NES General Practice Nurse Appraisal Form February 2016 1

General Practice Nurse Appraisal

NES General Practice Nurse Appraisal Form February 2016 2

General Practice Nurse Appraisal Form

STEP ONE

Complete pre appraisal form

STEP TWO

Appraisal Interview

STEP THREE

Appraiser writing summary report

STEP FOUR

Personal Development Plan signed off by employer

Purpose statement: This appraisal form is designed to be used to support the appraisal process for

General Practice Nurses and should take place in the style of an interview. The appraisal process is

best performed annually and for Registered Nurses, can be used flexibly in the following ways:

1. Annual appraisal.

2. Annual appraisal and reflective discussion with NMC registrant for revalidation.

3. Annual appraisal, reflective discussion and confirmer for revalidation.

4. Annual appraisal and confirmer, having previously had reflective discussion with NMC

registrant for revalidation.

Please note:

All the instructions for filling in this form are in the attached notes, so please refer to each

section as required.

The time set aside for this appraisal should be of meaningful length.

NES General Practice Nurse Appraisal Form February 2016 3

Step One: Complete and Send Your Pre appraisal form to appraiser

The person being appraised should send the completed section to their appraiser with their

supporting information at least one full week before the pre-arranged interview date.

Your details

Your name NMC Number:

Revalidation date:

Contact Details

Your appraiser’s details

Name Status

Current role

For NMC Confirmation purposes

Professional body Registration number

Your current role and job information

Title of current role

What qualifications do you hold on the NMC register? See Note 1

Registered: Recordable:

Hours worked per week in current job Hours worked per week for other employer

Do you have an up to date job description for your post? (please circle) See Note 2

Yes No Not sure

Confirm that your employing practice has indemnity cover for you (insurance)? (please circle) See Note 3

Yes No Not sure

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Annual learning and development information based on previous learning plan

Learning in past year Implementation in practice

1.

2.

3.

Clinical Practice: This is your nursing clinical role and how it relates to quality improvement. You

should show how your practice links to the NMC Code areas: Prioritise People; practice effectively;

preserve safety. See Note 4

Reflect on your clinical role within the practice team.

Describe what you do

What do you think you do well and what do you think you could do better?

What support do you need to develop in your clinical role?

NES General Practice Nurse Appraisal Form February 2016 5

Facilitation of Learning: This is about your nursing role in supporting self and others to learn and

develop. You should show how your practice links to the NMC Code areas: Prioritise people;

promote professionalism and trust. See Note 5

Reflect on your own learning particularly with regard to staff mentoring; clinical supervision;

teaching of all staff levels.

Describe what you do

What do you think you do well and what do you think you could do better?

What differences can you make to improve/develop your skills in learning?

Leadership: This is about your team working, supporting and developing care. You should show

how your practice links to the NMC Code areas: Prioritise people; practice effectively; promote

professionalism and trust. See Note 6

Reflect on your own leadership and participation: Include any details of management /

administrative responsibility and activity; contribution to practice meetings; delegation.

Describe what you do

What do you think you do well and what do you think you could do better?

What differences can you make to improve/develop your leadership?

Evidence, Research and Development: This is about your role in implementing and contributing to

evidence based practice, quality improvement and change management. You should show how your

practice links to the NMC Code areas: practice effectively; preserve safety See Note 7

Reflect on your own contributions. You may find it useful to include evidence which supports the

above theme, such as SEA, audit, improvement tools. Include any of management / administrative

responsibility and activity; contribution to practice meetings; delegation.

Describe what you do

What do you think you do well and what do you think you could do better?

What differences can you make which will enable you to deliver quality care?

NES General Practice Nurse Appraisal Form February 2016 6

Probity and Accountability: You may wish to use this space to reflect on any circumstances or conditions in your personal or professional life which could have an impact on your ability to carry out your role. See note 8

You should complete the forms on this checklist if this appraisal is being used to support your 3

yearly NMC Revalidation Process and bring them to the Appraisal

Information required to support revalidation:

Practice Hours 450/900

Provide log of how many hours per 3 years worked: NMC Practice hours log template

CPD hours 35 hours (20 hours participatory)

ePortfolio for CPD sheets/reflection NMC CPD log template

5 written reflections linked to NMC Code

NMC Reflective accounts form

5 practice related feedbacks http://revalidation.nmc.org.uk/download-resources/forms-and-templates

Discussion of 5 reflective accounts with another NMC registrant

NMC Reflective discussion form (if your appraisal is not being conducted by a registered nurse this form should be completed by a registered nurse and brought to the appraisal)

Confirmation Please print out confirmation NMC Confirmation form and use as part of appraisal

Declaration Use the Probity and Accountability opportunity to reflect

NES General Practice Nurse Appraisal Form February 2016 7

Confidentiality

This interview will be confidential unless an issue arises that causes the interviewer or you concern which may require to be discussed with others to determine if any action is needed.

Reason for appraisal (please circle)

Annual review Annual Review with NMC revalidation

Date and time

Interview venue

NES General Practice Nurse Appraisal Form February 2016 8

Step Two: Your Appraisal Interview

At least 1 week prior to the interview, share the above (Step 1) information with your appraiser.

For appraisals to be meaningful, you should request that an appropriate amount of time is set aside

for this (at least 30 minutes but it is reasonable to request an hour). This could be a longer time if the

appraisal is to be used as reflective discussion and/or to confirm revalidation. You should ask for

protected and allocated time without interruptions. Your interview should take place in a

confidential environment.

Step Three: Summary of discussion

The form below offers a template for the summary of your discussions in Step 2 based on your Step

1 evidence.

Name of Nurse Interviewee: NMC No. :

Name of Appraiser:

Date:

Summary of Learning and Development appraisal

Clinical Practice

Discussion Summary:

Action / Agreed Outcomes:

NES General Practice Nurse Appraisal Form February 2016 9

Facilitation of Learning

Discussion Summary:

Action / Agreed Outcomes:

Leadership

Discussion Summary:

Action / Agreed Outcomes:

Evidence Research and Development

Discussion Summary:

Action / Agreed Outcomes:

NES General Practice Nurse Appraisal Form February 2016 10

Probity and Accountability: if applicable

Comments

Additional comments

NES General Practice Nurse Appraisal Form February 2016 11

Step Four: Your Personal Development Plan

See note 9

A draft of your personal development plan is written by you and the appraiser during the

interview. In Step Four it can be refined by the appraiser and then by yourself with your manager

Action Plan for learning development needs

Learning Development Needs Action and Evaluation Suggested date of completion

1.

2.

3.

Name NMC Number

Nurse comments

Signature

Date

Name Appraiser comments

Signature

Date

NES General Practice Nurse Appraisal Form February 2016 12

Notes

NOTE 1: NMC Registration Information

Please indicate on which parts of the Register you hold qualifications relevant to your current post.

Do not include lapsed entries.

Registered qualifications include for example; Registered Nurse, Registered Midwife

Recordable qualifications include:

- V100: Community practitioner nurse prescriber

- V150: Community practitioner nurse prescriber (without SPQ or SCPHN)

- V200: Nurse independent prescriber (extended formulary)

- V300: Nurse independent / supplementary prescriber

- LPE: Lecturer / Practice educator

- TCH: Teacher

- SPA: Specialist practitioner: Adult nursing

- SPMH: Specialist practitioner: Mental health

- SPC: Specialist practitioner: Children's nursing

- SPLD: Specialist practitioner: Learning disability nurse

- SPGP: Specialist practitioner: General practice nursing

- SCMH: Specialist practitioner: Community mental health nursing

- SCLD: Specialist practitioner: Community learning disabilities nursing

- SPCC: Specialist practitioner: Community children’s nursing

- SPDN: Specialist practitioner: District nursing

NOTE2: Job Description

It is essential to understand the role you are being employed for and that the description of that role

fits the practice you are undertaking. Your job description will underpin the rationale for continuing

professional development that is agreed with your employer for the coming year.

NOTE 3: Indemnity

The NMC states that ‘As a registered nurse or midwife, you are legally required to have a

professional indemnity arrangement in place in order to practise. Most employers provide the

appropriate cover for their employees, but it is worth checking with your employer to confirm this. If

you are self-employed you will need to have arranged your own professional indemnity cover. You

NES General Practice Nurse Appraisal Form February 2016 13

don’t need to provide evidence to prove you meet this requirement – you just need to confirm you

have the appropriate cover when making your application.’

Note: If self-employed/locum you will need to have your own indemnity arrangements.

NOTE 4: Clinical Practice

Your role may be very diverse or extremely specialist. This section allows you to broadly reflect on

the service you deliver, and the expertise needed to deliver this role. Please consider your job as a

whole, any developments or extensions of your role and any autonomy you have been given.

The following clinical and non-clinical areas are the most common in general practice nursing

however please also consider any others relevant to your role. Examples are Chronic Disease areas

(Asthma COPD CHD CKD, diabetes, hypertension), core treatment room work, Triage, minor

ailments, illness and injury, travel health, health screening, contraception, sexual health, Nurse

Prescribing, communication skills.

NOTE 5: Facilitation of Learning

Please mention any form of teaching that you do from taking a nursing student to supporting

learning in your new practice nurse. If your practice is a teaching practice you may be involved in

teaching all levels of staff, including GP trainees, and medical students please consider these in your

answer. In addition, you may be involved in teaching or facilitating on courses for Higher Education

Institutions or NHS Education for Scotland / Education for Health.

NOTE 6: Leadership (Team Working)

This is about your role in team working and levels of clinical and administrative responsibility that

you have been given.

NOTE 7: Evidence, Research & Development – supporting information

At least one of the following types of written evidence should be submitted as supporting evidence

for your development interview: Reflective Case Study, Significant Event Analysis, Audit, and/or

patient satisfaction survey. You may be involved with other groups or organisations out with the

practice, e.g. NHS Health Boards, SPNA, National Policy Groups (SIGN / NICE) or Local Policy

groups such as MCN’s. Please consider any other relevant to you.

This should be evidence of your nursing activity in the practice, which you have completed or are

directly involved in. Please keep this information free from identifiable names or persons

(especially patient details). It is preferable to email this supportive information using NHS.net or

Health Board equivalent.

Reflection is a vital part of continuing professional development and has been formally linked into

revalidation. The following links are tools to enable you to fulfil appropriate and meaningful

revalidation:

Effective Practitioner

The Knowledge Network

NICE Guidelines for reflective practice in nursing

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Nursing and Midwifery Council reflective practice

NOTE 8: Probity and Accountability

This is for you to note any learning issues you wish to discuss with your appraiser. Are there any

particular circumstances which have helped or hindered your ability to learn and perform over the

last year? For example, is there better clinical supervision or a recent retirement which has left you

without nursing support?

The NMC states that ‘Your character is central to the Code. This requirement asks you to declare

that your health and character are sufficiently good to enable you to practise safely and effectively,

and to declare any cautions or convictions. You don’t need to collect evidence to prove you meet

this requirement – you just need to complete the declarations when making your application.’

The NMC Code (2016) https://www.nmc.org.uk/standards/code/ says “As a professional, you are

personally accountable for actions and omissions in your practice and must always be able to justify

your decisions” AND “You must always act lawfully, whether those laws relate to your professional

practice or personal life.”

NOTE 9: PERSONAL LEARNING PLAN (PLP) / PERSONAL DEVELOPMENT PLAN (PDP)

Requirements of revalidation model

Practice Hours 450 hours Registrants who practice as both nurses & midwives 900 hours (450 nursing, 450 midwifery)

Continuing Professional Development

35 hours – 20 of which must be participatory (with others)

Feedback Obtain minimum 5 pieces of practice related feedback and provide evidence of how used to improve practice

Reflection Minimum 5 written reflections on NMC Code and application in practice, how feedback used & CPD

Reflective discussion with other nurses/midwives

Discussion of reflective accounts with another NMC registrant. It is for the nurse or midwife to decide who is most appropriate person

Maintain Portfolio NMC recommend evidence is retained in a portfolio

Indemnity Insurance Self-declaration by the NMC registrant

Health & Character Self-declaration by the NMC registrant

Confirmation

Confirmer reviews evidence within the portfolio and uses judgement to determine whether NMC registrant has met revalidation requirements. Line manager strongly recommended. Does not have to be NMC registrant.

References:

Aird, Ruth; Kennedy, Susan; McIntosh, Patricia; Practice Nursing, 2016; Benefits of peer appraisal for general

practice nurses 27(3): 140-142. 3p

Appraisal form developed by: Ruth Aird (NES); Kathy Kenmuir (NHSGGC); Susan Kennedy (NES)