QIA

For the purposes of revalidation, the GMC requires that all doctors demonstrate that they regularly participate in activities that review and evaluate the quality of their work. However, these requirements are sufficiently broad to recognise all activities that allow you to review what you do.

We recommend that where you maintain a clinical skill, such as IUS insertion or minor surgery, you keep a log of your personal outcome data. You can then reflect on this at least once in the revalidation cycle to demonstrate the appropriateness of the quality of care you are able to provide in these areas. We recognise the value of reflective case reviews, learning event analysis, and clinical audits as useful QIA. However, there are also may other types of QIA that may be equally, or more, appropriate for your circumstances, and which will also meet GMC requirements.

In your appraisal portfolio your QIA should show that you have:

• thought about the quality of care you provide
• reviewed your care in the context of current guidance on good practice
• celebrated where there are no changes that you need to make
• made changes where necessary or appropriate to improve the quality of care you provide
• revisited the question to see if the changes made have made an improvement.

It is important that you routinely review the effectiveness and appropriateness of the care that you provide to keep patients safe. Demonstrating that this is a professional habit is a matter of choosing examples that show what you do and how you do it. You do not need to document every review of your work that you do.

Depending on your circumstances, different quality improvement tools are helpful including:

• reflective case review
• learning event analysis
• review of personal outcome data
• search and do
• plan, do, study, act cycles
• clinical audit.

You may wish to plan your QIA for the coming year with your appraiser and include them in your PDP. If you are aware that what you are planning as a quality improvement activity is unusual, you should discuss it with your appraiser and agree it with your responsible officer before including it.

You do not need to do all the background work and data collection or analysis for your quality improvement activity yourself. For some doctors there are national clinical audits into which they contribute their personal outcome data. Equally, delegating someone else to run a search, or do some of the research, is a reasonable and proportionate use of your time.

GPs work in teams and much of the QIA that is important to reflect on arises from teamwork. You can learn from the review of your own performance, and we recommend that you also try to learn from reviews of the team’s performance, including the mistakes and near misses of others.

• A clinical audit: try using our quick guide to help you create a clinical audit report (external PDF)
• A practice-wide quality improvement activity such as this example for early diagnosis of cancer (external PDF).
• A PDSA cycle:
  1. Plan - document the objective, the initial plan, identify who will be doing the test, how will it be done, and when the change will be made.
  2. Do - undertake the change, gather the data and document any problems.
  3. Study - analyse the data and summarise learning.
  4. Act - what changes will you make based on the outcome of the first change and develop a plan for the next cycle to make it better.

'Locum friendly' Improvement Activities:

• consultation analysis - if a locum does two shifts or regular shifts at same practice - review all consultations in a session and look at outcomes and learning from them
• Telephone appointment analysis - similar to above but looking at all telephone appointments done in a session and see whether either of the following occurred and if you could learn from that:
  1. you felt they needed a face-to-face appointment instead and were correct in that
  2. whether you felt that it was dealt with over the phone, but the patient then proceeded to come in about the same thing.
• Time analysis - look at the session they have done and how close they were to running to time - is there anything that could be changed in future shifts? (e.g. asking for a break in the middle.)
• Referral analysis / two-week referral review – If you go back to a practice look back to your previous referrals/two-week referrals and reflect on the outcomes.
• Practice development – Are there improvements in AccuRx template or helpful resources you can signpost to the practice team?
• Set up/join a peer-learning group and keep some record of case-based discussions shared.

Ask your appraiser or appraisal team for help if you’re still not sure what to do. They may have templates and suggestions for you to use.