Quality Improvement Activity
Along with a minimum of 50 CPD credits annually, an average of two significant event analyses to make at least 10 over the five years, a verified patient feedback and colleague survey for the purposes of revalidation you are required to demonstrate participation in activities that evaluate the quality and improvement of your work.
In the past this concentrated on clinical audit but this could be difficult to complete satisfactorily and was often criticised for lacking scientific rigour, not least the necessary repeat audit cycle especially by appraisers with an educational background. Now it is accepted by the GMC that quality improvement can be demonstrated by, for example, review of clinical outcomes in such fields as this could include review of morbidity or mortality data, minor surgery data or commissioning information. Locum and other sessional doctors would often find data collection over a period of time hard so now case reviews or discussions are acceptable. This could involve peer review of an interesting or challenging case and might also include significant event reviews. As always it is vital to show reflection on the discussion, what has been learnt and what might change in your clinical practice as a result. Unlike some of the previous local schemes involving audit there is no need to worry that the work is covered under some other system or enhanced services. There is no question of “being paid twice” so evaluation of the impact of some new DES that requires audit under its conditions could be included in your appraisal. Wessex LMC has suggested the Admissions Avoidance DES as an area for discussion, for example. Practice based audits are acceptable so long as you they consider something that makes a difference to your clinical practice and you reflect upon it. It is polite to refer to your practice staff’s efforts in actually collecting and processing the data.
You do not have to demonstrate quality improvement activity in each annual appraisal but could use your appraisal discussion to plan one. A better idea is to undertake a variety of quality improvement activities and discuss with your appraiser that, over the five year cycle, some of these enable you to provide the necessary evidence.
Some examples for those short of ideas of audits currently already undertaken in most practices including: minor surgery including joint injections; cervical smears; monitoring of DMARDs; end of life care; cancer diagnosis and two week wait referrals; general referrals and admissions; hypertension management; investigations and imaging. Sessional doctors could look at the outcome of referrals, or look at the next 50 prescriptions for antibiotics. The LMC has issued strong guidance for employing practices to encourage the extraction of the necessary information for sessional GPs to complete this important part of their appraisal and revalidation cycle.