Quality Improvement Activity
For the purposes of revalidation you are required to demonstrate that you regularly participate in activities that evaluate the quality and improvement of your work.
The RCGP consider significant event review and clinical audit as being core elements to quality improvement but are happy to accept other appropriate quality improvement activities that you can demonstrate have had a positive impact on your care of patients.
In the past GPs were told that once in every 5 years they would need to complete a full clinical audit. This is now not a requirement as defined by the GMC.
Each year at your appraisal you will need to demonstrate that you have been involved in quality improvement activities.
The LMC’s advice is to undertake a variety of quality improvement activities and ensure that, over the five year cycle, some of these enable you to provide evidence that demonstrates the impact and change this activity has had on your clinical practice.
Practice based audits are acceptable so long as you reflect on the outcomes personally, and this impacts your clinical practice and you detail your role in the audit.
QoF is a simple way to audit quality but simply recording and comparing 2 year's results is not acceptable; you need to discuss the outcomes in one year, suggest and implement change and evaluate the impact at a later date.
Quality improvement activities should be robust, systematic and relevant to your work. They should include an element of evaluation and action, and where possible, demonstrate an outcome or change.
At each appraisal you need to demonstrate that you are engaged in quality improvement activities and provide supporting information for this. Examples include:-
- Case review or discussion: A documented account of interesting or challenging cases that a doctor has discussed with a peer, another specialist, or within a multi-disciplinary team. You must record an outcome, only need one line but, will this discussion change your clinical practice for the better?
- Significant event review: All practices discuss significant events, use these as quality improvement activities. What appraisers are looking for is your reflection and then any action that has been taken which will improve the quality and safety of care in your practice.
- Review of clinical outcomes: Where robust, attributable and validated data is available. This could include morbidity and mortality statistics or complication rates where these are routinely recorded for local or national reports. For example in general practice you could look at the outcomes of joint injection at 3 months. Again ensure you record the reflections and actions taken.
- Audit and monitor: For example the effectiveness of a teaching programme.
- Clinical audit: Evidence of effective participation in clinical audit, or an equivalent quality improvement exercise, that measures the care with which an individual doctor has been directly involved.
There are many examples of audits currently undertaken in most practices including:
- Minor surgery
- Cervical smears
- Monitoring of DMARDs
- End of life care
- Cancer diagnosis
- Referrals and admissions
- Hypertension management
- Leg ulcer care
- Investigations and imaging
It may be more difficult for locums or OOHs GPs to participate in audit, but you could audit your referrals, or look at the next 50 prescriptions for antibiotics, look at avoiding those that can cause clostridia (Co-amoxiclav, ciprofloxacin, cephlosporines and clindamycin). See our Locum Toolkit for more ideas.
Please click on the image below, to access our complete document - Appraisal and Revalidation Guidance for GPs and Nurses