Grade	Description
A	An excellent and timely review, providing a set of comments that are comprehensive, insightful, and clear, and are informed by a close familiarity with the topic and/or the methodology of the study. There is a clear recommendation on acceptance for publication, consistent with these comments, which are structured, immediately comprehensible to the authors, and which can act as a constructive guide to redrafting and resubmission. There are useful comments to the editor about matters such as the novelty, importance, and likely interest to readers of the BJGP. These top-class reviews often suggest additional literature and references for consideration by the authors.
B	A very good review, with useful and timely guidance for the editor, clear comments to the authors, and sufficient detail for resubmission and redrafting, although perhaps with less subject or methodological expertise, less incisiveness, and perhaps also missing some key details. Like Grade A reviews, these reviews are likely to run to at least 40 or 50 lines of comment, providing sufficient material to not only help authors improve their manuscript but also to reflect on their methods, findings, and interpretation.
C	An adequate review that is still useful, but may not provide a comprehensive opinion or absolutely clear advice to the editor. This may be problematic when a more detailed review has come to a different conclusion about quality or a different recommendation on acceptance, so that a further review may be needed to supplement the shortcomings in the Grade C report.
D	An evaluation that is too brief and superficial to be useful. It not only fails to identify significant shortcomings in the study, but also is too thin to be used as a basis for rejection. A very short review of this kind recommending acceptance can be equally unhelpful, particularly when it has to be weighed against a more guarded opinion in a more detailed report.
E	A review that is short, dismissive, or mildly offensive, with evidence of bias or personal animosity, with no attempt to provide objective or constructive comments and with very weak academic/intellectual content.