Clinical Audit
Because "we've always done it this way" is not a quality improvement strategy — and your ARCP panel will agree. (Warmly.)
Last updated: April 2026 · Verified against RCGP WPBA guidance
Clinical audit is one of the most important — and most misunderstood — tools in GP training. Done well, it improves real patient care and satisfies your ARCP. Done badly, it eats your time and still doesn't count. This page tells you everything you need to know to do it properly, efficiently, and with minimum pain.
Downloads
Handouts, summaries, templates, and teaching extras — ready when you are. The good stuff, all in one place.
path: ...
- audit-samples
- audit-tools
- 4 step guide to audit.pdf
- audit - a practical guide for primary care.pdf
- audit - an intro.doc
- audit - choosing an area to look at.doc
- audit - criterion setting using a donabedian approach.ppt
- audit - falling in love with audit (with slide notes).ppt
- audit - how to write it up.doc
- audit - practical tips.pdf
- audit - principles for best practice by nice.pdf
- audit - simple steps to success.pdf
- audit - structured reflective template.doc
- audit - the easy guide for gp trainees.doc
- audit guidance from rcgp.pdf
- audit guide.doc
- audit in general practice.pdf
- audit on one side of a4.pdf
- audit theory - the basics.pdf
- audit theory.ppt
- audit training by manchester.pdf
- audit vs research vs evaluation.pdf
- bristol audit guide - 01 what is clinical audit.pdf
- bristol audit guide - 02 intro to clinical audit.pdf
- bristol audit guide - 03 choose a topic.pdf
- bristol audit guide - 04 setting aims objectives and standards.pdf
- bristol audit guide - 05 sample and data collection.pdf
- bristol audit guide - 06 data analysis and presenting.pdf
- bristol audit guide - 07 the write upt.pdf
- bristol audit guide - 08 implementing change.pdf
- bristol audit guide - 09 involving patients.pdf
- bristol audit guide - 10 the ethics of audit.pdf
- clinical audit - a manual by hquip.pdf
- clinical audit by rcgp.pdf
- clinical audit for medical students.pdf
- clinical audit report - developing a patient friendly report.pdf
- definitions for clinical audit.pdf
- double cycle audit.pdf
- ideas for audit in gp.docx
- practical guide to clinical audit from ireland.pdf
- sample size calculator.xls
- sea versus audit.pdf
Web Resources
A hand-picked mix of official guidance and real-world GP training resources. Because sometimes the best pearls are not hiding in the official documents.
🏛 Official Guidance
The official RCGP page on what a QIA is, what counts, and the mandatory requirements. Start here.
The full QIP guidance including PDSA cycles, mandatory requirements, and real QIP examples from registrars.
An excellent RCGP-run site packed with QI ideas, templates, and tools. One of the most useful free resources available.
NICE guidance on using their guidelines as the basis for clinical audit standards in your practice.
📚 GP Training Resources
The main QI hub with all activity types, project guidance, and practical advice for trainees across all years.
Plan–Do–Study–Act cycle explained clearly with practical primary care examples for GP trainees.
Invaluable article showing exactly what a trainer looks for in your ePortfolio audit write-up, with real examples.
The most approachable free online course for learning clinical audit. Recommended for all trainees starting their first audit.
📺 Video Resources
A curated playlist of quality improvement videos relevant to UK GP training and primary care audit.
NHS England's QI framework — useful context for understanding where audit sits within the broader patient safety picture.
Structured BMJ module on clinical audit methodology — useful supplementary reading for trainees wanting depth.
Quick Summary — If You Only Read One Thing
(ST1 or ST2 GP post)
(other training years)
the audit cycle
a proper audit
What is Clinical Audit — Really?
Clinical audit is a quality improvement process. Its purpose is to check whether healthcare is being delivered in line with current evidence and standards — and to put it right where it isn't.
Think of it as a structured health check for your practice, not a critique of individuals. The NHS's most widely used definition comes from NICE (2002):
"A quality improvement process that seeks to improve patient care and outcomes through systematic review of care against explicit criteria and the implementation of change."
- GPs manage hundreds of patients with long-term conditions — audit reveals whether standards are being met across the board
- Small consistent gaps in care (e.g. missed blood pressure reviews) compound over time at population level
- QOF incentivises audit thinking but good GPs should want to know anyway
- It's a professional duty for all registered doctors — not just a training exercise
- Audit often reveals system problems, not individual failures — blame-free by design
🔍 "Is It Actually Clinical Audit?" — The 4-Question Test
Before you commit to an audit, run your idea through these four questions. If your answer to any of them is wrong, you may be doing research, a survey, or service evaluation — not audit. Knowing the difference saves you time and avoids a difficult conversation with your supervisor.
Q3 is YES → you may be doing research. Discuss with your ES before proceeding — it may need ethics approval.
Q4 is NO → mostly free-text questions → this may be a survey or service evaluation, not audit.
RCGP Requirements — What You Actually Need
| Training Year | What You Need | Where & When | Key Notes |
|---|---|---|---|
| ST1 | 1 QIP or 1 QIA | QIP must be in a GP post. QIA can be any post. | If you do a QIP in ST1, you do not also need a QIA for that year. |
| ST2 | 1 QIP or 1 QIA | QIP must be in a GP post. QIA can be any post. | Ideally do your QIP in ST1 or ST2 GP post — this is when there's most time. |
| ST3 | 1 QIA | Any post. | No QIP required in ST3. A Leadership Project is required separately. |
| By end of training | Minimum: 1 QIP + 2 QIAs | As above | The GMC recommends QI involvement at least once per year throughout training. |
- SEA / LEA (Learning Event Analysis) — these are separate mandatory requirements
- Reflection on patient or colleague feedback
- Surveys without a clear action taken
- Reviewing a national audit your practice participated in — without your personal data collection involvement
- Simple case reviews without systematic data
- A Leadership Project (counted separately)
- Reflective piece without evidence of data, comparison, or change
- Clinical audit (with data, comparison, action, re-audit)
- Notes review (structured, with outcomes)
- Prescribing analysis
- Referrals review
- PDSA-based improvement project
- Literature review with action
- Questionnaire project (with change)
- Case study or new service implementation
- Discussion paper (where action was taken as a result)
QIP vs QIA — What's the Difference?
| Feature | QIP (Quality Improvement Project) | QIA (Quality Improvement Activity) |
|---|---|---|
| Scale | Larger, more formal project | Smaller scale — more flexible |
| Where done | Must be in a primary care post (ST1 or ST2) | Any post, any year |
| Structure | Formal RCGP QIP template — must include PDSA cycles (minimum 2) | Reflective log entry — more flexible format |
| Where recorded | QIP section of 14Fish ePortfolio (NOT learning log) | QIA reflective learning log entry |
| Assessed by | Educational Supervisor — graded and discussed | Educational Supervisor — reviewed at ESR |
| Audit as example | Yes — audit qualifies as a QIP if at the right scale | Yes — a smaller audit qualifies as a QIA |
Audit vs Research vs Service Evaluation
"Research is concerned with discovering the right thing to do; audit with ensuring that the right thing is done."
Smith R. Audit and Research. BMJ 1992.
| Feature | 🔬 Research | 📋 Clinical Audit | 📊 Service Evaluation |
|---|---|---|---|
| Purpose | Generate new knowledge | Check that best practice is happening | Describe what current practice achieves |
| Key question | "What is the right thing to do?" | "Are we doing the right thing?" | "What are we currently achieving?" |
| Uses a standard | No | Yes — compares against a defined standard | No — describes without a standard |
| New treatment? | May involve a new treatment | No — uses existing treatments only | No |
| Randomisation | May involve randomisation | Never randomised | Never randomised |
| Ethics approval | Usually required | Not usually required — but check locally | Usually not required |
| GP training example | Investigating whether medication X reduces hospital admissions in COPD | Are our COPD patients receiving annual spirometry reviews per NICE guidance? | How many COPD reviews happened in our practice last year? |
Audit vs PDSA — Old Fashioned vs New, or Two Sides of the Same Coin?
A common question in GP training: "Should I be doing a PDSA cycle instead of an audit?" The honest answer is: they are more complementary than they are competing.
Both rely on measurement to assess change. Both use a structured cycle to drive improvement. The difference is mainly in pace and scale:
- Audit tends to involve a larger-scale data collection, a defined standard, and longer intervals between cycles
- PDSA involves rapid, small-scale cycles of change — making one tweak at a time, studying the effect quickly, and iterating
- A high-quality audit often uses PDSA cycles within the change phase (stage 5) to test interventions
Plan — Define the change, who will test it, and how you will measure it.
Do — Make the change. Collect data. Note what went wrong.
Study — Analyse the data. What did the change achieve?
Act — Adopt, adapt, or abandon the change. Start the next cycle.
Your QIP must include at least 2 PDSA cycles. This is an RCGP requirement.
The Audit Cycle — 6 Stages
There are six stages to a clinical audit. Completing all six — including a re-audit after implementing change — is called an "8-point audit cycle" (the gold standard). Stopping at stage 5 is a "5-point cycle" — acceptable but less impressive.
Choose a topic with clear evidence-based standards. Pick areas of high volume, high risk, or known variation from best practice.
Criteria = what you're measuring (e.g. "HbA1c ≤ 48 in T2DM"). Standard = the expected compliance rate (e.g. "80% of patients").
Use your clinical system. Delegate the search to someone who knows the system. Define inclusions, exclusions, and time period clearly.
How well did your practice meet the standard? Identify the gap and try to understand why it exists — system failure or knowledge gap?
Create a written action plan. Present findings to the team. Name who is responsible for each action and set a timeline. This is where most audits go wrong — action planning must be specific.
Repeat the data collection after a defined interval. Compare to cycle 1. Did the change work? If not — why not? A further PDSA cycle may be needed.
💡 The 5-point vs 8-point distinction: Stages 1–5 = a 5-point audit cycle. Including stage 6 (re-audit) = an 8-point audit cycle. Always aim for the 8-point. It's the only way to know if your change actually worked — and it significantly strengthens your ARCP portfolio entry.
- Two full data collection cycles (before and after)
- A specific, named action plan with timelines
- Evidence that change was presented to the team
- Reflection on what worked and what you'd do differently
- SMART aims from the start
- Setting a standard of 100% — unrealistic and sets you up for failure
- Doing all the data collection yourself instead of delegating the search
- Forgetting to do the re-audit (leaving you with a 5-point cycle)
- Choosing criteria with no national standard — makes setting your standard very hard
Visual Guide — See It, Understand It
Sometimes a picture really is worth a thousand words. Here are the key concepts shown visually — so they stick in your mind and come out when you need them.
🔄 The Audit Cycle — As a Flowchart
📊 What Counts Towards Your RCGP Requirements — Hierarchy
🥧 Why QIAs Get Rejected at ARCP — The Pattern
Based on patterns from UK deanery ARCP feedback, trainer forums, and GP training community experience. These are the recurring reasons supervisors see QIAs sent back for revision.
🗺️ Choosing Your Audit Topic — Decision Flowchart
How to Do Your Audit — Step by Step
This is the practical guide. Follow these steps and you will not go far wrong. The most important principles are: keep it simple, delegate the data collection, and always do two cycles.
-
Choose your topic wisely
Pick a topic with a clear national standard (NICE, QOF, BNF) — this makes setting your audit criterion straightforward. Choose something with a genuine potential for improvement. Avoid overly complex multi-variable topics. A good audit topic is: specific, measurable, clinically important, and realistic for a single trainee to complete.
-
Define exactly what you're measuring
Write your criterion as a precise, measurable statement. Example: "Patients with type 2 diabetes should have a HbA1c documented in the last 12 months." Then set your standard as a percentage: "90% of eligible patients." Avoid 100% — it is rarely achievable and rarely meaningful. Check what NICE or QOF already recommends for your topic.
-
Delegate the data search
Every GP practice has someone — a senior administrator, practice manager, or data analyst — who can run computer searches on SystmOne or EMIS. Find this person and ask for their help early. They can run a search in a fraction of the time it would take you, and they know how to refine it correctly. This transforms audit from exhausting to manageable.
-
Collect your data carefully
Define your inclusion/exclusion criteria before you start. Who is in scope? Any exceptions (e.g. patients who declined the test)? What time period? Keep patient data confidential — identifiable information must not be shared. Use a spreadsheet to log your results cleanly.
-
Analyse the gap — and understand why it exists
Compare your results against your standard. If 68% of patients met the criterion but your standard was 90%, why? Is it a system failure (not enough review appointments booked), a knowledge gap (clinicians unsure of the standard), or patient behaviour (repeated non-attenders)? Understanding the cause guides a meaningful action.
-
Present to the team and create an action plan
Present your findings at a practice meeting. This is crucial — audit is a team activity, not a solo exercise. Create a written action plan with specific named actions, named responsible individuals, and deadlines. Vague actions produce no change. "We should improve HbA1c monitoring" is not an action. "The practice manager will run a recall search and admin team will contact outstanding patients by [date]" is an action.
-
Re-audit after an agreed interval
Agree a timeframe to re-audit (typically 3–12 months depending on the topic). Repeat the same data collection using the same method. Has the rate improved? Present the comparison to the team. Reflect on what worked and what didn't. This is your 8-point cycle — the gold standard.
Choosing a Good Standard — The Hierarchy
| Source | Strength | Example |
|---|---|---|
| NICE guidance | 🟢 Strongest — gold standard | NICE CG66: Hypertension — target BP < 140/90 |
| QOF indicators | 🟢 Strong — already used nationally | QOF DM017: HbA1c ≤ 58 in T2DM |
| Local / deanery guidance | 🟡 Good — locally agreed | Local antimicrobial stewardship targets |
| Published literature | 🟡 Acceptable | Meta-analysis supporting a screening interval |
| Expert consensus | 🟠 Weaker — use with explanation | Royal College statement without NICE backing |
| No standard — made up | 🔴 Avoid | Never set a standard without a source |
🏗️ What Are You Actually Measuring? — Structure, Process, Outcome
A useful framework from Avedis Donabedian — one of the founding thinkers of healthcare quality — divides audit criteria into three types. This is worth knowing because it helps you write a sharper criterion and set a more meaningful standard.
📂 Where Does Audit Data Come From? — The Sources
Most GP audit data comes from the clinical system — but it is worth knowing all the options. Different types of data suit different audit questions. The key rule: only collect data you can act on. Beware the "wouldn't it be interesting to know" trap — if you can't change practice as a result of the data, don't collect it.
| Data Source | What It Is | GP Example | Collection Type |
|---|---|---|---|
| Client records | Medical records already maintained in the clinical system | HbA1c dates, BP readings, medication records on EMIS/SystmOne | Retrospective — data already exists |
| Routine data | Information maintained day-to-day (appointments, referrals) | Appointment book, referral logs, prescription data | Retrospective or prospective |
| Questionnaires | Structured questions with Yes/No or multiple-choice answers | Post-appointment patient satisfaction survey | Prospective — collected going forward |
| Observation | Simply watching and recording what happens | How many patients pick up a leaflet from the waiting room display | Prospective |
| Activity analysis | Recording the frequency of specific events | How many phone calls the practice receives about prescription queries per week | Prospective |
| External data | Information sent from outside the practice | National immunisation data, hospital discharge letters, referral outcomes | Either |
| Peer review | A colleague of equal status reviews your records and gives feedback | One registrar reviewing another's safety-netting in their consultation notes | Retrospective |
🎯 Sampling — How Much Data Do You Need?
You do not always need to look at every patient. Here are the main ways to define your sample. The right choice depends on your topic, your practice size, and how much data you need to make a confident decision.
💡 Practical rule: Collect enough data to be confident about your findings — but not so much that the exercise becomes exhausting. For most GP audits, a time-period or all-of-population approach works best, because a single EMIS/SystmOne search gives you the data automatically. Remember: this is audit, not research. You will not change the world. You are simply improving healthcare in one primary care setting.
✅ Writing Your Action Plan — The Who/What/Where/When Framework
Once you have your findings, you need a written action plan. This is the step most trainees do poorly — because vague actions produce no change. Every action in your plan must answer four questions. If it can't, it isn't specific enough yet.
This has no named person, no specific task, no location, and no deadline. Nothing will change.
At the meeting: designate one named person as responsible for each action. This prevents the whole audit being quietly forgotten when the meeting ends.
Audit Topic Ideas for GP Trainees
All of these have existing national standards to audit against — which makes setting criteria much easier. Choose a topic that genuinely interests you or relates to something you have noticed in your clinical work.
Are first-line antibiotics for common conditions (UTI, tonsillitis, LRTI) matching local formulary guidance? High-impact, quick to audit.
Are patients on methotrexate, azathioprine, or other DMARDs receiving monitoring bloods at the correct frequency?
HbA1c, BP, cholesterol, foot check, retinal screening — what percentage of patients have all components documented?
Are patients with COPD having inhaler technique reviewed at annual review? Easy to audit from notes review.
Are patients newly diagnosed with depression being seen at 2 weeks after starting antidepressants per NICE guidance?
Are women on the COCP having BP documented at least annually and were contraindications checked at initiation?
Are domestic abuse disclosures being coded correctly in patient records? Sensitive but impactful.
What proportion of patients seen in the last 12 months have a smoking status coded? Improve opportunistic health promotion documentation.
Are 2-week-wait cancer referrals meeting the NICE criteria documented? Requires careful ethical consideration but high educational value.
E.g. Are patients prescribed lithium, clozapine, or warfarin receiving monitoring at appropriate intervals?
What percentage of patients with asthma have had an annual review in the last 12 months? Simple, high-volume, clear standard.
Are eligible patients being recalled for cervical screening? Is the practice meeting national uptake targets? Easy data to access.
Writing Up Your Audit — What Supervisors Actually Want to See
A QIA reflective log entry needs to show all of the following. It doesn't need to be long — it needs to be complete.
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Background and rationale
Why did you choose this topic? What made it relevant to your practice? What standard were you measuring against and where did it come from?
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Method and data
How did you collect data? What was your sample? What criteria did you use? How many patients were included? What time period?
-
Findings
What did the data show? How did your practice compare to the standard? Present actual numbers or percentages — not vague descriptions.
-
Action taken
This is the most important section. What specifically changed as a result of your findings? Who was involved? What was implemented? When? A QIA without a clear action is not a QIA.
-
Reflection — What will you maintain, improve, or stop?
Reflect on the process as well as the outcome. What did you learn about the system? What would you do differently? What unintended consequences did you notice?
A QIP requires the formal RCGP QIP template and must include:
- A clearly defined aim — what are you trying to improve?
- Baseline data — a measurement before any change
- At least 2 PDSA cycles with documented Plan, Do, Study, Act for each
- A second data collection demonstrating change (or explaining lack of change)
- Evidence of team involvement and discussion
- SMART objectives from the outset
- Reflection on the whole process
- Uploaded to the correct QIP section of 14Fish — not the learning log
- Assessed and graded by your Educational Supervisor
What Good Looks Like vs What Weak Looks Like
| Section | ❌ Weak Write-Up | ✅ Strong Write-Up |
|---|---|---|
| Aim | "I wanted to improve diabetes management." | "I aimed to audit whether ≥90% of T2DM patients had a HbA1c recorded in the past 12 months, in line with NICE NG28." |
| Data | "I looked at some diabetic patients." | "A EMIS search identified 78 patients with coded T2DM. I excluded 4 with terminal illness. 74 patients included. Data collected for January–December 2024." |
| Findings | "Some patients had not had a recent HbA1c." | "63 of 74 patients (85%) had a HbA1c recorded in the past 12 months, against a standard of 90%. 11 patients had no record." |
| Action | "I suggested the team should improve recall." | "I presented findings at the practice meeting on [date]. The practice manager agreed to run an automated recall for the 11 outstanding patients. We updated the EMIS template to flag missing HbA1c at any diabetes contact." |
| Reflection | "This was an interesting exercise." | "I learnt that the gap was primarily due to patient non-attendance rather than system failure. I would address this earlier in future. The template change is likely to have sustained benefit beyond this audit." |
Voices From the Trenches — What UK GP Educators & Trainees Actually Say
These insights come from UK GP trainers, deanery guidance documents, and the collective experience of GP registrars across UK training schemes. Every point here is consistent with RCGP and GMC guidance — it just says things in a way that official documents rarely do.
🗺️ The Driver Diagram — Your Project's Blueprint
A driver diagram is a simple visual tool recommended by GP educators for planning your QIP. It maps the aim of your project to the drivers (the things that need to change) and the change ideas (what you'll actually do). Think of it as a mind-map that also tells a story about cause and effect.
📄 The QIP Write-Up — Sections in the Right Order
A piece of advice from experienced UK GP trainers: your write-up needs a clear structure. Supervisors read dozens of these. A muddled structure — even with great content inside — can lead to a lower grade. Here is the recommended order, used by GP trainers across UK deaneries.
🤝 The Peer Group Advantage — Use Your VTS
UK deanery guidance is clear on this: trainees who use peer groups to work on their QIA/QIP consistently produce better projects — and find the process much less stressful. Your VTS half-day release group is a built-in resource that many trainees never use for this purpose.
Here is what peer groups actually help with — and how to use yours well.
- Someone in your cohort has probably tried EMIS or SystmOne searches already — ask them how they set it up
- Other registrars may have already done an audit on your chosen topic — and can tell you what pitfalls to avoid
- Talking your driver diagram through with a peer often reveals gaps in your logic before your supervisor does
- Bouncing your action plan off a colleague is the fastest way to make it more specific
- Your TPD may run a dedicated QIP peer group or workshop — check with your programme administrator
- Stuck on topic choice for weeks
- Reinventing the search wheel
- Action plan stays vague
- No one to sanity-check your idea
- Reflection feels forced
- Topic chosen in first tutorial
- Admin search shared in 30 min
- Specific named actions agreed
- Logic tested before submission
- Richer reflection, less effort
🔎 The "Keep It Small" Principle — Visualised
Every UK GP trainer teaching QIP says the same thing: most trainees aim too wide. The RCGP explicitly says QIPs should be "simple and small scale." Here is what that looks like in practice.
A focused audit done properly is always better than a grand vision that never quite finishes.
🗣️ What UK GP Educators Actually Tell Their Trainees
🪜 What Good Reflection Looks Like — The Staircase
The most common reason a QIA or QIP is sent back for revision is a thin reflection. Good reflection is not about length — it is about depth. Here is what the steps look like, from the bottom (weak) to the top (strong).
⚡ Five Things the UK GP Training Community Keeps Saying
These themes come up again and again — from Half Day Release sessions, deanery induction days, GP training forums, and GP educator teaching. They are consistent with RCGP and GMC guidance but rarely said this directly.
🏆 What "Above Expectations" Actually Looks Like — The RCGP Marking Domains
Your supervisor grades your QIP against specific domains. Most trainees don't look these up. Reading them takes 15 minutes and tells you exactly what to aim for. Here are the key domains and what separates "meeting" from "above" expectations.
| Domain | Meeting Expectations | ⭐ Above Expectations |
|---|---|---|
| Choice of topic | Relevant to primary care, has a national standard | Linked to a real practice need; original; has clear patient safety rationale |
| Aim & evidence base | SMART aim stated; 1–2 references cited | SMART aim with justification; multiple relevant sources cited clearly |
| Data & measurement | Baseline data collected; method described | Baseline + follow-up data; clear comparison; visual presentation (charts) |
| Change implemented | A change was made; PDSA cycles documented | Change is team-agreed, specific, sustainable; evidence team was genuinely involved |
| Reflection | Reflects on what happened and what was learned | Reflects on why the gap existed, systemic factors, what was unexpected, and what the next registrar could build on |
| Team engagement | Practice team aware of the project | Evidence of active involvement; meeting minutes or named contributors; feedback collected |
Based on RCGP QIP feedback level descriptors. Always check the current RCGP QIP guidance at rcgp.org.uk for the most up-to-date marking criteria.
Trainee Traps — What Catches People Out
Memory Aids — Make It Stick
The AUDIT Mnemonic
The "SMART Criteria" Checklist for Audit Standards
Before finalising your audit criterion, check it against the SMART framework:
- Specific — clearly defined, not vague
- Measurable — can be expressed as a number
- Achievable — realistic given your setting
- Relevant — clinically meaningful and important
- Time-bound — a defined period for data collection
SMART: "85% of patients with coded hypertension aged 18–79 should have a BP reading of ≤ 140/90 mmHg documented in the previous 12 months (NICE NG136), measured from January to December 2025."
Quick Comparison Table — The 3 Things People Confuse
| ✅ QIA | ✅ QIP | ❌ Not counted | |
|---|---|---|---|
| Scale | Small to medium | Larger, structured | Any size |
| PDSA required? | No (but beneficial) | Yes — minimum 2 cycles | N/A |
| Data required? | Yes — must have data | Yes — baseline + follow-up | SEA/LEA has no QI data requirement |
| Action required? | Yes — must show change | Yes — PDSA changes | Reflection alone = not QIA |
| Examples | Audit, prescribing review, notes review | Formal audit with re-measurement, PDSA QI project | SEA, feedback reflection, case review without data |
Insider Pearls — Real-World Wisdom
- Two data cycles — numbers before and after the change
- A specific, written action plan with named individuals and timelines
- Evidence the practice team was involved (meeting minutes or named colleagues)
- Reflection that goes beyond "I learned a lot" — articulate what you learned and how it changed your practice
- Understanding of why the gap existed, not just that it existed
- A topic with a clear NICE or national standard
- Your practice manager or senior administrator almost certainly knows how to run complex EMIS or SystmOne searches. Ask them on day one of your GP post. This one conversation will save you enormous effort.
- Most practice managers have done many audits before. They often have templates. Ask to see them.
- NICE guidelines specify clear, measurable standards that are perfect for audit criteria. Spend 10 minutes on NICE CKS before picking your criterion — it saves hours of trying to construct your own standard from scratch.
- Audit done at the right time genuinely improves patient care. The trainees who get the most from it are the ones who take it seriously as a quality improvement exercise — not just a portfolio exercise.
Wisdom From the Trainee Community
These are patterns gathered from UK GP trainee forums, deanery teaching sessions, and peer-to-peer training communities across the country. They are consistent with RCGP and GMC guidance. Nothing here conflicts with official advice — it just says it more honestly.
- You show TWO full data cycles with actual numbers
- Your action plan names specific people and has dates
- You presented at a practice meeting (even briefly)
- Your reflection addresses WHY the gap existed — not just that it did
- You discuss what you would do differently next time
- You link your learning to a Professional Capability (especially OML)
🏔️ The Standard-Setting Pyramid — Where to Get Your Benchmark
Always work from the top down. Use the strongest source you can find for your topic.
🗓️ Suggested Timeline for a GP Post Audit
This is a rough guide for a standard 4–6 month GP placement. Adjust for your placement length. The key rule: finish data cycle 1 before the halfway point, so you have time to implement change AND re-audit before you leave.
💊 Quick-Win Audit Topics — Monitoring Blood Tests
These are consistently recommended by trainers and training communities as ideal first audits: clear standards, accessible data, and genuinely useful to the practice. Always verify the current monitoring frequency against your local formulary or BNF before setting your standard.
| Drug / Condition | What to Audit | Where to Find Standard | Typical Standard |
|---|---|---|---|
| Metformin | Annual eGFR check in T2DM | NICE NG28 / BNF | ≥90% annually |
| Statins | LFTs at 3 months (new starts) / 12 months (ongoing) | NICE CG181 / BNF | ≥90% at appropriate interval |
| DMARDs (e.g. methotrexate) | FBC + LFT monitoring frequency | BNF / local rheumatology protocol | Check local shared care guideline |
| ACE inhibitors / ARBs | Annual U&Es and eGFR | NICE NG136 / BNF | ≥90% annually |
| Levothyroxine | Annual TFTs | NICE CKS Hypothyroidism | ≥90% annually |
| Allopurinol | Annual serum uric acid check | BNF / NICE CKS Gout | ≥90% annually |
| Long-term NSAIDs | Gastroprotection offered / prescribed | NICE CG87 | ≥85% with PPI co-prescribing |
| Long-term steroids | Bone protection assessed | NICE NG187 | ≥85% assessed or on treatment |
⚠️ Always verify specific monitoring intervals against current BNF and local formulary guidance before setting your audit standard. These figures are indicative, not prescriptive.
When trainees across UK deaneries are asked what they wished they knew before starting their audit, the same answer comes up again and again — not the theory, but the mindset.
The trainees who find audit genuinely useful are the ones who stop thinking of it as "a thing I have to do for my portfolio" and start thinking of it as "a chance to check whether my patients are getting what they deserve." That shift changes everything. The topic becomes interesting. The reflection writes itself. The team engages. And something in the practice actually gets better.
As one experienced GP trainer put it: "The best audit is a love letter to your patients. It says: I checked. I found a gap. I fixed it. For them."
For Trainers & TPDs — Teaching Audit
Teaching Audit to Trainees — The Key Principles
- Help the trainee choose a topic early — ideally in the first tutorial of their GP post
- Link the audit to a genuine practice need where possible — this makes it far more educationally engaging
- Introduce them to the practice manager or admin lead who handles computer searches early
- Review the SMART criteria for their audit standard before they start data collection
- Ensure they understand the difference between QIA, QIP, and what counts for ARCP
- Review their action plan — vague plans produce no change
- Topic chosen in first 2 weeks of placement
- Standard sourced from NICE or QOF
- Baseline data collected by week 6
- Findings presented at practice meeting by week 10
- Action implemented and re-audit data collected before end of post
- Write-up completed and uploaded to correct 14Fish section
Common Trainee Blind Spots — What to Watch For
- Confusing SEA with QIA — a very common misunderstanding; address explicitly in early tutorial
- Choosing a topic too broad — "improving diabetes care" is a lifetime's work; help them narrow to one specific measurable element
- Setting a standard of 100% — this demoralises trainees and is clinically unrealistic; discuss setting achievable but meaningful thresholds
- No action plan specificity — "we agreed to monitor" is not an action; help trainees write named, timed, specific actions
- Not involving the team — trainees sometimes do audit solo, without presenting to the wider practice; this is a missed opportunity for OML capability evidence
- Forgetting to re-audit — leaving before the re-audit data can be collected; agree timeline explicitly at start
- Uploading to the wrong portfolio section — QIA in learning log instead of QIA section; TPDs and panels see this regularly
- Thin reflection — describe, don't just describe; encourage "so what?" and "what would you do differently?"
Tutorial Ideas and Reflective Questions
Tutorial 1 — Early in GP Post: Choosing a Topic
- "What aspect of care have you noticed might have a gap in our practice?"
- "Can you find a NICE guideline that specifies a standard we could measure against?"
- "What would make this topic genuinely interesting to you — not just achievable?"
- Exercise: Browse NICE CKS together for 15 minutes and identify 3 audit-ready topics
Tutorial 2 — Mid-Post: Reviewing Findings
- "What did your data show? What surprised you?"
- "Why do you think the gap exists? System? Knowledge? Patient behaviour?"
- "What would a meaningful action look like — not just 'raise awareness'?"
- "Who in the practice needs to be involved in implementing the change?"
Tutorial 3 — End of Post: Reflection and Learning
- "What would you do differently if you did this again?"
- "What did you learn about how this practice works — beyond the clinical topic?"
- "How will this audit change your practice after you've left this placement?"
- "What does this tell you about the wider system of primary care quality improvement?"
Quality Assurance Notes for TPDs and Panel Members
| Portfolio Red Flag | What It May Mean | Action |
|---|---|---|
| QIA entry in learning log, not QIA section | Trainee/trainer unfamiliar with portfolio requirements | Ask trainee to re-upload to correct section before panel; trainer education |
| Reflection without any data | Trainee has confused reflection with QIA | Return for revision; ask for specific numbers and method |
| SEA submitted as QIA | Common misconception — both required separately | Explain both requirements; ask trainee to complete a separate QIA |
| No action documented | May reflect a system barrier or trainee inexperience | Ask trainee to describe what action was taken — even if small. Return for revision if none identifiable. |
| QIA completed very late in training year | Time management concern or low engagement with QI | Note for ES; encourage better spread in remaining years |
Frequently Asked Questions
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RCGP QIA page · Bradford VTS QI Hub · Disclaimer
Content verified against RCGP WPBA guidance (updated February 2025). Always check the RCGP website for the most current requirements.