The GMC says:
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"You must discuss with your appraiser or responsible officer the extent and frequency of quality improvement activity that is appropriate for the work you do."
You must be able to show you have participated in quality improvement activity that is relevant to all aspects of your practice at least once in your revalidation cycle. However, the extent and frequency will depend on the nature of the activity. You should participate in any national audit or outcome review if one is being conducted in your area of practice. You should also reflect on the outcomes of these audits or reviews, even if you are unable to participate directly. You should evaluate and reflect on the results of the activity, including what action you have taken in response to the results and the impact over time of the changes you have made, and discuss these outcomes at your appraisal. If you have been unable to evaluate the result of the changes you have made or plan to make to your practice, you must discuss with your appraiser how you will include this in your personal development plan for the following appraisal period." |
Out of Hours GP work is considered to be GP work so does not require additional QIA to in hours GP work.
You do not need to write up any quality improvement activity.
It can all be described and reflected on orally during the appraisal discussion.
It can all be described and reflected on orally during the appraisal discussion.
What counts as quality improvement activity?
QIA may take many forms including taking action as a result of:
- reflective case reviews
- large scale national audit
- formal audit
- review of personal outcome data
- small scale data searches
- information collection and analysis (‘search and do’ activities)
- plan/do/study/act (PDSA) cycles
- learning event analysis (LEA) and significant event review
- feedback from any source
- compliments and complaints
- learning from continuing professional development
- writing or revising a practice policy
- monitoring and evaluation e.g. patients on DMARDS or warfarin.
How much quality improvement activity must i do?
You should aim for at least one QIA per year, and over the 5 year revalidation cycle your QIAs should cover your whole scope of practice.
However, there is much flexibility.
The GMC says, "You must discuss with your appraiser or responsible officer the extent and frequency of quality improvement activity that is appropriate for the work you do."
The RCGP says, "Seek for quality not quantity of your QIAs" and "No fixed number of QIAs is recommended."
However, there is much flexibility.
The GMC says, "You must discuss with your appraiser or responsible officer the extent and frequency of quality improvement activity that is appropriate for the work you do."
The RCGP says, "Seek for quality not quantity of your QIAs" and "No fixed number of QIAs is recommended."
can i submit a qia done by someone else?
You do not need to have undertaken data collection personally.
So you could get a member of staff to run a computer search and give you the data in a spreadsheet.
Your reflection should describe your personal involvement in the activity.
You should compare your own performance with current standards of good practice.
You should state what changes you plan to make as a result of each QIA or how you will maintain high standards of performance.
So you could get a member of staff to run a computer search and give you the data in a spreadsheet.
Your reflection should describe your personal involvement in the activity.
You should compare your own performance with current standards of good practice.
You should state what changes you plan to make as a result of each QIA or how you will maintain high standards of performance.
Is this item qia or cpd?
"In CPD there is an element of learning what to do and in quality improvement either of checking if it was done right, or if changes have made a beneficial impact.
So, if learning what the right thing is or how to do it, e.g. the correct emergency management of sepsis in my clinical setting, that is CPD.
Quality improvement is checking whether the right thing was done properly or measuring outcomes, e.g. was the right antibiotic given or were readmission rates within agreed limits."
So, if learning what the right thing is or how to do it, e.g. the correct emergency management of sepsis in my clinical setting, that is CPD.
Quality improvement is checking whether the right thing was done properly or measuring outcomes, e.g. was the right antibiotic given or were readmission rates within agreed limits."
What resources are available to help me?
The RCGP website has numerous resources.
Your local prescribing team will be very happy to help run prescribing audits.
GMC example "Prescribing valproate in primary care: how to demonstrate quality improvement"
Structured Reflective Templates:
Your local prescribing team will be very happy to help run prescribing audits.
GMC example "Prescribing valproate in primary care: how to demonstrate quality improvement"
Structured Reflective Templates:
- Quality improvement project
- Case review
- Significant event
- Audit or data collection
- Complaint report
- A "factors for consideration template" for doctors wishing to reassure themselves that they are competent across the whole scope of their work (counts as QIA).
What can locums do as qia?
Locums often find it hard to do meaningful quality improvement activity because they don't have access to practice computers when they are not employed to see patients, nor do they have the support of the wider primary care team beyond their contracted hours.
For help with access see
Access to clinical records for professional development activities (ROAN, 2019)
Access to clinical records for professional development activities (ROAN, 2019)
Here are some suggestions:
Case reviews.
Write up a case which interested you for whatever reason (e.g. a difficult consultation, unusual presentation or diagnosis, legal issue).
Describe the events, reflect on what happened and what you learned from this case.
What might you do differently if the same thing happened again?
A simple prescribing audit comparing your prescribing with the local formulary.
Learning Event Analysis. (previously called significant event analysis, SEA).
What could you do to prevent the same event from happening again?
You must discuss these and develop an action plan with others.
What could you do to prevent the same event from happening again?
You must discuss these and develop an action plan with others.
Log your referrals.
How many were rejected and why?
How can you improve?
How many were rejected and why?
How can you improve?
Key documents
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GMP Framework for appraisal and revalidation (GMC, 2013)
Guidance on supporting information for appraisal and revalidation (GMC, revised November 2020) or go to the on-line version
Good medical practice (GMC, 29 April 2019)
Factors for consideration template (AoMRC, April 2020) for doctors wishing to reassure themselves that they are competent across the whole scope of their work.
Medical Appraisal Guide 2022 (Academy of Medical Royal Colleges, June 2022)
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