How do I manage staff performance and appraisals?

Why it matters

In a small practice, one person's performance shapes every patient's experience. In England, CQC regulation 18 requires staff to receive the support, training, professional development, supervision and appraisal they need to do their job. The CQC's guidance says staff should have regular appraisal from an appropriately skilled and experienced person, with learning needs identified, planned for and supported. Regulation 19 also requires you to monitor that staff remain fit for their role.

Running appraisals

Acas advises employers to conduct regular performance reviews for employees, ideally at least once a year. A simple structure works well:

1. Preparation. Ask the employee to reflect on the year beforehand, and collect relevant information, such as patient feedback, audit results, training records and any complaints or compliments.
2. Review. Discuss what went well, what didn't, and whether previous objectives were met.
3. Objectives. Agree a few SMART objectives: specific, measurable, achievable, relevant and time-bound. For a receptionist, this might be completing chaperone training by a set date. For a nurse, it might be leading an infection control audit.
4. Development. Agree training and support, including mandatory training such as basic life support, safeguarding, infection control and information governance.
5. Record. Write up what was agreed and share it with the employee. Keep it on their personnel file.

The appraisal should rarely contain surprises. Acas recommends regular informal conversations, feedback and one-to-ones alongside formal reviews. In a small team, a short monthly check-in is usually enough.

New staff and probation

Give every new starter an induction, then review at set points during probation. The CQC expects you to assess competence before someone works unsupervised, and to supervise them until they are competent. Record each review. This matters more from January 2027, when the qualifying period for unfair dismissal falls to six months under the Employment Rights Act 2025. See employment law when hiring staff.

Clinical staff and revalidation

• Nurses. NMC registrants revalidate every three years. You can help by providing practice-related feedback, supporting reflective discussion, and acting as or arranging a confirmer.
• GPs you employ or engage. Doctors revalidate through their designated body and annual whole-practice appraisal. Give them the information they need about their work with you, such as activity, complaints, significant events and patient feedback. See appraisal and revalidation for private GPs.
• Healthcare assistants. They are not regulated, so your competence assessment and training records are the main assurance. The CQC expects providers employing healthcare assistants to follow the Care Certificate standards when assessing competence.

Clinical supervision is separate from line management. Make time for it, especially for staff working under patient group directions or patient specific directions.

When performance falls short

Acas separates two kinds of problem:

• Capability: the person cannot do something, perhaps because of skills, training or health. Respond with support, coaching or training. Employers must provide adequate resources for staff to do their job.
• Conduct: the person's behaviour, such as lateness, unauthorised absence or not following procedures they have been trained in. Start with an informal conversation unless it is serious.

The two can overlap. Lateness might be caused by a health condition. If the issue relates to a disability, you must consider reasonable adjustments before taking any action.

If informal steps don't work, use a performance improvement plan with clear targets, support and a review date. If that fails, follow a fair procedure in line with the Acas Code of Practice on disciplinary and grievance procedures. An employment tribunal takes the Code into account, and dismissal should be a last resort after you have considered changes to duties or another role.

When there is a risk to patients

If a clinician's performance puts patients at risk, act straight away. That may mean restricting duties or adding supervision while you investigate. Record the concern as a significant event where appropriate, and take advice from your indemnity provider or an HR adviser. Regulation 19 requires you to take proportionate action when someone is no longer fit for their role and, for registered professionals, to inform their regulator where appropriate. For a doctor, also contact their responsible officer.

Records and fairness

• Keep appraisal and performance records confidential and in line with UK GDPR.
• Apply the same standards to everyone, and avoid bias linked to protected characteristics.
• Use the same broad approach for workers and self-employed contractors where you can. The Acas Code mainly applies to employees, but a consistent approach helps working relationships.

In England, appraisal records, a training matrix and supervision notes are also evidence for the CQC's Well-led and Effective key questions. Compliance systems such as QCS or GP TeamNet can hold training records and policies. A good example of a tool built around inspection evidence is Practice Control Tower, which keeps each CQC requirement with an owner and its evidence and flags evidence more than about a year old. It is currently taking a waitlist.

For how appraisals fit your wider governance, see clinical governance.

Scotland, Wales and Northern Ireland

The employment law and Acas guidance here apply in England, Scotland and Wales. Northern Ireland has separate employment legislation, and the Labour Relations Agency provides advice there. The CQC regulates services in England. In Wales, Scotland and Northern Ireland, Healthcare Inspectorate Wales, Healthcare Improvement Scotland and RQIA set their own staffing standards.