Performance Appraisal & Development Review (PADR)
Appraisal Document Year__________
The appraisal form has three sections. Some parts you need to complete in preparation before you meet your appraiser, other parts you will complete together:
1a. Personal reflections
1b. Review performance against objectives
1c. Discuss your rating
1d. Identify and discuss any issues of health and well-being / work-life balance
2a. Agree your performance objectives
3. Complete the Summary and confirmation of appraisal section
Appendix- Follow up one to one if requested by Appraisee/Appraiser
Appraisal Process
|PERSONAL DETAILS |
|Employee Name : |Job Title: |Name of Practice: |
|Professional Registration: Revalidation Date: |Date of this annual appraisal: |Date of follow up one to one if agreed: |
|/ / |/ / |/ / |
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|REVIEW OF PREVIOUS YEAR’S TRAINING AND DEVELOPMENT |
|Description of training and development |Date completed |Comments |
| | | |
| | | |
(UK Core Skills Training Framework Skills for Health2016)
|Mandatory and Statutory Training |Updates |Date |Mandatory and Statutory Training |Updates |Date |
|Anaphylaxis and BLS |Annually | |Safeguarding children (incl. DA, CSE,) | | |
| | | | |Level 2 | |
| | | |Safeguarding adults (Incl. Prevent Training & MCA & DOLS) |3-4 hours over 3 | |
| | | |(see safeguarding Guidance-levels and updates apply to both adults |years for each | |
| | | |and children) | | |
| | | |Level 2 Non-clinical and clinical staff with some degree of contact | | |
| | | |with children, young people or their parents or carers:- |Level 3 | |
| | | |e.g practice managers, managers and administrators with safeguarding |6 hours over 3 years| |
| | | |responsibilities phlebotomist, healthcare assistants |for each | |
| | | |Level 3 All Nurses and GPs | | |
|Chaperoning (HCA’s & non-clinical staff) |Once | | | | |
|Conflict Resolution |3 yearly | | | | |
|Dementia Tier 2 all clinical staff |Once | | | | |
|Equality, Diversity & Human Rights |3 yearly | | | | |
|Health and Safety & Welfare |3 Yearly | | | | |
|Fire Safety |2 yearly | | | | |
|Infection Prevention and Control |Annually | | | | |
|Information Governance |Annually | | | | |
|Manual Handling Updates based on local assessment | | | | |
|Cervical screening |Date of initial Training: |
|Is your Job Description Up to Date? If not please say | |
|why? | |
|What has gone well? | |
|What have you learnt? | |
|What has gone less well? | |
| | |
|What have you learnt? | |
|Have you any skills not being used? | |
|What has your manager/Practice done that has been | |
|helpful to you? | |
|Specifically, what would you like them to do more of? | |
|What would you like them to do less of? | |
Section 1b- Review of your performance against objectives
| |Objective |Achieved/Partially |Your comments |Manager comments |
| |Do not rewrite previously agree objectives – just the key |Achieved/Not Achieved | | |
| |words | | | |
| |100% compliant with Statutory & Mandatory requirements | | | |
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Section 1c- Assess health & wellbeing at work
|Identify and discuss any health and well being issues / work life balance |
| |
Section 1d- Assessment of performance
To be completed jointly at time of appraisal
| | |A |B |C |D |
| |Employer’s Comments |Well ahead of standard |More than satisfactory |Less than satisfactory |Unsatisfactory |
| | | |– slightly above job requirements|– needs slight improvement |- below the standard reasonably|
| | | | | |expected |
|Volume of work | | | | | |
|How does the amount of work done | |( |( |( |( |
|compare with the job | |Exceptionally high output |Output is usually above average |Output is occasionally |Insufficient improvement |
|requirements? | | | |unsatisfactory |needed |
|Job Knowledge | | | | | |
|Does the employee have the | |( |( |( |( |
|knowledge to do the job properly?| |Exceptionally thorough knowledge of|Good knowledge of own job and |Lack of job knowledge sometimes |Inadequate knowledge of own |
| | |own and related work |related work aspect |hinders progress |work |
|Safety Awareness | | | | | |
|Consider in regard to safe | |( |( |( |( |
|working practices | |Highly motivated towards safety. |A good attitude to safety and |Sometimes has to be reminded of |Disregards basic safety |
| | |Always insists on safe working |encourages others likewise |safety precautions at work |precautions |
| | |practices | | | |
|Dependability | | | | | |
|How well does the employee follow| |( |( |( |( |
|procedures | |Always thoroughly reliable |Little supervision required |Requires more frequent checks |Requires constant supervision |
| | | | |than normal | |
|Teamwork | |( |( |( |( |
|How well does the employee work | |Works extremely well with others |Cooperative and flexible |Usually gets along reasonably |Uncooperative, resists change |
|with others to accomplish the | |and responds enthusiastically to | |well but occasionally unhelpful | |
|goals of the job | |new challenges | | | |
|Attendance and Punctuality | |( |( |( |( |
|What is the employee’s pattern of| |Exceptionally punctual. Rarely |Attendance levels are acceptable |Absence and/or lateness levels |Frequently late and/or absent |
|absence and punctuality | |absent |and is rarely late |are higher than average | |
|Work Planning | |( |( |( |( |
|Consider employee’s success in | |Displays excellent planning ability|Organises work well |Needs to improve some aspects of |Does not plan effectively |
|planning own work | | | |work planning | |
|Communication | |( |( |( |( |
|How effective is the employee at | |Exceptionally effective in all |Usually a good communicator |Some difficulties with written |Does not communicate |
|verbal and written communication | |written and verbal communication | |and/or verbal communication |effectively |
|Overall Marking | |( |( |( |( |
| | |Well ahead of standard performance |More than satisfactory – slightly|Less than satisfactory – needs |Unsatisfactory – below the |
| | | |above job requirements |slight improvement |standard reasonably expected |
Section 2a- Objectives for the coming year From_________To____________
Set SMART (Specific, Measurable, Achievable, Realistic, Time bound) objectives in line with practice objectives
| |Objective |How |By when |Expected outcomes / measure of |Support / action required from |
| |List objectives for coming year’s Appraisal | | |achievement |manager or others |
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Section 3- Summary and confirmation of appraisal
This section confirms the outcomes of the Appraisal and the reporting process. It is recommended that you complete this at the time of appraisal, whilst you are both together.
3.1: Summary of performance and development
|Manager/ appraiser’s summary comments on performance and development, including demonstration of behaviours, over past year. |
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|Staff member’s summary comments on performance and development, including demonstration of behaviours, over past year. |
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3.2 Character check
|Have you any criminal charges, convictions or cautions that have not been declared since your last DBS check? |Yes |No |
|Note for managers: If the answer is Yes then, within 7 days, a separate meeting should be held to discuss the matter, together with practice manager and allocated GP partner. |
|NMC to be informed by registrant in keeping with the Code. |
3.3: Clinical supervision
|If applicable to the professional group, please indicate whether the staff member has accessed clinical |Y/N |Comments: |
|supervision this year or attended Practice Nurse Forums, accessed peer review, other supervision. | | |
3.4 Nurse revalidation (If Applicable) - Revalidation date: ___________________
|To record progress and preparation for revalidation. |On track |Areas for focus/support |
|Period ………………….to ……..….……… |Y/N | |
|CPD Hours | | |
|Minimum 35 hours of CPD over 3 yrs, at least 20 must have included participatory learning | | |
|Practice Hours- 450 Hours over 3 yrs | | |
|Five Written Reflective Accounts | | |
|Five pieces of practice-related feedback | | |
|Eg:, Audits, Team Feedback, Near Misses, Serious Incidents, Patient/Team feedback. 360° Feedback | | |
|Reflective discussion partner identified | | |
|Name: | | |
|Confirmer identified | | |
|Name: | | |
|Appraisee Name: | |
|Contact Number: | |
|Email Address: | |
|Signature: | |
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|Date: | |
3.5 Signatures:
|Appraiser Name: | |
|Contact Number: | |
|Email Address: | |
|Signature: | |
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|Date: | |
Appendix One: Follow up One to One- Planned Date:________________
|Appraisee Update: |
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|Manager Update: |
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|Agreed outcome/plan: |
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|Employee/appraisee signature: Managers signature: |
|____________________________ __________________________________ |
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|Date_______________________ Date:_________________ |
Updated Apr 2019
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Section 1
Review and rate the past year
Section 2
Plan for the year ahead
Section 3
Summarise and confirm appraisal
Practice Nurse prepares section 1 of appraisal form including:
1a Personal Review
1b Review of performance against objectives and development action plan
1c Review of health and well-being / work-life balance
1d Consideration of assessment of performance rating
Identify and agree an appraiser and set the appraisal date
A copy of the completed appraisal form is sent to the appraise and line manager within 1-2 weeks of the appraisal interview or negotiated timescale
Practice Nurse
Sends prepared forms to appraiser before the appraisal or within the negotiated timescale
Appraiser and appraisee
Complete and sign off all forms summarised and signed off by appraiser and appraisee
Appraiser
Reads material and prepares for appraisal 1-2 weeks before the appraisal, or within the negotiated timescale.
Consider section 1d assessment of performance rating
Appraisal takes place
A copy of the completed appraisal form is sent to the appraise and line manager within 1-2 weeks of the appraisal interview or negotiated timescale
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