Significant events

The GMC says

The purpose of collecting and reflecting on significant events:

  • To allow you to review and improve the quality of your professional work.
  • To identify any patterns in the types of significant events recorded about your practice and consider what further learning and development actions you have implemented, or plan to implement to prevent such events happening again.

The GMC's requirements

You must declare and reflect on every significant event you were involved in since your last appraisal.

  • Your discussion at appraisal should focus on those significant events that led to a change in your practice or demonstrate your insight and learning. You must be able to explain to your appraiser, if asked, why you have chosen these events.

Your reflection and discussion should focus on the insight and learning from the event, rather than the facts or the number you have recorded.

What is a significant event?

For the purposes of this guidance a significant event is any unintended or unexpected event, which could or did lead to harm of one or more patients. This includes incidents which did not cause harm but could have done, or where the event should have been prevented.

Formerly, there was some confusion about what should be included as significant events (SEs) in the appraisal and revalidation portfolio. This GMC guidance makes clear the definition of a significant event. In order to avoid confusion, the RCGP has agreed that the learning events, previously called significant events, in primary care, which may be positive, neutral, or adverse events or incidents, will no longer routinely be called significant events. The new terminology more accurately reflects the use of learning from events in primary care and avoids the potential negative connotations of being 'significant'. Learning event analysis in primary care is a form of QIA (see above) and may involve events that are routine in practice but worthy of analysis to see what can be learned and improved.

  • You must be aware of the GMC definition of significant events.
  • Like all doctors, you must declare and reflect on all significant events in which you have been personally named or involved, and your reflections and actions agreed as a result must be provided in this section of supporting information and discussed during your annual appraisal.
  • Not all significant events need to be discussed in detail – you should choose those that have led to important learning and changes that have an impact on your practice.
  • All significant events should be written up on a standardised pro forma, and analysed to look at how actions and conditions interacted in contributing to the outcome. Where possible, it is appropriate to consider any changes that can be made to protect patients. Such significant events should be discussed with colleagues to maximise and share learning according to GMC requirements.
  • If you have not been personally named, or involved, in a significant event during the year, you should sign the statement to confirm there were none and include a reflective note about the systems that are in place to ensure that such events would be recognised and reported.
  • It is best practice to demonstrate that you are aware of how significant events are captured in all the organisations within which you work, across the whole of your scope of practice. You should know how to report any significant events that you become aware of and how to ensure, as far as possible, that you find out if you have been named, or involved, in any.
  • All relevant data included in the appraisal and revalidation portfolio should be anonymised to remove third party identifiable information. This may include the identification of rare conditions or specialist clinics. For this reason, although the reflective note should always form part of your appraisal portfolio, specific original supporting information relating to significant events in which you have been named, or involved, may sometimes appropriately be submitted separately or reviewed in paper format, which your appraiser should then reference in the appraisal summary

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