Primary Care 

PRIMARY CARE APPRAISAL PACKAGE DOCUMENTS 

Guidance notes for annual appraisal for ACPs and Appraisers in primary care

 In 2014 the UK government published the Five Year Forward View in recognition that a new way of commissioning and delivering care was needed. It set out a vision for the future NHS focused on prevention of ill health and a shift away from hospital-based care towards more integrated, community-based care. The Interim NHS People Plan later highlighted how new roles such as ACPs are fundamental in enabling this system-wide service and workforce transformation. The We are the NHS: People Plan for 2020/21 – action for us all emphasised the need to develop skills and expand capabilities of the workforce in order to create more flexibility, increase morale and support career progression. Subsequently, Health Education England launched the new governance maturity matrix tool in 2022. This tool has been developed to enable organisations to formatively assess their own level of maturity and have invaluable insight of the governance and assurance process they have in place to ensure their ACPs are trained appropriately and remain safe practitioners. This covers 8 domains including governance, leadership, workforce, business cases, training, clinical, supervision, continuing professional development (cpd).

This guidance document is intended to support the primary care ACP and their appraisers to achieve a thorough and appropriate review of the ACPs clinical competence, confidence and job satisfaction for the preceding year. This will support the practices to achieve good governance oversight of the ACPs employed.

It is recommended that the appraisal be conducted by the ACP’s Educational supervisor (usually a General Practitioner) and the ACPs line manager/ACP lead.

The ACP appraisal should focus on evidence related to the 4 Pillars of Advanced Practice as defined by Health Education England (2017):

●  Clinical

●  Leadership and management

●  Education

●  Research

The ACP should complete as much of the document as possible prior to appraisal.

Quality is fundamental to reducing unwanted variation in recruitment and retention and achieving a sustainable growth of ACPs.  By using this ACP appraisal template across SY primary care it is hoped that a consistent approach to this annual review will improve standards in ACP behaviours and highlight good, and poor practice.

Forms of evidence suggested (but not limited to) include:

●  Reflective accounts

●  Personal assessment against the prescribing framework Prescribing Competency Framework: Supporting Tools | RPS (rpharms.com)

●  WPBA assessments (rcgp.org.uk) is also another great prescribing audit tool

●  Course Certificates

●  Work based assessments (WBAs) such as:

○  Case based discussions (CBDs)

○  Mini consultation evaluation exercise (Mini-CEX)

○  Directly observed procedural skills (DOPS)

The ACP is required to obtain Multi Source Feedback (MSF) from 10 colleagues before the appraisal. The format of which is to be agreed with the appraiser, but it is recommended that a portfolio such as pep is supported to collate evidence

Mandatory training

In primary care the following training in mandatory:

Basic life support - Annual

Fire safety - Annual

Manual handling - 3 yearly

Safeguarding children level 3 - 3 yearly

Safeguarding adults level 2 - 3 yearly

Infection control - Annual

Mental capacity act - 3 yearly

GDPR - 3 yearly

Equality and Diversity - Annual

Prevent - One off

Multi-professional framework

The ACP should have achieved all the requirements of this framework prior to being awarded the MSc. However, Where your ACP has qualified by a different route, or is a long established and experienced practitioner, without a formal qualification, they will need to consider the e-supported portfolio route in order to gain recognition.

Please review these, which are available via the multi-professional framework (2017) document or are available within the pep portfolio for your ACP/organisation to purchase.

If there are any areas that the ACP or the employer feel that are not being met this should be highlighted and a plan put in place to address these.

Core capabilities framework for advanced clinical practitioners working in General practice/Primary care

The ACP, depending on years since qualifying, may have already achieved all of these. However, a review of this should include identifying if there are any capabilities or core clinical skills that need refreshing.

These can be reviewed via the Core capabilities framework for advanced clinical practitioners working in General practice/Primary care document. They are also available within the pep portfolio for your ACP/organisation to purchase.

Pre review Audit

It is good practice to participate in self and peer review audits. Although this is only part of the feedback process, it can help the ACP self-audit their work Alongside the views of a clinical colleague. Reflective practice is an important part of the clinical role, and a requirement of registration is to remain up to date in our professional capacity. This is also an important consideration in this more litigious society. Reflection also acts as a feedback mechanism reassuring the ACP that their practice is at the required standard. While it is likely all feedback will be positive, negative feedback delivered fairly and constructively can be a useful tool for development. It is also helpful in the unlikely event of a complaint for ACPs to have experience in how to perform when feedback is negative. This is part of developing a professional identity.

The appendix 2 illustrates key themes to assess for within the written notes. The ACP can score 2 for fully achieved, 1 for partial, 0 for not achieved. If the question is not applicable, then they score 2. The final percentage score should be >80%.

Evidence of reflections and learning                                                                                                      

Nurses and allied health professionals are required by their own professional bodies to revalidate and evidence their fitness to practice and continuing professional development. Currently, there is no formal governing body of ACPs and consequently no guidance on how many reflections and how much evidence is required to prove ongoing competence. Therefore, the ACP should be guided by their governing body, although it is recommended good practice to document case based discussions and clinical supervision sessions.

Clinical supervision

Clinical supervision is essential to enabling ACPs to be supported to reflect on their clinical practice and maintain or increase their clinical competence and confidence. The primary aim is to improve the quality of patient care. Goddard (2022) clearly defines clinical supervision as a professional form of supervision. This is not delivered by line management but usually with peers where in-depth reflection on clinical practice can take place.

Supervision could be delivered to an individual or as part of a group. Clinical supervision should be facilitated by an appropriately trained supervisor.

Offering clinical supervision is demonstrating maturity as an organisation for the governance of ACPs and upholds the Health and Safety Act 2008 regulations 12 and 18. 

Sickness/time management

Prolonged sickness and or multiple episodes of sickness can not only be detrimental to the service delivery but also the ACP themselves. Absence management should be undertaken outside of the appraisal, but it may be appropriate to discuss this due to any underlying reason on the effect this may have on the ACPs practice/performance.

Annual leave

Planning regular annual leave is important for the wellbeing of the staff. Having annual leave to look forward to enables the individual to plan holidays/time with family and friends and achieve work life balance. Regular breaks also can reduce stress and burnout at work. Planned annual leave also reduces the impact on the service. In some circumstances emergency annual leave is appropriate and at the discretion of the manager.

Date of revalidation

This should be referenced annually so the individual can prepare ahead of time and ensure they are collating evidence rather than leaving this until the date arrives.

Health and wellbeing

It is recommended that a general conversation is held with the ACP to understand if there are any concerns that the workplace could offer support. For example, stress management and appropriate signposting

4 pillars of advanced clinical practice

Each of the 4 pillars is clearly identified to clarify any events that have been positive and require acknowledgement. Here, any training needs can be identified and suggestions for support.

Personal developments plans

Following the discussion, please record objectives for the forth coming year. These should uphold the principles of SMART. Specific, measurable, achievable, relevant and time bound.