotics they wanted. Are they are going to give me fair feedback?

At present GPs are leaving the NHS in droves, mainly due to high workloads. GPs are working far too hard and are exhausted – the last thing they need is an extra 55 hours of unpaid work every year to get through their annual appraisal.

The icing on the cake

A couple of years ago some bright spark had a rather mean-spirited idea: GPs’ appraisals should be in their birthday month, instead of them all being in February.

It probably doesn’t sound too unreasonable to spread out appraisals over a year. But, actually, I like my birthday and usually try to plan something nice. It’s in the summer when I would rather be on holiday, not spending every spare moment preparing for my appraisal.

Now I think of my birthday and my heart sinks – my appraisal! It’s become just about the worst time of the year.

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The Secret GP

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