SUMMARY: What could the NHS appraisal system contribute to revalidation in pharmacy?

By Ellen Schafheutle, Samuel Jee, Karen Hassell and Peter Noyce

Ellen Schafheutle lecturer in law and professionalism of pharmacy

Samuel Jee research assistant, Karen Hassell professor of social pharmacy

Peter Noyce professor of pharmacy practice

— all at the University of Manchester

In 2007, the White Paper “Trust, assurance and safety — the regulation of health professionals in the 21st century” tasked all healthcare regulators, including the Royal Pharmaceutical Society of Great Britain (and now the General Pharmaceutical Council), to implement a system of revalidation.

Revalidation aims to reassure the public and is generally described as the process that allows healthcare professionals to demonstrate that they remain up to date and fit to practise. Although the undertaking and recording of continuing professional development are already a requirement for pharmacists and pharmacy technician registrants, other sources of evidence may also be suitable.

The General Medical Council (GMC), for example, is adopting a revalidation model that integrates appraisals as a cornerstone. The GMC is currently in the process of developing a framework against which doctors’ practice can be appraised and objectively assessed.

The use of appraisals has been considered by the RPSGB revalidation advisory group as one possible component of a model for revalidation in pharmacy. Appraisals for NHS employees follow the principles of the NHS Knowledge and Skills Framework (KSF), which could be used as the basis for revalidation.

The aim of our study was to explore the existence and content of current appraisal systems for pharmacists and pharmacy technicians employed by NHS hospitals or primary care organisations (PCOs), and whether elements of them might lend themselves to a potential use for revalidation.

Method

A questionnaire was designed to explore whether appraisal systems were in place in PCOs and hospital trusts, the frequency of use, their content and who conducted them. Questions about the adaptability of current appraisal systems to revalidation were also included.

Following a pilot, the questionnaire was addressed to clinical governance leads in all 152 primary care trusts (PCTs) and in a 50 per cent random sample (n=85) of acute hospital trusts in England. It was initially sent by post in October/November 2009, followed by two reminders also involving medicines management and hospital chief pharmacists.

Questionnaire data were entered onto and analysed using SPSS. Despite statistical comparisons between PCTs and NHS hospital trusts not being possible due to small sample sizes, findings are presented alongside each other to facilitate some comparison across these types of organisations. Open comments were transcribed verbatim and grouped under similar themes.

Results

Appraisal systems currently in place

The response rates were 44 per cent (n=67) from PCTs and 33 per cent (n=28) from hospital trusts. All hospital respondents stated that appraisal systems were in place, which was the case for 80 per cent of PCT respondents.

When asked who was responsible for conducting appraisals, all stated this was the line managers. Most respondents from PCTs (n=51; 96 per cent) and hospital trusts (n=21; 75 per cent) reported that appraisals were conducted annually.

Respondents stated that appraisals included a review of progress on the personal development plan, the identification of learning needs and reviewing performance. A review of CPD was common in hospitals (86 per cent) but less so in PCTs (47 per cent).

Adaptability of current appraisal for revalidation purposes

When asked about the potential adaptability of appraisals for revalidation purposes, 46 per cent of PCT and 65 per cent of hospital trust respondents rated their appraisal system as adaptable. Despite most respondents in both sectors having no (40 per cent and 50 per cent) or only minor (25 per cent and 19 per cent) concerns about adding further questions to appraisals for revalidation, some concerns were raised in open comments.

Nearly half of PCT (n=24; 45 per cent) and half of hospital trust respondents (n=14; 50 per cent) provided such additional comments. Although there was support from some that it made sense to link appraisals with revalidation, others thought that they should be kept separate. Some qualified this by explaining that appraisals and revalidation had different purposes: one was about a supportive and open performance review; the other was about performance monitoring.

Other comments concerned the issue of time and how long the conduct of appraisals already took.

Further comments were made with regard to who would have responsibility for the conduct of appraisals for revalidation purposes, that sometimes pharmacy staff were appraised by non-pharmacy professionals and that appraisers ought probably to be familiar with work sector and context. To meet these objectives, training for appraisers may be required, which would also ensure a consistent and unbiased approach.

Some more general comments were also made about revalidation and most of these came from hospital trust respondents. Some were positive and supported the need for revalidation. Some suggested that revalidation ought to draw on a number of sources, and that CPD ought to at least be a part of revalidation.

Discussion

Appraisals are considered as one potential source of evidence for revalidation in pharmacy, and this study has provided useful and novel insights into current practice and NHS organisations’ views on their adaptability to revalidation. From PCT and hospital trust respondents, it appears that there may be some scope to consider the use of appraisals for revalidation, but some issues would need to be explored further.

Respondents had conflicting views over whether they believed the usual appraisal system could be combined with those undertaken for revalidation, or whether these would need to remain separate, concerns that have also been raised with regard to doctors’ revalidation.

Further issues concerned any specific requirements appraisers would need to satisfy, such as their background and experience of the particular sector of practice, as well as specific training to ensure consistency.

Issues of objectivity of assessment, and who would have ultimate responsibility for a revalidation assessment and feeding this back to the GPhC, would also require further exploration. The latter is the duty of the responsible officer for doctors but no such structure is currently in place or even considered for pharmacy.

Finally, it is worth noting that these findings and conclusions only apply to pharmacy professionals employed in the NHS managed sector. Further pieces of work were commissioned by the Society and are now managed by the GPhC. These were undertaken by the authors in other sectors employing pharmacy professionals, in particular community pharmacy, the pharmaceutical industry and academia.