The GP Appraisal System is Pants. Part 1.

“Pants” is the polite version. “Utterly pointless, demeaning, futile, bullshit” is a bit stronger. “One of the biggest piles of wank there has ever been in the history of the NHS” is more accurate. “One of the greatest causes of stress that GPs face and one of the largest losses to GP productivity that idiotic medical leaders have yet dreamed up” (and there are many) is a tragically true description.

It takes most GPs at least a week of normal working hours to fill the sodding forms in for themselves and their colleagues. That’s a week out of seeing patients, seeing their family or sleeping (as it’s often done late at night and early in the morning) just to get the crap done.

Let’s start with the section that covers feedback from colleagues.

Every five years we have to submit a (Warning NHS Jargon shite:) ‘360 degree survey’ by asking enough colleagues to rate us. I am in a small practice, thank God, but I still have to do several a year. This is also partly because I am such a old fart others who I vaguely know ask me to do one for them too. Usually I haven’t a fucking clue what they get up to in their consulting rooms but I have sympathy with them because if they don’t have sufficient colleagues they trust then they have to go wider just to jump this particularly futile hoop.

It’s futile because we are now into round two of (Warning NHS Jargon shite:) “Revalidation” from which I, like most of my colleagues, are burnt out. Well, to be honest we’re burnt out with the NHS full stop. Revalidation and 360 surveys are just two of the many straws that have broken us.

I have done tens of bloody 360s in the last 8 years or so. In the beginning I relished the idea of being able to anonymously tell certain colleagues I thought they were shit but the novelty soon wore off as it was hardly rocket science for them to guess who was being more honest than others. These relationships will almost certainly never recover and what bloody good for patients has that been?

Nowadays I am competing for the world record for the fastest time it takes to complete one. It does depend on whether I already have an account with one of the multitude of fee earning sharks that are capitalising on this bullshit at my and every taxpayer expense (- of course it’s a tax deductible). If I do have an account, the sequence is

  • get heart sink email from equally broken colleague,
  • click on link, hope the computer has remembered my password because I really cannot be arsed to reset it and…
  • Hey Presto! I’m in and ticking “fucking marvellous” for everything.

The speed of completion also depends on the speed of my internet connection and location when I complete it.

I managed one at home, where my internet connection is moderately good, in under a minute. The record at the practice is more like 4.5 minutes because NHS internet speeds are shite. It’s quicker doing them on my mobile driving home or cycling to the pub. Of course I would never ever do either. I have much greater respect for breaking the record and sometimes I have to watch the road.

All those who ask me get a 6, top marks, for everything. I am beyond quibbling on 4-6. Everyone I know works bloody hard and they would have to have seriously pissed me off to score less. I give no-one free-text comments in the hope they will give me none back. Otherwise the knobhead appraiser will want me to reflect until the end of time on the banality of “Dr R is a great colleague and clinician”. God forbid anyone leaves a more negative or cryptic comment such as “Dr R is much loved by his patients”. Shit! I am? Is that sarcastic or true? Is it a snide comment, a view that I am dishing out too many antibiotics or painkillers? How the fuck do I reflect on that? Being loved by them is entirely inappropriate! The only person I love is the wife, and the dog. How can I stop such inappropriate attention? I can barely be ruder.

I only ask people to do my 360 that I think I get on with. Trust me, in most partnerships there will be at least one pair who feel each other are slime filled toads who can never compromise let alone agree. No-one is going to ask their toad to do a 360 on them as we all know they’ll bring the average score down a lot and our knob head appraisers will expect us to reflect on how this can be improved. Often little more than a rampage through the surgery with an AK47 will improve the 360 scores and that, I think, is what the process is designed to prevent.

If I’m stuck for colleagues I will ask the wife to do one, (as she practices under her maiden name so no-one will ever know). She knows what I’m like with her and the kids when they’re ill so she has seen my doctoring skills at their best and she doesn’t do bloody free-text comments, I think….!

Of course I do have to lie a lot whilst filling in the health bit. All of us, by definition, are mentally ill. No-one would do this impossible job for the decreasing professional satisfaction or the money. We are trapped by our social and economic realities. Even those of us whose kids go to state schools are trapped but we can explain that more another time. Many of my colleagues have had time off with stress. It may have been as little as one day, it may have been months. One or two I know have jacked it in at 40, and 50. At least they don’t have to lie that they know of no health reason why Dr A, B or C should be working! Of course I do, they’re all on the edge. WE ALL ARE! But if I state that and their knob head appraiser gets them to start reflecting on it, they’ll be off to occupational health and starting counselling before I can say “Fucking appraisals”.

Then we have to check our locum insurance and scour the earth for a locum, A locum, that is who, just because they are wise enough not to buy into the idiocy of permanent GP roles, is regrettably treated with skepticism, if not contempt, by the patients. For me though they’re fucking angels. I really should start a charity “Help for GP Locum Angels” with two GP partners carrying a locum on a stretcher. Without them, the service would be even more shit, though perhaps that would help persuade the leading medical dickheads that GP appraisal should be scrapped. Our mental health and productivity would then soar.

And I could delay the purchase of that AK47.

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