- 7.1. Myth: Time spent on Quality Improvement Activities (QIA) is not CPD
- 7.2. Myth: I must do at least one clinical audit in the five year cycle
- 7.3. Myth: I must do all my Quality Improvement Activity (QIA) myself
- 7.4. Myth: There are specific types of Quality Improvement Activities (QIA) that I must include
7.1. Myth: Time spent on Quality Improvement Activities (QIA) is not CPD
All learning activities can be included in CPD credits. They should be demonstrated by an appropriate reflective note about the time taken, lessons learned and any changes you made as a result.
Continuing professional development can include:
- traditional CPD
- QIA
- significant events
- reflecting on feedback from patients and colleagues, including complaints and compliments.
You should avoid unnecessary duplication. Once you have demonstrated sufficient CPD to keep up-todate across your whole scope of practice you do not need to write additional reflective notes. You should not stop learning, and reflecting on what you learn, but we recommend that you stop documenting in detail what you have learned and reflected on, unless it is important to you.
7.2. Myth: I must do at least one clinical audit in the five year cycle
Clinical audit is not a revalidation requirement, but it can form part of quality improvement activities or projects.
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.
We used to recommend that you should complete two examples of reflection on your significant event analysis or reflective case review every year and a formal two cycle audit once in five years. If you continue to do this, you will still meet the GMC requirement to demonstrate reflection on review of your work.
After getting feedback that that this recommendation was too restrictive, we have broadened our recommendation. We now recommend there are many different types of quality improvement activity, other than audit, that are equally acceptable as QIA. You 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
- made changes where necessary or appropriate to improve the quality of care you provide
- celebrated where there are no changes that you need to make
- revisited the question to see if the changes 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
- significant event analysis
- review of personal outcome data
- search and do
- plan, do, study, act
- clinical audit.
You may wish to plan your quality improvement activities 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.
7.3. Myth: I must do all my Quality Improvement Activity (QIA) myself
You do not need to do all the background work and data collection or analysis for your quality improvement activity yourself.
Delegating someone else to run a search, or do some of the research, is a reasonable and proportionate use of your time. We recommend that you select QIA that allow you to review what you do. Your personal reflective notes should include an explanation about your role in the quality improvement activity and a description of the findings, including any lessons you have learned and the impact they have had on the quality of care that you provide.
GPs work in teams and much of the quality improvement activity that it is important for us to reflect on arises from teamwork. Significant event analysis in primary care is a team activity. You can learn from the review of cases, data, incidents or events, or from feedback, and we recommend that you try to learn from the mistakes and near misses of others.
The questions to ask yourself are about what you have learned about the quality of the care you provide and what, if any, changes you should make as a result.
7.4. Myth: There are specific types of Quality Improvement Activities (QIA) that I must include
You do not have to include any specific type of quality improvement activity but you must reflect on the quality of your practice and how you meet the requirements of Good Medical Practice (GMP).
The GMC 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 review and significant event analysis as useful QIA but no longer recommend that you include two every year. Similarly, we recognise the value of clinical audit but no longer recommend that you should include one two cycle audit every five years. There are many other types of QIA that may be equally, or more, appropriate for your circumstances, which will also meet GMC requirements.
Where your organisation provides you with clinical governance data about your practice, or there is a national clinical audit to which you contribute, which allows you to benchmark your work, it is appropriate to include this information in your portfolio of supporting information and reflect on what you have learned from the results and any changes you will make as a result.