Example of a GP Summary Form using the GMC 4 Domain Framework
Item 30
FORM 4A - SUMMARY OF APPRAISAL DISCUSSION
Summary of Written Supporting Information Presented
Form 1
Form 2 with previous and current PDPs and records of other learning activities
2 Audits
1 Case review
Patient Satisfaction Survey
Certificates:
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RCGP residential course
CPR training
Diabetes Managed Clinical Care conference
In-house orthopaedic training sessions for upper limb, lower limb
SUMMARY OF APPRAISAL DISCUSSION
Year 2012, Domain 1
 Maintain your professional performance
 Apply knowledge and experience to practice
 Keep clear, accurate and legible records
Discussion:
Scope of Practice/Post
Dr Jones is a part-time partner working 5 sessions per week in a partnership of 9 GPs with 3 Clinical
Assistants, who care for 14000 patients. The practice has a strong educational ethos, training medical
students, a GPST1, a GPST3, and a Career Start GP who has an interest in Palliative Care.
Dr Jones described his work as general medical services, with lead responsibility for Diabetes, Child
Protection (named lead for practice), Cancer register, and coordination of doctors’ annual and study leave.
His learning activities have been shaped by patient care.
Previous PDP
Family Planning and Sexual Health update – unable to attend local course, but has identified and used
websites. Learning outcomes include:
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Guidelines for management of Chlamydia
Use of LARCs in young people
New developments – new IUD (10 Year), new Post Coital Contraception
Palliative Care – did not have a suitable patient to follow through local palliative care facility. Did meet with
Macmillan Nurse to discuss ‘just in case’ boxes, and identified palliative care website on intranet as a source
of information.
Other Learning Activities
Attended RCGP residential course – this included:
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CPR update
Psychiatry
Child Protection update
Radiology
Has joined Problem Based Small Group Learning set. Topics covered:
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Coeliac disease
Hepatitis C
Current PDP (for year ahead)
Cardiology update – registered for course. Also intends to visit cardiology laboratory for insight into
patient experience.
Palliative Care – DNCPR resuscitation policy (need identified from case report). Has attended
meeting. Will cascade to practice. Exploring end of life care pathways with a partner and with Career
Start GP who has an interest in palliative care.
Audit Activity
Dr Jones chose this for his core category for this year.
Diabetic care – this is audited every year and demonstrated that the practice meets targets for diabetic
control.
Thyroxine monitoring – this had two components:
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checking for thyroid function tests in the last 18 months – standard achieved
registration with GAFUR hospital database - 83% were not registered (86/498). Registration was
inappropriate for 30 of these. Discussed with partnership for appropriate referrals to be made.
Vitamin B12 monitoring – a full 8 point audit with two components:
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Appropriate interval between injections (2 – 3 monthly after initial loading dose) – criterion met in
85%, meeting minimum standard set of 70% but short of optimum 90% standard. Some
identified as having injection monthly. A register created.
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Annual blood tests for FBC, RGS and TFT – initial audit 30%; repeat audit 83%. Two patients
with iron deficiency anaemia identified, one new diabetic and one subclinical hypothyroidism.
Case Report
Dr Jones included one case report relating to the end of life care for a patient with Alzheimers
disease. This involved difficult decision making for the family and medical staff about feeding and
subcutaneous fluid administration. During hospital admission the patient was resuscitated on one
occasion, fed via a nasogastric tube and given intravenous fluids. After discussions with relatives she
was discharged without the nasogastric tube, but with subcutaneous fluid administration. She lived
for three months, but eventually SC administration became difficult due to inflamed sites.
Action/Outcomes :
Vitamin B12 audit will be discussed with the practice nurse team. These audits will be repeated annually. A
register has been created.
Audit activity resulted in changes to practice as described above.
Dr Jones has explored the use of DNCPR resuscitation policy and has included this in his PDP as a result of
reflection on the case report.
Dr Jones’ PDP reflects other learning needs identified from patient care.
Year 2012, 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:
The audits described in Domain 1 are examples of systems to protect patient and improve care.
Patient Satisfaction Survey (PSS). The practice undertook a PSS: almost all parameters were scored
above the Scotland average (see Domain 3).
Significant Event Analysis (SEA). We discussed the use of SEAs. Although Dr Jones submitted none with
this year’s evidence, his practice does have regular SEA meetings. He was reminded of the need to include
SEAs relating to any Child Protection issues and any Resuscitation event and of the RCGP’s
recommendation that two SEAs are brought to appraisal each year.
Case Report – The Case Report described in Domain 1 demonstrated a desire to ensure good end of life
care for a patient, while tryng to respect family wishes.
Health – Dr Jones stated that he has no health issues and is registered with a GP in the practice. He
registered prior to becoming a partner and has no issues necessitating change. We discussed the pros and
cons of this arrangement after which Dr Jones decided that he would register with a different GP practice in a
neighbouring area.
His immunisations are up to date; there is a practice policy on this.
He is aware of the role Occupational Health can play should he or colleagues encounter any health and/or
performance difficulties.
Action/Outcomes :
Undertake and bring 2 SEAs to next appraisal
Register with a different GP Practice
Keep immunisations up to date
Year 2012, Domain 3
 Communicate effectively
 Work constructively with colleagues and delegate effectively
 Establish and maintain partnerships with patients
Discussion:
Communication - Dr Jones included in his documentation description of team meetings that occur on a
regular basis in the practice. He described the use made of the practice computer system to pass messages
between team members.
His case report demonstrated joint working with the District Nurse team, Marie Curie Nurses, Care Workers
and handover to another partner when he was absent from practice.
Work with Colleagues – The PSS described above scored below the Scotland average for the parameter
relating to the practice nurse team. Although the scores were still satisfactory, discussion with partners
suggested that issues in the practice nurse team may have contributed to the lower scores. These included
staff turnover leading to training and support needs and also concern about the performance of one member
of the PN team. The practice is addressing these needs in a supportive way and seeking to maintain staff
morale.
Complaints/Partnership with patients – Dr Jones stated he has received no patient complaints since his
last appraisal.
The issues relating to end of life care described in his Case Report necessitated liaison with family members
to achieve a shared understanding of the issues.
The practice has an active patient participation group, who have seen and discussed the results of the PSS
with members of the practice team.
Action/Outcomes :
Continue to have regular team meetings
Work to improve the practice nurse team
Year 2012, Domain 4
 Show respect for patients
 Treat patients and colleagues fairly and without discrimination
 Act with honesty and integrity
Discussion:
Respect for patients was indicated in the PSS and Case Reports described above. PSS scores were above
average. The practice reception desk has information about the practice standards for doctor availability.
Opening hours are advertised in the Residents Association broadsheet and this is used on occasions for the
practice to communicate with its population e.g. the start of seasonal influenza vaccination campaigns.
Multi-Source Feedback – No MSF has been undertaken yet. We discussed possible tools for the future.
Honesty and Integrity – Dr Jones stated that he is not subject to any investigative or disciplinary procedure.
He confirmed he has insurance indemnity. He is not involved in research activity at present.
Dr Jones stated that he does offer very limited non-NHS services to a small number of patients (n=5) who
wish to see him privately. Any appropriate fees for non-NHS services are discussed in advance of bookings.
Action/Outcomes :
We discussed GMC advice set out in Good Medical Practice regarding probity and health, and Dr Jones
agreed a need to refresh his knowledge of this as it had been some time since he had read the guidance.