It has been acknowledged that little is known about the impact of general practice (GP) appraisal on clinical and professional practice, as may be demonstrated by identifiable or 'hard' outcomes, and further, that the way in which appraisal informs professional development is unclear. In spite of this acknowledgement and the existence of a substantial number of studies about GP appraisal, to date an overview of the field of enquiry which maps what is known, has been lacking. In this leading article we present the first extensive thematic narrative synthesis of the literature on appraisal. In it we highlight the issues and tensions around research into appraisal, based on what we found (or didn't find) in our review. Key conclusions concern the focus of existing research - which has tended to report the perceptions of change from individual appraisees, rather than specific examples of change captured from other sources and perspectives - and the scope of research - which has been limited to certain data collection methods. Based upon our review, we draw out implications for research and researchers in the future.

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