Barriers and attitudes influencing non-engagement in a peer feedback model to inform evidence for GP appraisal

Esther Curnock,John Mckay,Lindsey Pope,Paul Bowie

doi:10.1186/1472-6920-12-15

Abstract

BackgroundThe UK general practitioner (GP) appraisal system is deemed to be an inadequate source of performance evidence to inform a future medical revalidation process. A long-running voluntary model of external peer review in the west of Scotland provides feedback by trained peers on the standard of GP colleagues' core appraisal activities and may 'add value' in strengthening the robustness of the current system in support of revalidation. A significant minority of GPs has participated in the peer feedback model, but a clear majority has yet to engage with it. We aimed to explore the views of non-participants to identify barriers to engagement and attitudes to external peer review as a means to inform the current appraisal system.MethodsWe conducted semi-structured interviews with a sample of west of Scotland GPs who had yet to participate in the peer review model. A thematic analysis of the interview transcriptions was conducted using a constant comparative approach.Results13 GPs were interviewed of whom nine were males. Four core themes were identified in relation to the perceived and experienced 'value' placed on the topics discussed and their relevance to routine clinical practice and professional appraisal: 1. Value of the appraisal improvement activity. 2. Value of external peer review. 3. Value of the external peer review model and host organisation and 4. Attitudes to external peer review.ConclusionsGPs in this study questioned the 'value' of participation in the external peer review model and the national appraisal system over the standard of internal feedback received from immediate work colleagues. There was a limited understanding of the concept, context and purpose of external peer review and some distrust of the host educational provider. Future engagement with the model by these GPs is likely to be influenced by policy to improve the standard of appraisal and contractual related activities, rather than a self-directed recognition of learning needs.

Highlights

The United Kingdom (UK) general practitioner (GP) appraisal system is deemed to be an inadequate source of performance evidence to inform a future medical revalidation process
GPs in this study questioned the ‘value’ of participation in the external peer review model and the national appraisal system over the standard of internal feedback received from immediate work colleagues
Future engagement with the model by these GPs is likely to be influenced by policy to improve the standard of appraisal and contractual related activities, rather than a self-directed recognition of learning needs

Summary

Introduction

The UK general practitioner (GP) appraisal system is deemed to be an inadequate source of performance evidence to inform a future medical revalidation process. A long-running voluntary model of external peer review in the west of Scotland provides feedback by trained peers on the standard of GP colleagues’ core appraisal activities and may ‘add value’ in strengthening the robustness of the current system in support of revalidation. Since 2003, general practitioners (GPs) in the United Kingdom (UK) have been contractually obliged to engage in a peer appraisal of their professional practice [1]. This involves an externally nominated peer colleague (appraiser) reviewing specific aspects of an individual GP’s (appraisee) professional practice on an annual basis. The evidence for the effectiveness of this form of peer appraisal in improving individual learning and the quality of patient care remains inconclusive [4]

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