GP appraisal was introduced for all UK general practitioners (GPs) in 2004. The Department of Health in England offered no specific guidance on how the process was to be delivered, leaving PCTs to implement their own GP appraisal systems. This is in contrast to Wales and Scotland which both have centrally controlled and highly standardised appraisal systems. In 2005, the National Clinical Governance Support Team (NCGST) set up a working party to agree criteria by which appraisal systems throughout the UK could be quality assured. The Postgraduate Institute for Medicine and Dentistry (PIMD) at Newcastle University has been closely involved in delivering training for GP appraisers and providing support for GP appraisal via the GP tutor network. The PIMD decided to use the NCGST framework to review the quality of GP appraisal systems in all PCTs across the Northern Deanery. This review suggests that the NCGST checklist is a useful instrument to assess the quality of GP appraisal systems. The report shows that GP appraisal has been implemented with defined resources and clear clinical and administrative leadership in all PCTs in the Deanery. Appraisers have all been trained and receive ongoing support in their role. The review also identified areas in which the quality criteria are not fully met. Not all PCTs have a robust appraiser selection and appointment process, and few have clear methods of internal quality assurance of their appraisal system, especially in terms of actions to be taken when inadequate appraisal evidence is submitted. GP appraisal is located within clinical governance structures in some PCTs, in others it is primarily the responsibility of the GP tutor, and in some PCTs it spans both areas. This seems to have some influence on whether appraisal is seen as primarily an educational tool, or also as a means of performance review linking into clinical governance. Clarification of the links between appraisal and revalidation is awaited from the Chief Medical Officer's (CMO's) review of the Shipman Inquiry report.
