NES Medical Appraisal Feedback Details of DoctorDoctor’s name(Required)GMC number(Required)Knowledge Skills and DevelopmentDoes the doctor recognise and work within their level of competence? Yes No Has the doctor completed any additional training specific to their work at the hospital? Yes No Does the doctor offer good care in the event of any emergency? Yes No Does the doctor seek advice/escalate concerns relating to the management of patients as required? Yes No Does the doctor liaise with the clinical lead on a regular basis taking opportunities for feedback and support? Yes No Has the doctor been involved in any significant events? Yes No Has the doctor taken part or contributed in any audit or quality improvement? Yes No Patients Partnerships and CommunicationDoes the doctor respect the patient’s right to privacy and dignity? Yes No Does the doctor treat patients with kindness, courtesy, and respect? Yes No Does the doctor respect patient confidentiality? Yes No Trust and ProfessionalismDoes the doctor act with honesty, integrity, and professionalism? Yes No Is the doctor (to the best of your knowledge) trustworthy? Yes No WellbeingHas the doctor raised any wellbeing concerns or needed any additional wellbeing support from the hospital team? Yes No Has the doctor needed any support from the hospital team and was it available to them? Yes No Colleagues, Culture and SafetyDoes the doctor treat colleagues with kindness, courtesy, and respect? Yes No Does the doctor work effectively as part of the ward team? Yes No Does the doctor communicate clearly, politely, and considerately? Yes No Is the doctor accessible and responsive when called? Yes No Is the doctor’s medical note keeping clear, accurate, contemporaneous, and legible? Yes No Does the doctor contribute to incident reviews and complaints (where necessary)? Yes No Further InformationIf applicable, please provide reasons for any of the above answers and add any other comments to share with the doctor’s appraiser.Do you have any suggestions for the doctor’s next personal development plan? For example any additional training, audits or quality improvement activitiesYour DetailsForm completed by(Required) First Designation(Required)Hospital(Required)Date of completion(Required) DD dash MM dash YYYY
