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WPBA: Quality Improvement Activity

Publication date: 19 January 2024

The GMC recommend that all doctors demonstrate involvement in Quality Improvement at least once a year.

During your GP training you are expected to complete a Quality Improvement Project (QIP) when you are in your primary care placement in either ST1 or ST2 and a Quality Improvement Activity (QIA) in both of the other 2 training years.

The QIP is covered in more detail in the QIP section.

By the time you reach the end of training you need a minimum of 1 QIP and 2 QIAs.

The definition of QIA covers a wide range of activities (see FAQs).

The QIA should be recorded electronically in your Portfolio.

This reflective learning log entry enables QIA to be captured across the full training programme. At present, the GMC and RCGP are promoting quality improvement activities, which use a different methodology to audit, (however audits are still considered in the wider environment to be a quality improvement activity and would count as a QIA).  The QIA reflection should involve a personal connection to the work and include an element of evaluation and action, and where possible, demonstrate an outcome or change.

Please note you do not need to also do a QIA in the same training year as your QIP.

For the purposes of GP training, Learning Event Analysis (or Significant Events) and Reflection on Feedback do not count towards your annual QIA requirements. The QIA reflective log specifically involves taking some action as a result of data. Involvement in QIA throughout your training ensures you are equipped with appropriate quality improvement methods for lifelong competence.

Quality Improvement Activity (QIA) FAQs

The GMC recommend that all doctors demonstrate engagement in Quality Improvement at least once a year. You are required to demonstrate that you regularly participate in activities that review and improve the quality of your work for the purposes of revalidation. When qualified, it is a requirement each year at your appraisal to demonstrate that you have been involved in quality improvement activities (QIA). Engagement with QIAs during training ensures you are equipped with appropriate quality improvement methods for lifelong competence. 

The Quality Improvement Activity reflective learning log entry should be used to capture QIA across the full training programme (which is separate from the required QIP - see below). The QIA should be robust, systematic and relevant to your work. Your reflection should include an element of evaluation and action, and where possible, demonstrate an outcome or change. 

A Quality Improvement Activity (QIA) is a more broad term which encourages doctors, both qualified and in training to evaluate the quality of their work in addition to what works well in the clinical environment, to promote and consider change where appropriate. QIA also encourages reflection on the changes (if any) that are made.

Do I need to do a QIA the same year as completing the mandatory QIP?

No. The QIP needs to take place in a primary care placement in either ST1 or ST2 and QIAs in the other training years. If you have done a QIP in a training year a QIA is not needed in that training year.

QIA can take many forms; the QIA is intended to be a smaller activity than the formal QIP. Although you are encouraged to think about quality rather than quantity of any QIA.  The QIA should involve a personal connection to your work and look to create an improvement and/or change, which requires action to be taken. The following are suggested types of QIA suitable to be completed annually which involve taking action as a result of data:

  • a review of personal outcome data through case reviews e.g. referral review
  • involvement in large scale national audit with data collection at an individual/practice level
  • small scale data searches which could include reviewing prescribing (separate to the prescribing assessment)
  • small specific QIP using plan/do/study/act (PDSA) cycles
  • writing or revising a practice policy
  • monitoring and evaluation e.g. patients on DMARDS or warfarin using PINCER data
  • ‘search and do’ activities involving information collection and analysis

It is a separate mandatory requirement to complete at least one Learning Event Analysis (LEA) per year. A Significant Event Analysis (SEA) should be completed should the event reflected on reach the GMC threshold. It is recognised that LEA/SEA will demonstrate how you review and learn from both positive and negative events and incidents;  in many cases the learning will also lead to quality improvement activity (QIA), however the aim of the QIA focuses on reflection following data collection.

A separate reflective log entry has been created to reflect on feedback received from any source (not a mandatory requirement). This could be feedback from an assessment including multisource feedback, the educational supervisor review, other solicited or unsolicited feedback and a compliment/complaint. Although feedback may lead to QIA through the nature of personal reflection on a specific case, the QIA strives to empower you to look at areas for change/improvement within the clinical setting more broadly.

The quality improvement activity (QIA)  and the leadership project both have an outcome of improving patient care but focus on different skills. Two separate activities need to be completed to provide evidence of your understanding and competence. These are documented on the relevant learning log templates in your Portfolio.

A QIA allows you to evaluate the quality of your work, either on something personal to you or on activities within your clinical environment to both promote and consider change where appropriate, while leadership includes looking at your own leadership skills, leadership of the team and the organisation.