Appraisal

Appraisal Summary

• Context and scope of work: Dr Eleanor Vance (GMC: 6129483) completed her annual appraisal on 14/05/2026. She is in year 3 of her 5-year revalidation cycle, due on 30/11/2028. Her full scope of work was reviewed, encompassing her substantive 6-session salaried GP role at Oakwood Medical Centre, 1 session per week as a community dermatology GPwER at St Jude's Hospital, and ad-hoc out-of-hours (OOH) shifts for Urgent Care North.
• Objectivity: All appraisal statements have been agreed upon and are fully supported by comprehensive, objective evidence provided in her portfolio. The summary is free from bias or prejudice, and the documentation is typed, well-organised, and presented to a high professional standard.
• Challenge, support and encouragement: The appraisal discussion offered a supportive environment for Dr Vance to reflect on winter workload pressures while challenging her to formalise her clinical leadership in practice prescribing. She was encouraged to delegate routine administrative tasks to the clinical pharmacist to protect her time for complex dermatology cases.
• Statements not agreed: All pre-appraisal declarations, including those relating to health and probity, were signed and agreed without exception. There were no areas of disagreement during the appraisal process.
• Supporting information and learning: Dr Vance submitted 58 CPD credits, two clinical audits, and reflective notes across all roles. Following learning on updated NICE guidelines for heart failure, she introduced a standardised template at Oakwood Medical Centre to ensure timely initiation of SGLT2 inhibitors (dapagliflozin (Forxiga®) 10 mg PO OD).
• Review of last year's PDP: Two of the three objectives from the previous PDP were fully achieved, including completion of the Diploma in Practical Dermatology and a 2-cycle audit on direct oral anticoagulant (DOAC) monitoring. The third objective regarding minor surgery accreditation was deferred due to clinic room refurbishments at the practice, and she has opted to focus on dermoscopy instead.
• Excellence and aspirations: Dr Vance demonstrated excellence by reducing local secondary care dermatology referrals by 18% through her internal practice triage system. She aspires to become a GP trainer within the next 24 months and has begun preliminary discussions with the local deanery.
• Gaps in revalidation requirements: There are no current shortfalls in her revalidation requirements for stage 3 of the cycle. She has already completed her multi-source feedback (MSF) this year and plans to undertake her patient satisfaction questionnaire (PSQ) in year 4.
• SMART PDP objectives: Three new SMART objectives have been agreed for 2026/2027, focusing on establishing an in-house dermoscopy clinic, auditing high-risk DMARD prescribing, and completing the Postgraduate Certificate in Medical Education. These goals are time-bound to the next appraisal and appropriately challenge her to enhance clinical quality and educational leadership.
• New PDP items: The new PDP items arise directly from today's discussion regarding her newly acquired dermatology diploma and the practice's need for an educational supervisor. The DMARD audit objective stems from a significant event analysis (SEA) discussed in Domain 3.
• Revalidation and preparedness: Dr Vance is fully on track for revalidation in November 2028. Her benchmark MSF completed in March 2026 showed scores above the national average, and she was reminded to complete her formal GMC-compliant PSQ across both her GP and GPwER roles before her year 4 appraisal.

Context

• Dr Vance works part-time as a 6-session salaried GP at Oakwood Medical Centre, an urban practice serving 11,500 patients.
• She undertakes 1 session per week as a GPwER in Dermatology at St Jude's Hospital and completes approximately two 6-hour OOH shifts per month for Urgent Care North. She has no active academic research sessions.
• She achieved her previous PDP goals of completing her dermatology diploma and conducting a two-cycle audit on renal function monitoring for patients prescribed apixaban (Eliquis®) 5 mg PO BD. Her minor surgery objective was discontinued due to estates limitations.
• Her revalidation date is 30/11/2028, making this her third appraisal in the current five-year cycle.
• Oakwood Medical Centre recently merged with a smaller neighbouring surgery, increasing clinical demand; despite this, Dr Vance has maintained her 7 total weekly clinical sessions and has had no periods of prolonged absence during this cycle.

Domain 1: Knowledge, Skills and Development

• 1.1 Dr Vance demonstrates strong clinical competence across general practice and holds a special interest in dermatology, recently passing her Postgraduate Diploma in Practical Dermatology with distinction on 12/02/2026.
• 1.2 She delivers high-quality care, evidenced by her management of complex multimorbidity and chronic disease clinics, particularly optimising cardiometabolic therapy using agents such as semaglutide (Ozempic®) 1 mg SC weekly and empagliflozin (Jardiance®) 10 mg PO OD.
• 1.3 Her remote consultation skills were reviewed via an OOH call-recording audit from Urgent Care North, which confirmed safe telephone triage, clear red-flagging, and appropriate conversion to face-to-face video or in-person assessment when clinically indicated.
• 1.4 Although she does not hold dedicated research sessions, she facilitates patient recruitment for the NIHR PRINCIPLE and PANORAMIC primary care trials during routine consultations at Oakwood Medical Centre.
• 1.5 She logged 58 hours of balanced CPD spanning general medicine, paediatrics, women's health, and dermatology, accompanied by clear reflections on how learning has updated her clinical management.
• 1.6 She promotes sustainable resource management by switching eligible asthma patients from metered-dose inhalers to dry-powder inhalers in line with the Greener NHS initiative, and by reducing unnecessary secondary care dermatology referrals.
• 1.7 Her primary achievement this year was completing her dermatology diploma alongside managing high winter clinical demand; she aspires to transition into medical education over the coming two years.
• 1.8 She completed a two-cycle QIA on DOAC dosing, reviewing 84 patients on rivaroxaban (Xarelto®) 20 mg PO OD and apixaban, which improved correct dose-adjustment compliance based on CrCl from 82% to 98%.

Domain 2: Patients, Partnership and Communication

• 2.1 Dr Vance treats patients fairly and without discrimination, evidenced by her proactive outreach to improve cervical screening uptake amongst underserved ethnic minority groups within the practice population.
• 2.2 Her politeness and empathy were highlighted in four unsolicited patient thank-you cards submitted in her portfolio, praising her compassionate approach during palliative care home visits.
• 2.3 She supports shared decision-making by utilising NICE patient decision aids during consultations for hormone replacement therapy and lipid modification with atorvastatin (Lipitor®) 20 mg PO OD.
• 2.4 She routinely sends tailored SMS information leaflets via Accurx to reinforce verbal consultations, ensuring patients have clear written guidance on medication side effects and self-care.
• 2.5 She reflected sensitively on a complex case involving a patient with advanced vascular dementia, demonstrating effective, timely communication with the patient's lasting power of attorney to establish an advance care plan.
• 2.6 Her holistic approach is evident in her dermatology clinic, where she routinely screens patients with severe psoriasis or eczema for concurrent depression and anxiety using PHQ-9 and GAD-7 scores.
• 2.7 She holds Level 3 Safeguarding qualifications for both children and adults (updated 10/11/2025) and regularly contributes to multi-agency safeguarding hub (MASH) reports.
• 2.8 She completed her annual Basic Life Support (BLS) and automated external defibrillator (AED) training on 04/09/2025, and reflected on managing an acute anaphylaxis presentation in the treatment room with adrenaline (epinephrine) 500 mcg IM STAT.
• 2.9 She reflected on a consultation involving a patient experiencing acute psychosis who expressed threats towards a neighbour, detailing how she safely arranged an urgent Mental Health Act assessment in collaboration with the crisis team and police.
• 2.10 She demonstrated duty of candour following a delayed two-week-wait colorectal referral caused by an administrative task failure; she apologised directly to the patient in person, explained the system remedial actions, and expedited the endoscopy.

Domain 3: Colleagues, Culture and Safety

• 3.1 Her March 2026 MSF from 18 clinical and administrative colleagues across both workplaces was universally positive, noting her approachable demeanour and respectful communication.
• 3.2 She contributes to a positive training environment at Oakwood Medical Centre by supervising fifth-year medical students during their primary care placements and leading monthly practice clinical meetings.
• 3.3 She displays clinical leadership as the practice prescribing lead, chairing quarterly meetings with the PCN clinical pharmacists to review local formulary adherence and antimicrobial stewardship.
• 3.4 She ensures safe continuity of care by writing detailed, structured handovers for the community palliative care and OOH teams, and by maintaining strict personal list continuity for frail elderly patients.
• 3.5 She delegates safely and appropriately to Physician Associates and Advanced Nurse Practitioners, providing clear supervision parameters and reviewing all complex or unscheduled re-attendances.
• 3.6 Internal peer review of 20 random consultation records confirmed her clinical documentation is clear, contemporaneous, structured, and appropriately coded using SNOMED CT.
• 3.7 She adheres strictly to infection prevention and control (IPC) protocols during cryotherapy and skin biopsy procedures at St Jude's Hospital, with zero post-procedure wound infections recorded in her annual log.
• 3.8 She presented two SEAs: one regarding the delayed cancer referral and another concerning a near-miss prescription of methotrexate 15 mg PO weekly in a patient with declining eGFR, resulting in strengthened automated EMIS safety alerts.
• 3.9 She is registered with an independent GP, has had no sickness absence over the past 12 months, and manages work-life balance effectively through regular running and protected administrative time.

Domain 4: Trust and Professionalism

• 4.1 Dr Vance signed her probity declaration confirming honest and ethical conduct across all professional roles, with no GMC, NHS Resolution, or employer disciplinary investigations.
• 4.2 When screening patients for NIHR primary care trials, she adheres strictly to Good Clinical Practice (GCP) standards, having renewed her NIHR GCP certification on 19/01/2026.
• 4.3 She maintains clear professional boundaries, evidenced by her reflection on declining a high-value gift from a grateful patient and explaining the practice policy sensitively.
• 4.4 Her written correspondence with secondary care consultants and allied health professionals is concise, courteous, and clinically thorough.
• 4.5 She does not use public-facing social media for medical commentary and does not endorse or advertise any commercial healthcare products.
• 4.6 She completed a factual, objective coroner's report in August 2025 following an unexpected community death, adhering strictly to GMC guidance on acting as a professional witness.
• 4.7 She completed her annual NHS Information Governance and GDPR training on 15/01/2026 and ensures all patient-identifiable data in her appraisal portfolio is fully anonymised.
• 4.8 She has no financial or commercial conflicts of interest to declare and has signed the practice register of interests accordingly.
• 4.9 She holds full medical indemnity with the Medical Defence Union (MDU), maintains her performers list inclusion, and complies with all statutory CQC and GMC regulatory requirements.

General Summary

• Dr Vance has had a highly productive year, successfully balancing her substantive GP role, OOH work, and community dermatology sessions while completing a demanding postgraduate diploma. Her portfolio is comprehensive, well-organised, and demonstrates deep reflective practice with clear focus on patient safety and quality improvement. We discussed strategies to protect her time as she transitions towards becoming an educational supervisor over the next year.

Aspat

• Encompass all? The summary fully addresses the context of Dr Vance's work across all three clinical roles (salaried GP, GPwER in Dermatology, and OOH GP) and notes that she is in year 3 of her revalidation cycle.
• Exclude bias and prejudice? Every statement in this summary is objective, directly supported by portfolio evidence, and free from bias or prejudice; the document is typed and written in a professional format.
• Challenge, support and encourage? The appraisal provided pastoral support regarding recent practice merger pressures while challenging Dr Vance to delegate routine medication reviews and expand her leadership into medical education.
• Explain why any statements have not been agreed? All statements, including health and probity declarations, were agreed upon by both appraiser and appraisee, so no explanations for unagreed statements are required.
• Look at supporting information, lessons learned and changes made? The summary explicitly evaluates her 58 CPD hours, DOAC audit, and SEAs, detailing the resulting practice changes such as the heart failure SGLT2 inhibitor template and automated EMIS DMARD alerts.
• Look at last year's PDP and reflect on each objective? Every objective from last year's PDP was reviewed, noting the successful completion of her dermatology diploma and DOAC audit, alongside the valid estates-related reason for discontinuing her minor surgery objective.
• Encourage excellence, celebrate accomplishments and record aspirations? Her distinction in the dermatology diploma and 18% reduction in secondary care referrals were celebrated, and her two-year aspiration to become a GP trainer was recorded.
• Note any gaps in the requirements for revalidation and how they will be addressed? It is confirmed there are no gaps for stage 3 of her cycle; her MSF is complete, and a clear plan is in place to complete her PSQ in year 4 across both primary and community roles.
• Contain SMART PDP objectives? The three agreed PDP objectives for 2026/2027 are specific, measurable, achievable, relevant, and time-bound, challenging her to improve clinical safety and educational capability.
• Explain the new PDP items? The summary explains that the new PDP items stem directly from her newly completed dermatology qualification, the DMARD SEA discussion, and her career aspiration to become a GP trainer.
• Comment on stage of revalidation and preparedness, remind regarding PSQ and MSF: Her stage 3 preparedness was confirmed as completely on track, noting her completed March 2026 MSF and recording a formal reminder to complete her PSQ before her year 4 appraisal.

PDP Plan for Next Year

• Objective 1 (Clinical Care): Establish a monthly in-house dermoscopy triage clinic at Oakwood Medical Centre by 30/09/2026, and audit 50 consecutive cases by 30/04/2027 to evaluate diagnostic concordance with histopathology and secondary care referral rates. Objective 2 (Quality Improvement & Safety): Conduct a two-cycle clinical audit of all practice patients prescribed methotrexate and azathioprine by 31/01/2027 to ensure 100% compliance with 12-weekly FBC, U&E, and LFT monitoring following recent EMIS alert updates. Objective 3 (Education & Leadership): Enrol in and complete the local deanery Intending Trainers Course and the first module of the Postgraduate Certificate in Medical Education by 14/05/2027 to prepare for GP Educational Supervisor accreditation.

Five-Year Development Plan

• Across the remainder of her revalidation cycle up to November 2028, Dr Vance plans to complete her PSQ in year 4, achieve formal accreditation as a GP trainer in year 4/5, and integrate GP specialty registrars into both her general practice and community dermatology clinics.

Career Development

• Dr Vance is well-established in her portfolio career combining general practice and community dermatology; over the next two to three years, she aims to step back from ad-hoc OOH shifts to dedicate 1 session per week to postgraduate medical education as an approved GP trainer at Oakwood Medical Centre.