NHS: Performance Appraisal

All National Health Service trusts are independent employers and are required to comply with employment legislation and relevant Advisory, Conciliation and Arbitration Service codes. Local human resources (HR) policies and procedures should follow best practice guidance, which may include model HR policies developed nationally.

At a national level, safeguards also exist to help prevent the misuse of performance management tools. The NHS Constitution commits employers to fair and supportive treatment of staff. The Care Quality Commission’s inspection framework includes workforce culture and governance, which can highlight poor practice. Every trust is required to have a Freedom to Speak Up Guardian, giving staff a confidential route to raise concerns. The annual NHS Staff Survey provides transparency on staff experience and fairness, enabling action to be taken where concerns are identified.

In 2025, NHS England also published the expectations of line managers in relation to people management, alongside the launch of the NHS Management and Leadership Programme to ensure that NHS leaders and managers at all levels meet the standards and competencies expected of them, have access to professional development and support, and that the NHS continues to attract, develop and retain the best talent while strengthening public confidence in NHS leadership.