The standardised NHS appraisal scheme has been in place since 2002, arising partly to address inconsistencies in earlier local, specialty and organisational schemes, partly to embed performance review into managerial process following the Bristol and Shipman inquiries (Kennedy, 2001; Smith, 2001–05), and partly as a result of the increasing complexity of doctors’ working practices (Follet and Paulson-Ellis, 2001). Although the main elements of the scheme are similar for all doctors, the appraisal exercise is different for consultants, academic clinicians, non-consultant career-grade doctors and GPs.

The primary aim of the appraisal scheme is to identify personal and professional development and educational needs, with the ultimate aim of improving clinical performance and patient care. Doctors in training are subject to annual workplace appraisals in the same way as fully qualified consultants and GPs, and this can cause some overlap in practice with the regular reviews that take place during training (e.g. the end-of-year ARCP panel) and workplace-based assessments. These issues are yet to be fully resolved so that review, appraisal and assessment processes are more streamlined for individual trainees and those responsible for ensuring their progress.

The schemes are continuously being revised and updated, and therefore the specific elements of each scheme for groups of doctors are not addressed in this module. The Department of Health Appraisals site brings together documents, activities and forms from all relevant bodies. The Useful links section in this module provides a list of websites relating to appraisal for different groups of doctors. 

Appraisal is linked closely to revalidation and ‘is based on the GMC's document Good Medical Practice (General Medical Council, 2001), which describes the principles of good medical practice, and standards of competence, care and conduct expected of doctors in all aspects of their professional work’ (Department of Health, 2007a).  Appraisal documentation and activities are based on the core headings of Good Medical Practice:

• good clinical care
• maintaining good medical practice
• relationships with patients
• working with colleagues
• teaching and training
• probity
• health.

Doctors are required to collect evidence from a range of sources (patients, colleagues and their own reflections) against these headings. The evidence and forms that are completed provide the basis of the appraisal discussion and the production and agreement of the personal development plan (PDP). Standard forms are used both before and after the appraisal interview. The standardised system aims to identify and support poorly performing or underperforming doctors as well as development needs, and as such, appraisal is a key part of the overall clinical governance mechanism of the NHS. However, appraisal is not the main mechanism through which poor performance is identified or addressed. It should be a positive and forward-looking process and should aim to identify reductions in performance or aspects that need development at an early stage and as part of an ongoing CPD process.

The NHS Appraisal Toolkit is the official online site for completing appraisal paperwork, sharing it between appraisee and appraiser online, and producing and managing a PDP. The site brings together advice, guidance, best practice, practical tools and access to a community of peers in the appraisal domain. Reviews of the site indicate that people find it easy to use, particularly the way in which it facilitates the process of gathering and storing information so that it can be used for appraisal.