My vision for appraisals

Dr Neil Paul

NHS Appraisals. It feels wrong to kick them when they are down; but hey I can’t let that stop me. This wouldn’t be a column if I didn’t highlight the lows as well as the occasional positives of all things related to NHS IT.

My appraisal was due in November, and I admit I left it as long as possible before booking it. In my defence, I’m sure the last four haven’t really developed me in any way and it was mad busy before Christmas.

So, in late February I emailed my appraiser. Keen for the fee and to prove that I’m not another Harold Shipman (not that appraisal will actually do that…) he sent me a few dates. ‘Great,’ thought I, ‘let’s get this over with’.

I fired up the NHS Appraisals website. Amazingly, I remembered which of the 72 passwords I tend to use for this type of thing (single NHS sign-on anyone?) and I was in.

I had a quick flick at last year’s personal development plan. Yet again, it seemed to have completely missed any real relevance to anything that I had needed to do over the year.

For example, an in-depth knowledge of how to set up a swine flu clinic when different advice was being issued by the hour was probably my biggest learning need – yet it was strangely absent from my PDP.

Then, I started the laborious process of filling in all the details for this year while thinking: ‘I’ve got about a hundred things I could be doing that would be more productive right now. I could be digging the vegetable patch, which would be so much better for me on so many levels.’

I gave up after an hour of moderate progress. My last appraiser always says I’m the only person he ‘does’ who has entries in every box; management, teaching, research etc. I was planning on doing a bit more a few days later, when I had some more time.

Then, of course, I got caught up in the whole security breach lock out story and couldn’t access the site for ten days or so.

(Note to readers lucky enough not to be caught up in this story: the Department of Health took the site offline for the best part of a month, having worked out that it no longer met modern security requirements and might be open to hackers).

Now, to be fair, taking the site down was the right thing to do and that’s not what I’m complaining about. In fact, I was happy to rearrange my appraisal and the disruption gave me a little longer to find all those pieces of paper from meetings I’ve attended.

What I am complaining about is the unrealistic assumptions made by those who built the site about its usefulness. I quote: "Points of interest often occur in consultations in the middle of a busy session and are likely to be forgotten. You can have the NHS Appraisal Toolkit open on your computer while you are seeing patients: this means that you can record Reflective Learning as it arises."

Are they insane? Even if you wanted to try it, the website logs itself out faster than Choose and Book. Every time you turn your head it has logged out.

It is so user-unfriendly I don’t know where to begin. If the builders really want me to record everything I look up or think of in a consultation, they need to work on integrating it with clinical systems and having an open API. I’m increasingly convinced that the future of NHS IT is open APIs with full functionality.

Now, I realise I’ve not done any research into how the site is funded. No doubt the answer is ‘badly’. I’m glad I can access this for free as bad as it is it beats paper – but I am surprised there isn’t a charge as there is for many other things these days.

I think it could be better funded and that income could be generated for work on development if there was a charge for API access.

There are plenty of learning sites on the web – BMJ, doctors.net, onmedica.net – to name a few. There are plenty of courses and meetings that award pieces of paper for attendance.

How much easier would life be if every time I completed an online BMJ course it recorded the fact in my appraisals system, instead of producing a crappy screen shot that I can print off.

I’m sure some of these companies would write really nice interfaces and have all sorts of links to NHS Appraisals if it acted as an approved central store. They’d probably pay for the privilege, as well.

Mentor – which comes with EMIS – has the ability to record what you have looked up. I’ve never really used it, but if it logged it to my centralised store that might be great. If I could upload prescribing data to my appraisal record, that might be useful.

If every computer system uploaded the data in a standard way, I could then even compare myself to my peers. I could look to see where I’m an outlier and justify it. It could all be done. Does anybody have the vision?

About the author: Dr Neil Paul is a full time GP working at the Ashfields primary care centre in Sandbach. He sits on his primary care trust’s professional executive committee and has a lead role for IM&T and practice-based commissioning.

This column first appeared on the Microsoft NHS Resource Centre.