Medical appraisal needs the right approach, not the quick-and-easy approach

By Dr Paul Evans

FMLM Medical Director

In 2012, when medical revalidation came into force, I had not seen a patient on the frontline for many years. In the British Armed Forces, where I spent the majority of my career, we medics are moved into medical management roles relatively early when compared to our civilian healthcare peers. It therefore made practical sense for myself, my colleagues and our patients for my appraisal to focus on supporting my practice within medical management, rather than clinical expertise.

It is not always perfect, but when medical appraisal is done well, it is an encouraging, developmental, and all-too-rare opportunity to look at our medical practice as a whole and identify areas for additional support and improvement.

It has therefore been disturbing to receive reports from our colleagues working in medical appraisal of a growing view among some that, post-pandemic, appraisal and revalidation should be stripped back to its barest essentials, keeping it short and minimising the need for reflection and a deeper analysis of the impact of a doctor’s entire scope of practice.

Over the past few months I and colleagues have been working with FMLM Affiliated Organisations to support their medical appraisal systems, helping them to be developmental, to be underpinned by the FMLM Standards, and to include an element of leadership and management support that is commensurate with the leadership and management undertaken by the clinician being appraised.

The reaction has been almost universally positive, with organisations and individuals recognising the rare opportunity that appraisal presents to help support doctors and their whole scope of practice, which of course includes how they approach their wellbeing, as well as team working, leading improvement and all relevant elements from the FMLM Standards.

The aim of affiliated membership is to encourage organisations to create a culture of leadership development in collaboration with FMLM, the key elements being:

• Enhanced leadership development by incorporating leadership attributes as part of medical appraisal.
• Embedded FMLM Standards within the job descriptions and terms of reference of all doctors.
• FMLM Fellowship included as a desirable qualification for consultant/GP level posts and above.
• Support for ongoing sustainable medical leadership development and succession planning.

We are delighted that we are now in discussion with 11 Trusts in England and are keen to expand this interest to all four home nations. The downside to date has been that the interest has been from secondary care organisations, but we will endeavour to correct this in the coming months as the benefits are just as applicable in the primary care and community settings.  

The discussions have been positive, and we have quickly identified areas where the collaboration will be initially most valuable.

I would like to highlight two specific benefits identified so far, one concerning appraisal, the other concerning the adoption of our standards.

The use of the medical appraisal process as a conduit to disseminating leadership development throughout the organisation has been recognised as highly valuable. In collaboration with appraisal leads we are seeking to ensure that the appraisal content reflects an individual’s leadership responsibilities.

This is rightly seen as a real opportunity to maximise individual leadership capability that benefits not only the individual but also their organisation in establishing leadership development as a core value. We are examining the elements of the appraisal (such as quality improvement and feedback) using the FMLM Standards as a competency base to encourage a reflective and constructive approach that ultimately identifies areas for the leadership component of a personal development plan and helps direct continuing professional development for the coming year.

The value of the FMLM Standards as a basis for supporting colleagues and ‘refreshing’ the working environment when the workforce is generally under considerable pressure to tackle the complex effects of the pandemic has been universally acknowledged. One medical director quoted to me: 

“I already feel really pleased…when I sit in meetings now, I hear my peers now using language around ‘supporting colleagues’ and ‘ensuring we abide by good, professional standards’. This, I hope, is starting to herald a positive cultural change.”

Through this process we are seeking to embed not only the importance of accountability, team-working, inclusivity and professionalism among medical staff, but to create real opportunity sustained through career leadership development.

Moreover, as integrated care is accepted as the optimal way to improve both the quality and cost effectiveness of health and social care in the future, strong and collaborative medical leadership will be crucial to success.

I would encourage all FMLM members to advocate the benefits of becoming an FMLM Affiliated Organisation, not only to embed the FMLM Standards as the acknowledged basis for good medical leadership, but to continue to support medical appraisal as the developmental, supportive, and educational opportunity that it can, and should, be.

Find out more about FMLM Affiliated Organisations and consider appraising and revalidating through FMLM.