How To Ace Your Annual Medical Appraisal As A Locum Doctor

Medical appraisals are unfortunately a necessary part of being a doctor and are a mandatory requirement by the GMC that must be completed annually, regardless of whether you’re in a full-time training post or are locuming in your F3 year.

In this article, we’ll share with you everything you’ll need to know to ace your appraisal. Sharing with you the GMC’s guidance on what information you’ll need to submit, along with our own top tips for collecting the evidence you’ll need to support this.

You can find more about how to arrange this and the costs involved in our article “Do I need an appraisal as an F3 or locum doctor?”.

🕵️  What evidence do I need to collect

There are 6 types of supporting information that you will need for your appraisal, these are:

• Continuous Professional Development
• Quality Improvement Activity
• Significant Events or Serious Incidents
• Feedback From Patients Or Those You Provide Medical Services To
• Feedback From Colleagues
• Compliments And Complains

We’ve provided simplified guidance on these below, but if you want to learn more about these in greater detail, you can do so on the GMC’s ‘Guidance on supporting information for appraisal and revalidation’.

For each of these, you will need to provide reflections that allow you to draw insights into your own clinical practice, career aspirations, or how they fit into the wider goals of the NHS. You’ll also need to explain what you’ve learnt from them, and, where possible, how they have changed/benefitted your clinical practice. The mantra: collect, reflect, discuss works well here.

Additionally, your supporting evidence and subsequent reflections and discussions should include a mixture of the 4 domains of the GMC’s ‘Good Medical Practice’.

• Domain 1 - Knowledge, skills and performance
• Domain 2 - Safety and quality
• Domain 3 - Communication, partnership and teamwork
• Domain 4 - Maintaining trust

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🏋️  Your Personal Development Plan

Personal Development Plans, or PDP, are the main output of your previous ARCPs and medical appraisals (even at med school).

They form an agreement between you and your last appraiser to highlight your learning, development and career needs. The main aim of these is to identify achievable goals for these needs which you will have agreed on measurable actions and a date to achieve them.

As part of your next annual appraisal, your appraiser will want to see your previous PDP to see that your goals are being met.

📖  Keeping a portfolio

How do I collect evidence and where should I store them?

The purpose of your portfolio is to keep a record of the evidence that will demonstrate the 6 types of support information from above.

There are 2 types of portfolios, virtual and paper-based, which you can use. Each has its own pros and cons which we’ll look at below.

💻  ePortfolios

These are virtual portfolios that most of you will be familiar with from your time as a trainee (i.e. eHorus). However, for those that aren’t aware, here’s a quick summary of how they work.

• Once you sign up, you’ll be able to access a number of templates for collecting evidence. These will normally feature additional guidance on how to fill them and what areas to reflect/discuss
• You can pre-fill these forms online and then send them out to your supervisor who agreed to complete them via email - they will then need to sign these and get these back to you. You’ll normally get an alert when this is done

As an FYI - If you’re a trainee planning on locuming through your current Trust’s staff bank, they will normally be able to extend your current membership (i.e. eHorus) for an extra year for free.  If you can’t get an extension or are locuming through an agency, we recommend using MedAll currently as it’s one of the only free ones and has all the forms you’ll need.

☑  Pros

• Easy to use and organise
• Has extra guidance to help you collect and document your evidence
• Has all the templates you need, which you can normally download pdf copies so that you can print these out too
• You can’t lose your online forms

❌  Cons

• Most are very costly if you’re not a trainee
• Chasing up your Consultants and SpRs for signatures via email can be difficult. This is made more difficult if you’re only locuming as a specific hospital infrequently and so you won’t be able to chase these up in person

📃  Paper Portfolios

Exactly as they sound, hard copy portfolios using paper forms.

☑  Pros

• All the forms are available for free from the various Royal Colleges websites, although they can sometimes be tricky to find
• No need to pay for a Virtual Portfolio service
• Easier to get signs off on the spot as you can just hand the form to your senior who’s supervising you there and then. This can be especially useful for ad-hoc locum doctors

❌  Cons

• Need to keep safe - losing it could be disastrous
• Keeping a folder tidy, organised and clean for a year can be a difficult task when you consider how many forms will need to be collected over time

Tips for locums

We recommend keeping a ePortfolio and printing out paper forms as and when you need them. The paper forms can then be digitalized and uploaded onto your ePortfolio for safekeeping.

This makes life a lot easier in terms of organising, but still gives you all the benefits of being able to quickly get a signature.

You can find more free ePortfolios and links to paper forms in our Locum Toolkit, which you can find here.

📚  How much supporting evidence do I need to collect for each?

There’s no minimum requirement for each activity like there is for training jobs. You just need to be able to show through your portfolio that you’re meeting the requirements of Good Medical Practice. This makes it a lot easier to keep a portfolio as a locum doctor than it is in a training job.

Tips for locums

As a locum doctor, you might only be at a hospital for one shift. Nonetheless, you should never let a learning opportunity go to waste. We recommend printing out and carrying a number of paper Case Base Discussion, Mini-CEX,  and teaching feedback forms. You can download these from the Royal College of the specialty you’re working in. This will save you time from trying to try to chase a Consultant or Registar for a signature over email. Plus most people are far more receptive to signing something off for you if they’ve just helped you with it.

6️⃣  The 6 types of supporting evidence

For each of the 6 types of supporting evidence that you collect, you will additionally need to reflect on the events, focussing mainly on how they resulted in actions that improved your clinical practice or relate to your PDP actions and goals.

1️⃣  Continuous professional development

“Continuous Professional Development (or CPD) are any learning event outside of undergraduate or postgraduate training that helps you maintain and improve your performance” - GMC. They can take place in-person or online, but having a mixture of both is usually recommended.

What can be included?

Although CPDs are usually clinically related, you can also include things like finance, leadership and management that are in relation to being a doctor (i.e. we’ve seen CPD courses on NHS pensions). Essentially, it’s anything that will improve your clinical knowledge, provide a better service to patients, keep your practice up-to-date, and affect your practice in a way that benefits your career and increases job satisfaction.

The GMC gives further guidance on this:

The following is a good mixture to aim for to meet the GMC’s definitely of whole practice:

• Formal teaching is organised by your department along with informal teaching organised by your peers and seniors
• Any learning event that supports your achievement of your Personal Development Plan
• Courses in your current, or specialty of interest (i.e. ones organised by the Royal Colleges)
• Conferences in your specialty of interest of any level (regional to international)

What is a CPD point and how many do I need?

CPD points or hours are often used interchangeably and refer to the unit of time that a CPD event, course or module is expected to take. i.e. a CPD course that takes place from 9 am to 5 pm with a 1h break will count as 7 CPD points.

The GMC does not provide a hard number of how many points to aim for and instead states:

Many locum doctors tend to aim for around 20 CPD points for the year which is very achievable. However, don’t worry if you’ve got a bit less.

Where can I find CPD events and courses?

The most obvious place is in the hospitals you work at and you’ll be able to include both formal and informal teaching sessions. Just make sure to document and reflect on it.

You can also find lots of these being advertised online on social media or the Royal Colleges website, just be aware that these normally come with an astronomical cost (£250+).

We’ve included a few CPD Course finders in our ‘Locum Toolkit’ that you can use that offer a mixture of paid and free CPD courses that you can attend.

Tips for locums

1. Keep records of every formal and informal learning event that you’ve attended in a portfolio. This can be done online through an ePortfolio (MedAll have a really good free one), or on paper, which you can find forms for in our Locum Toolkit.
2. Try and make the most of any opportunities to get free teaching, as it can be more difficult to come by as a locum doctor!
3. Records also need to be kept of the online mandatory training you’ll do for the locum agency. Ask the agency for a copy of your completion certificate to include in your portfolio.

2️⃣  Quality improvement activity

QI activities are one of the more difficult areas that you will have to collect evidence of. Many of these can take weeks of your time to complete which can result in you having to travel to the hospital, even when you might not be scheduled to work. This can be tough for locum doctors who may not stay in one particular hospital for enough time to complete one.

Fortunately, the GMC guidance states that this only has to be completed at least once in every revalidation cycle, and if you’re doing an F3 year then you should have evidence of this from your F1&2.

However, if you are able to with your locum commitments, we would recommend trying to aim for one annually where possible.

GMC guidance for examples of QI activities

Here are examples of what you could do:

Collecting evidence of QI activities

You’ll need to be able to show proof of the above. For audits and QIPs this will normally be an audit report or a certificate or letter of participation issued by the organisers (normally after presenting your findings).

For Case reviews and discussions, this can be documented on paper (we recommend using a case-based discussion proforma) or done virtually (MedAll has a really good free portfolio that lets you do this).

For teaching sessions and programmes, a simple set of teaching feedback reports will do.

Tips for locums

QI activities can be extremely time-consuming, so as a locum doctor, we would recommend focussing on the ones that you can get done quickly. For instance, you could get a case review or discussion done in one shift!

3️⃣  Significant events

The GMC defines a ‘significant event’ any unintended or unexpected vent, which could or did lead to harm to one or more patients.”

For the purpose of your annual appraisal, you ‘must’ declare and reflect on all significant events since your last appraisal. These should focus on the insight and learning from the event in greater detail than the facts of the event itself.

You should be able to show these to your appraiser to demonstrate that you are aware of any types of patterns in the incident or events that you have recorded. You will also need to discuss the actions you have taken to change your practice to prevent recurrences of these events.

4️⃣  Feedback from patients or those you provide medical services to

The purpose of this is to demonstrate that you have reflected on feedback from your patients to help you understand their experience of your clinical practice. This can provide a unique insight into your areas of strengths and weaknesses from a patient's perspective so that you can improve upon them.

The good thing about this is that it only needs to be done once in a revalidation cycle, so that’s once every 5 years.

How to collect this information

Feedback should be collected on a standardised, validated questionnaire and filled out independently, where appropriate, to make the results as objective as possible. You might need to offer extra support, such as offering a feedback form in the patient's own language when there are language barriers.

The Feedback form

You can find these forms with a quick google for patient feedback forms. Here’s an example.

5️⃣  Feedback from colleagues

Similar to collecting patient feedback, this only needs to be collected once in a revalidation cycle.

This is a mandatory part of Foundation Training and Core Training, so most doctors will not need to perform another in their F3 or locum years.

However, if you are in a long-term locum position and can collect some feedback, it may help as evidence that you’re meeting the requirements of Good Medical Practice.

How to collect this information

You must get formal feedback from a mixture of colleagues from your whole scope of practice. This means getting a mixture of peers, seniors and your colleagues from the various health care teams (nurses, radiographers, physios etc) that you regularly work with.

The feedback form

You can use this form from the GMC to collect this information.

6️⃣  Compliments and complaints

The purpose of this section is detailed here:

Similar to the “Significant events” section, you must disclose and reflect on complaints (and compliments) made against you since your last annual appraisal.

You won’t have to explain all of these at your appraisal, but it’s worth having a few that you can demonstrate your insight, learning, and how might your practice has changed as a result.

You might be asked why you have chosen to discuss and reflect on these vs some of your other complaints or compliments, so give some thought to which have genuinely resulted in the most learning and beneficial changes to your practice.

⭐  Our Top Tips in Summary

1. Be realistic with your PDP, and make sure the goals you set from your appraisals are achievable and manageable as you’ll need to get these done by the next one.
2. Prepare for your appraisal in advance by learning about the process involved (we cover this in our article here)
3. Keep a portfolio from the very beginning
4. Actively look for opportunities for CPD activity during your locum work
5. Reflect, reflect, reflect!

The above advice should make the process of collecting evidence and keeping a portfolio more efficient and much less stressful. That will allow you more time to concentrate on your work and enjoy your year as a locum doctor.