What is a quality improvement activity? The quick answer
A quality improvement activity is any work that reviews and evaluates the quality of your own practice. The GMC asks you to take part in at least one in each revalidation cycle. It does not have to be a clinical audit. A case review, a learning event analysis or a review of your own outcome data can all count. What matters is that you reflect on the results, act on them and check whether care improved.
What the GMC requires
Quality improvement activity is one of the six types of supporting information the GMC asks you to reflect on and discuss at appraisal. Its requirements are short. In summary:
- You must actively take part in quality improvement activity relevant to your scope of practice at least once in your revalidation cycle.
- Your responsible officer agrees the type, amount and frequency that suits your practice. Your appraisal discussion may inform that decision.
- You must take part in regular reviews and audits of your work and your team’s work. That includes any national audit or outcome review in your area of practice.
- You must reflect on the outcomes of those audits or reviews, even if you could not take part directly.
- You should discuss the outcomes at appraisal, including what you did in response and the impact over time.
The GMC also says the amount and frequency depend on the scale of the activity. Some activities take more time and resources to run and evaluate than others. That affects how often you are expected to do one.
Source: GMC, quality improvement activity for revalidation.
Does a quality improvement activity have to be a clinical audit?
No. The RCGP lists “I must do at least one clinical audit in the five-year cycle” among its appraisal myths. It says clinical audit is not a revalidation requirement, although it can form part of your quality improvement work. Other types of QIA are equally acceptable.
In fact, the RCGP says you do not have to include any specific type of QIA at all. Instead, you must reflect on the quality of your practice and how you meet the requirements of Good medical practice.
Source: RCGP, appraisal and revalidation mythbusters, items 39 to 41.
Which types of quality improvement activity count?
Both the GMC and the RCGP describe a wide range. For example:
| Type of activity | What it looks like in general practice |
|---|---|
| Reflective case review | A documented account of an interesting or challenging case you discussed with a peer, a specialist or the wider team |
| Learning event analysis | A structured review of an event; in primary care it is often a team activity |
| Review of personal outcome data | A log of your own results for a skill you maintain, such as IUS insertion or minor surgery |
| Search and do | A search of the clinical system that finds patients who need action, followed by the action |
| Plan, do, study, act cycles | Small tests of change, each one checked before the next |
| Prescribing review | A review of your prescribing against guidelines, including lessons for improvement |
| Clinical audit | A measured audit of care you were directly involved in, ideally with a re-audit |
| Benchmarking | Comparing your practice against robust local, regional or national data |
Sources: GMC and RCGP pages linked above.
Significant events can also lead into quality improvement. If you are writing one up, see our guide on how to write a significant event reflection.
How to write up your quality improvement activity
The GMC says you should reflect on your QIA in the same cycle you collected it. Your write-up should cover four things:
| Cover this | What to write |
|---|---|
| Relevance | Why the activity matters to your work |
| Evaluation | How you looked at the results, for instance in reflective notes, peer supervision or a team meeting |
| Action | What you changed or plan to change, and whether you told colleagues |
| Impact | Whether care improved, or good practice held, ideally shown by a repeat check |
The RCGP adds a useful point. Your notes should explain your own role in the QIA and describe the findings. Then say what you learned and how it affected the quality of your care.
Keep it brief, though. The RCGP advises a short summary of your most important work rather than lengthy reflections on everything. Your verbal reflection at appraisal is just as valid as what you write.
An example write-up
This example is fictional and shows structure only.
Activity: I ran a search for my patients on a medicine that needs regular blood monitoring. Finding: Some were overdue. Action: I recalled them, and the team agreed a recall routine. Re-check: I repeated the search three months later, and fewer patients were overdue.
That covers relevance, evaluation, action and impact in four short sentences.
Quality improvement activity as a team
You do not need to do every part of the work yourself. According to the RCGP, delegating someone else to run a search or do some of the research is a reasonable and proportionate use of your time.
Much of the QIA worth reflecting on also comes from teamwork. So the RCGP recommends learning from reviews of the team’s performance, including the mistakes and near misses of others. Just be clear about your own part when you write it up.
Likewise, if your organisation gives you clinical governance data, or you contribute to a national audit, the RCGP recommends adding it to your portfolio. Then reflect on what the results mean for you.
Choosing your next quality improvement activity
Start with something that lets you review what you actually do. For instance, the RCGP recommends keeping a personal outcome log for any clinical skill you maintain. You can then reflect on it at least once in the cycle.
Next, plan it with your appraiser. The RCGP suggests adding planned QIA to your personal development plan. Also, if your idea is unusual, discuss it with your appraiser and agree it with your responsible officer first.
Locum or sessional? You still need QIA relevant to your scope of practice. See our guide to appraisal for locum and sessional GPs for ideas that work across several practices.
Quality improvement activity checklist
- You have at least one QIA in this revalidation cycle
- It reviews what you do in your own practice
- You explain your own role, especially in team work
- You say what changed, or why no change was needed
- You checked the effect, or put that check in your PDP
- You reflected on any national audit results in your area
QIA is one of six types of supporting information. For the rest, see our guide to the evidence you need for your GP appraisal. Learning from QIA can count towards CPD as well, as our guide on how many CPD credits you need explains.
Quality improvement activity: frequently asked questions
How often do I need a quality improvement activity?
The GMC requires at least one in each revalidation cycle. However, your responsible officer agrees the amount and frequency that suits your practice, so check what yours expects.
Is clinical audit compulsory for GP revalidation?
No. The RCGP says clinical audit is not a revalidation requirement. It is one useful type of QIA among many.
Can I use a practice audit I did not run myself?
Yes, if it reviews care you were involved in. The RCGP says delegating a search is reasonable. Explain your role and what you learned from the findings.
Does quality improvement activity count as CPD?
It can. The RCGP lists QIA, including learning event analysis, among the activities that count as CPD.
What if I could not measure the result of my change?
Then the GMC asks you to discuss with your appraiser how to include that check in your personal development plan.
What if nothing needed to change?
That still counts. The RCGP says you should celebrate where there are no changes you need to make. Record that good practice was maintained.
GP Tools portfolios follow NHS England’s Medical Appraisal Template, with the patient survey (PSQ) and MSF 360° colleague feedback included free. Every doctor’s first 12 months are free. Register at gptools.org.