Significant events

Myth: GMC significant events are the same as GP significant events 

The GMC definition of a significant event is not the same as that commonly used in primary care. The GMC says:


A significant event (also known as an untoward or critical incident) 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.

The GMC requires you to declare and reflect on those significant events in which you have been personally named or involved and in which a patient or patients could have or did come to harm.This means that all significant events that meet the GMC threshold of harm must be included in the Significant Events at your appraisal, but you do not need to provide your reflection on them.

There is no limit to the number of such significant events that you must include. However, if you have had no significant events that meet the GMC threshold of harm, you should declare that in the relevant sign-off statement. 

We recommend that you do not use the Significant Event section of your portfolio to record GP learning events. These are essentially any event, positive or negative, that has triggered a learning process for you or your team. They should be reflected on and included as quality improvement activities, where you are demonstrating your learning from events in your scope of practice.

Myth: I must include two significant events every year 

There are a very wide range of possible types of quality improvement activity (QIA) that can be used to demonstrate review of work, not just significant event analysis.

The RCGP previously recommended that GPs should include two detailed case reviews or learning event analyses (or one of each) every year as an easy way to demonstrate review of work. This was sometimes misinterpreted as a requirement, rather than a recommendation. While these are still an entirely acceptable way of demonstrating review of practice, we now recommend that there are many other types QIA that may be included as supporting information.

In some areas, such as Northern Ireland and Scotland, the appraisal policy (and the electronic platform) still includes a requirement to include two significant event analyses. These should be seen as learning events and quality improvement activities, not as implying that GPs in these areas have more patient safety incidents that reach the GMC level of harm than GPs elsewhere. We recommend that you ensure that you are aware of the requirements of your local appraisal policy in this area.

All GPs must ensure that they include all significant events that do reach the GMC threshold of harm. The GMC says:


A significant event (also known as an untoward or critical incident) 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.

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