Item 36
Example of a Partial Form 4
NHS SCOTLAND NON TRAINEE MEDICAL STAFF APPRAISAL DOCUMENTATION
Summary of Written Supporting Information Presented
Registered with GMC and on specialist register
CV and current job plan attached
Dr Smith provided in her job plan details of her contribution to clinical work, teaching, audit and research
CPD List of activities
Letters of appreciation of lectures
Examples of records and referral letters
Departmental Audit
National Audit
SUMMARY OF APPRAISAL DISCUSSION
Year 1, Domain 1
 Maintain your professional performance
 Apply knowledge and experience to practice
 Keep clear, accurate and legible records
Discussion:
Scope of practice
Dr Smith is a consultant in Paediatric Neurology. She works 9 sessions with 1 SPA.
This work covers out-patient and inpatient cover triage, with liaison work with GPs, General Paediatricians
and Paediatric Neurosurgeons.
She also covers on-call, EEG reports, and sub-specialises in Macrocephaly services, Neurogenetic and
Neurometabolic services and Anti/Perinatal neurological care.
She has teaching responsibilities for medical and nursing staff and is a Royal College of Paediatric and Child
Health question setter and examiner.
She has particular responsibility in organising and supervising audit in her department.
She takes part in and organises regular and ongoing Neurology CPD within her department and on an interdepartmental and national level.
She provided a PDP for the coming year which we discussed.
1. Continuing Paediatric and Neurology CPD She has met the recommended college CPD credits through weekly in-house grand-rounds, eg
complex case presentations, outside lectures. She also hosts and attends thrice annual International
general Paediatric and Neurological conferences.
She completes Personal reflective summaries from these lectures to consolidate and formalise her
learning.
2. Enhance foetal neurology skills
Dr Smith has in fact already attended a European conference to further support her study in this area
and has an invitation from a North American hospital to share skills.
3. Become an MRCPCH examiner
In fact Dr Smith has already completed her MRCPCH examiner training and is already established as
an examiner.
4. Pursue Patient Safety
Dr Smith attended a 3 day NES course 6 months ago exploring Measures to Improve Quality and
patient safety. She has 1 further day of this training and is aware that before October she needs to
establish and create pro formas for some patient safety projects within the unit.
Issues:
Dr Smith recognised that whilst the wide range of her job description requires a need to juggle time, delegate,
negotiate with (at times) complex work relationships, whilst overseeing quality improvement, she generally
feels confident and competent to meet her work needs easily.
We discussed in what ways she could expand or change her work to keep a sense of growing and freshness
in her work, and she described some early stage plans to
1. set up some charitably based neurology services in Africa
2. develop some new research skills related to nerve stimulation and her area of sub-specialty
Item 36
Example of a Partial Form 4
NHS SCOTLAND NON TRAINEE MEDICAL STAFF APPRAISAL DOCUMENTATION
Whilst Dr Smith demonstrates ongoing wide-ranging CPD relevant to her area of work, we spent some time
discussing the potential for expanding her PDP outside of her well-established comfort zone.
We discussed
Action:
1. In order to take some of her future plans to the next stage, Dr Smith may need to delegate some of
her regular and more established tasks.
2. To take the early plans of research into neural stimulation to the next level, she needs to arrange
meetings between interested parties to explore interest and possibilities of this research.
3. She plans to begin to look at funding streams to take some of her plans forward.
Continue to work with personal reflective summaries from CPD lectures to consolidate and formalise
her learning.
Year 1, Domain 2
 Put into effect systems to protect patients and improve care
 Respond to risks safely
 Protect patients and colleagues from any risk posed by your health
Discussion:
Dr Smith provided several pieces of supplementary supportive information including an audit, a significant
event analysis and a series of email trails demonstrating good communication.
We spent some time discussing an audit supervised by Dr Smith and set up by her FY1 relating to lack of
antimicrobial stickers in patient notes designed to alert staff to ongoing antimicrobial therapy.
This audit seems to have been the second cycle of the same investigation some time ago.
Reflective interventions had been instigated after a 3.8% rate of stickers from the 1 st cycle, and the sticker
rate had increased to 33% after the second cycle.
Further interventions had been added to attempt to further increase the compliance rate, but unfortunately
further audit did not elicit further improvement.
Issues: As lead in audit within the unit she felt it was important to follow up this study.
We discussed other ways in which the hoped-for improvements could be established.
Action:
Further audit cycle after interventions had been imposed.
Discussion with other units as to how to maintain compliance.
SUMMARY OF APPRAISAL DISCUSSION
Year 1, Domain 3
 Communicate effectively
 Work constructively with colleagues and delegate effectively
 Establish and maintain partnerships with patients
Discussion: not discussed at this appraisal
Issues:
Action: