In NHS England a new appraiser is normally allocated to a doctor after completing three appraisals. This provides a balance between continuity and objectivity in most situations. However, the NHS England medical appraisal policy allows flexibility to extend the allocation to additional appraisals provided the reasons are documented.

While there should be a clear reason for extending the allocation of an appraiser this should be more than simple personal preference. Examples are varied but may include where:

• the additional appraisal will allow the doctor and their appraiser to conclude a complex issue
• maintaining the doctor-appraiser connection will support retention of a doctor in the workforce
• the additional appraisal will be the last before revalidation and it is judged that maintaining the allocation will help this to proceed smoothly
• the additional appraisal is the last appraisal before the doctor retires
• the doctor is returning from abroad and it will be helpful for their next appraisal to be with an appraiser who knows them even if this takes them beyond the third appraisal.

Extending to additional appraisals will normally be by mutual agreement between the doctor, their appraiser and the responsible officer, within the terms of what is described in the NHS England medical appraisal policy about appraiser allocation.

The appraiser should record in the appraisal documentation that the appraisal is in addition to the normal allocation of three, describe the reason for this and confirm that approval has been given by the responsible officer via their team.

Notwithstanding this flexibility, a doctor is expected to have at least two appraisers in each revalidation cycle, to demonstrate objectivity within the process.

This information sheet is relevant primarily to NHS England responsible officers.

Released May 2023.