New Service Implementation
Because "we should probably do something about that" is not a quality improvement strategy — but this page will help you turn that instinct into a well-structured, portfolio-ready QIA.
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Sample write-ups, marking guides, and step-by-step templates for your New Service Implementation QIA.
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Official & Core Guidance
QI Methodology & Frameworks
GP Training Resources
Quick Summary — One-Minute Recall
📌 If You Only Read One Thing...
- A new service implementation is a valid QIA type — it involves planning and delivering a new service in your practice or PCN
- You need a minimum of 1 QIP and 2 QIAs by end of training (RCGP 2024)
- QIA ≠ QIP — QIAs are smaller scale, quicker, and more action-focused
- Must involve a personal connection to your work and demonstrate actual change
- Record as a QIA reflective learning log entry in your 14Fish ePortfolio
- You must take data-informed action — not just describe that change should happen
- Use PDSA cycles (Plan–Do–Study–Act) as your structural framework
- Identify a need → map stakeholders → set SMART aims → implement → evaluate
- LEA, SEA, and Leadership activities do NOT count as QIAs
- Involve the MDT — GPs who work solo on QI usually get worse outcomes and lower portfolio marks
What is a New Service Implementation QIA?
🏥 Definition
A New Service Implementation QIA involves identifying a gap or need in your practice, then designing, implementing, and evaluating a new service or care pathway to address it.
It is a structured approach to introducing something new — and demonstrating that it made things better (or if it didn't, understanding why).
🎯 Core Elements Required
- A clearly identified need or gap in current provision
- A SMART aim for the new service
- Evidence of stakeholder engagement
- Description of the implementation process
- Evaluation — did it work? How do you know?
- Personal reflection on the process and learning
"A QIA that says 'I noticed this problem and we should do something' is not a QIA. A QIA says 'I noticed this problem, I did something, and here's what changed.' The doing and the evaluating are everything."
Why Does New Service Implementation Matter in GP?
General practice is not a static environment. The NHS is constantly evolving — new guidance, new population needs, new technology, new pressures. GPs who can identify service gaps, design practical solutions, and implement them effectively are exactly what modern primary care needs.
For Your Development
Builds skills in project management, leadership, and systems thinking — all essential for modern GP practice.
For Your Portfolio
One of the most impressive QIA types when done well — demonstrates initiative, clinical leadership, and real-world impact.
For Your Patients
Directly improves patient care. Unlike some portfolio work, this one actually matters to real people in your practice.
QIA vs QIP — Know the Difference
QIA Quality Improvement Activity
- Smaller scale — manageable within one rotation
- Recorded as a reflective learning log entry in 14Fish
- Required in each training year where no QIP is done
- Must involve real action from data — not just reflection
- New service implementation sits here (usually)
- No formal supervisor marking rubric — but supervisor reviews it
- Must be separate from Leadership activity and LEA/SEA
QIP Quality Improvement Project
- Larger scale — typically a primary care placement project
- One required across ST1/ST2 (in a GP post)
- Formally assessed and graded by educational supervisor
- Requires PDSA cycles and structured write-up
- A new service can be a QIP if large enough in scope
- Replaces QIA requirement for that year
- Must be in primary care setting (unless agreed otherwise with ES)
| Feature | QIA | QIP |
|---|---|---|
| Scale | Small — targeted, manageable | Medium–large — structured project |
| Recording | Reflective learning log entry (14Fish) | Separate QIP section in portfolio |
| Formal assessment | No formal marking rubric | Yes — supervisor grades each domain |
| PDSA cycles | Recommended but not mandatory | Expected — at least one formal cycle |
| Frequency | At least 2 across training (years without QIP) | At least 1 across training |
| New service can be this? | ✅ Yes — when appropriately scoped | ✅ Yes — when larger in scope |
| Leadership activity | Must be a separate activity | Must be a separate activity |
Visual Guides
🔵 The New Service Journey — From Idea to Portfolio
Every successful new service QIA follows the same basic path. Here it is at a glance.
🔄 The PDSA Cycle — How It Actually Works
Many trainees have heard of PDSA but cannot explain it clearly. This diagram shows you exactly how it works — and why it matters for your write-up.
🏔️ The QI Ladder — Where Does New Service Fit?
Understanding the different levels of QI work helps you pitch your new service at the right level.
📈 What a Run Chart Looks Like — And Why You Should Use One
A run chart plots your data over time as a simple line graph. It is one of the most powerful — and most underused — QI tools available to GP trainees. It shows whether your change is actually making things better, and when.
The example below shows a fictional attendance rate for a new diabetes education session over 10 weeks, with a change made in week 4.
👥 Stakeholder Map — Who to Focus On
Not all stakeholders need the same amount of your time. This grid helps you decide how to approach each person in your practice.
The examples shown are for a typical GP surgery new service project.
Ideas for New Service Projects
- Introducing a structured frailty identification and review process in a GP surgery
- Setting up a complex case MDT meeting for polypharmacy patients
- Implementing a post-discharge telephone follow-up service for high-risk patients
- Introducing structured annual reviews for patients with severe mental illness
- Setting up a shared care protocol with a local specialist (e.g. ADHD, addiction medicine)
- Introducing a carers' health check service as an add-on to existing patient appointments
- Starting a palliative care register and proactive review process for end-of-life patients
- Introducing a medication review service targeting patients on 10+ medications
- Introducing a new triage system to improve same-day appointment allocation
- Setting up a telephone consultation pathway for specific patient cohorts
- Creating a clear referral pathway for patients with suspected domestic violence
- Introducing a structured handover process for out-of-hours (OOH) visits
- Implementing a direct access pathway to an onsite pharmacist for minor ailments
- Creating a new process for results communication to reduce patient anxiety and missed results
- Setting up a social prescribing referral pathway with a local link worker
- Introducing a structured group education programme for newly diagnosed T2DM patients
- Setting up a weight management group session (in partnership with a dietitian)
- Creating a patient information leaflet and brief counselling pathway for long-term opioid prescriptions
- Introducing pre-appointment education for patients starting disease-modifying medications
- Running an LGBTQ+ health awareness session for practice staff
- Developing a patient self-management toolkit for recurrent conditions (e.g. gout, atopic eczema)
- Introducing a smoking cessation service within routine consultations using brief advice and referral
- Setting up an NHS Health Check call-recall system for eligible patients not yet screened
- Implementing a proactive contraception review service for women on teratogenic medications
- Creating an immunisation catch-up pathway for patients who missed childhood vaccinations
- Introducing an alcohol brief intervention tool into routine chronic disease reviews
- Setting up a hypertension case-finding programme using community pharmacy collaboration
The 7-Step Implementation Framework
Follow these seven steps in order. Each one maps to something your write-up should cover. Skip a step and your write-up will have a visible gap — and your educational supervisor will spot it immediately.
🔍 Identify the Need (Needs Assessment)
Before you can implement anything, you need to understand the gap. What service is missing? Who would benefit? What is the current situation and why isn't it working?
- Look at practice data, patient complaints, significant events, audit results
- Talk to colleagues — reception staff and nurses often identify gaps before doctors do
- Review local prevalence data (e.g. from ICB population health dashboards)
- Consider health inequalities — is there a group whose needs are not being met?
- Reference national guidance — is there a NICE recommendation not being implemented?
🎯 Set Your SMART Aim
A vague aim produces a vague result. Before you start, define what success looks like in precise, measurable terms.
👥 Stakeholder Mapping & Engagement
No service runs on enthusiasm alone. You need the right people on board, in the right roles, at the right time. This step is what separates trainees who get things done from those who wonder why nobody followed through.
| Stakeholder | Role in Your Project | How to Engage |
|---|---|---|
| GP Partners / Principal GPs | Decision-makers; need sign-off | Present at practice meeting; keep it short and evidence-based |
| Practice Manager | Operational logistics, space, admin | Early one-to-one conversation; ask for help, not permission |
| Nursing Team | Often deliver the new service directly | Involve them in design from the start — they'll make or break it |
| Reception & Admin | Patient-facing; referrals into the service | Brief, practical training; clear process documentation |
| Patients / PPG | Service users; valuable design input | Patient Participation Group; informal feedback; surveys |
| ICB / PCN | May have funding or parallel initiatives | Check for existing resources before reinventing the wheel |
📋 Plan the Implementation (Driver Diagram & Work Plan)
Map out exactly what needs to happen, in what order, and who will do each part. Use a simple work plan or driver diagram.
- Primary drivers — the main factors that will make the service succeed or fail
- Secondary drivers — the specific changes needed to improve each primary driver
- PDSA cycle 1 — test the service with a small group first before going live
- Identify your measures: what data will you collect to show whether it worked?
- Anticipate barriers — what could go wrong? What is your contingency?
🔄 Implement Using PDSA Cycles
PDSA (Plan–Do–Study–Act) is the gold-standard quality improvement tool. Even for a smaller QIA, running at least one structured cycle demonstrates methodological rigour.
What are you testing? What do you predict will happen? Who will do what and when?
Carry out the test on a small scale first. Record what actually happens — including unexpected outcomes.
Analyse your data. Compare to your predictions. What did you learn? Did it have the effect you intended?
What next? Adapt and scale up, abandon and try something else, or run another PDSA cycle with changes?
📊 Evaluate — Did It Work?
This is the section most trainees underinvest in. Evaluation means gathering data before and after, and comparing the two. It also means acknowledging honestly when something did not work as intended.
- Use process measures (e.g. how many patients attended?) and outcome measures (e.g. did outcomes improve?)
- Collect patient feedback — even a short questionnaire adds credibility
- Present data clearly — a simple table or graph goes a long way
- Compare against your SMART aim from step 2 — did you meet it?
- If the service did not work as planned — explain why and what you would change
📝 Reflect & Write Up
The written reflection is where many trainees lose marks — despite having done genuinely excellent work in practice. The RCGP wants to see specific, personal, and action-oriented reflection — not generic observations about quality improvement.
- What did you learn — specifically? (Not: "I learned the importance of communication")
- What would you do differently? (Actionable and concrete)
- How has this changed your practice going forward?
- What aspects of the service are now embedded — and what still needs work?
- What Professional Capabilities does this demonstrate? (Link to OML, HPHS, CHES, TW)
🧠 Memory Aid — The N.S.I. Framework
Tools & Frameworks
What is a PDSA Cycle?
PDSA stands for Plan–Do–Study–Act. It is the primary improvement methodology used across the NHS and is the expected approach for QI activities in GP training. The key principle is: test small before you scale up.
| Phase | Key Questions | In Practice |
|---|---|---|
| Plan | What are we changing? What do we predict will happen? How will we measure it? | Define intervention, population, data to collect, predicted outcome |
| Do | What actually happened when we tried it? | Run the service with a small group (e.g. 5 patients, 1 session, 2 weeks) |
| Study | Did the data match our prediction? What did we learn? | Analyse uptake, outcomes, barriers, unexpected issues |
| Act | What do we do next? Scale up, modify, or abandon? | Decide on PDSA cycle 2 modifications or full implementation |
What is a Driver Diagram?
A driver diagram is a visual planning tool that links your overall aim to the specific changes you need to make. It has three components:
- Outcome / Aim — what you are trying to achieve (your SMART aim)
- Primary Drivers — the main factors that will determine whether your aim is achieved
- Secondary Drivers — the specific interventions or changes for each primary driver
Example: New Diabetes Education Service
Aim: 70% of newly diagnosed T2DM patients attend group education within 6 months of diagnosis
- GP invitation letter at diagnosis
- Nurse mention at 8-week review
- Sessions in morning and evening
- Interpreter available on request
- Brief training for reception staff
- Process document in shared folder
- Structured curriculum with DESMOND
- Patient feedback form after each session
Stakeholder Mapping — The Power/Interest Grid
Before engaging stakeholders, map them using the Power/Interest grid to decide how much time to invest in each group.
| Position | Who they are (examples) | Strategy |
|---|---|---|
| High power, high interest | GP Partners, Practice Manager | Manage closely — keep informed, involve in decisions |
| High power, low interest | ICB/PCN lead, ARCP panel | Keep satisfied — brief updates, no need for deep engagement |
| Low power, high interest | Patients, nursing team, reception | Keep informed — they are your champions and deliverers |
| Low power, low interest | Wider community, other practices | Monitor — minimal engagement needed |
In your write-up, demonstrate that you engaged all four quadrants appropriately — not just the GPs at the practice meeting.
Choosing Your Measures
Strong evaluation requires a mix of measure types. Include at least one of each in your QIA:
📋 Process Measures
Did the service run as planned? Attendance rates, sessions delivered, referrals made
🏆 Outcome Measures
Did patient outcomes change? HbA1c levels, blood pressure, patient knowledge scores
😊 Balancing Measures
Did anything get worse? Staff workload, other appointment capacity, unintended consequences
How to Write Up Your QIA
Your QIA is recorded as a reflective learning log entry in your 14Fish ePortfolio. There is no fixed template, but the RCGP expects all six elements below to be addressed. Missing any one of them makes the entry incomplete.
1️⃣ Title and Brief Description
+Title: Give your QIA a clear, descriptive title. For example: "Introduction of a Structured Group Education Service for Newly Diagnosed Type 2 Diabetes Patients at [Practice Name]"
Brief description: 2–3 sentences summarising what the new service is, what gap it addresses, and why it matters for your patient population. Include relevant epidemiological context — for example, local prevalence data, NICE guidance not being met, or a recurring theme in practice meetings.
2️⃣ What Were You Trying to Accomplish?
+State your SMART aim clearly. Explain the rationale for choosing this aim — what evidence or observation led you to this? What is the baseline (what was the situation before)?
If you conducted any baseline data collection (e.g. a notes review, a patient survey, a quick audit), describe it here briefly. Even a simple baseline measurement significantly strengthens your write-up.
3️⃣ How Did You Engage with Others?
+Describe specifically who you engaged with, when, and how. Use names of stakeholder groups (not individuals, for confidentiality). Show that you listened and adapted based on feedback.
For example: "I presented the proposal at the monthly practice meeting. The nursing team highlighted that the planned timing clashed with the immunisation clinic, which I had not anticipated. We agreed to move the sessions to Tuesday mornings instead. The practice manager identified an existing room that could be used without additional cost."
This level of specificity demonstrates collaborative working and evidence of real engagement — not box-ticking.
4️⃣ What Changes Took Place?
+Describe the PDSA cycle(s) you used. What did you test? What happened? What data did you collect? What did you change between cycles?
Include both process and outcome data if possible. For example: "In PDSA cycle 1 (January–February), we invited 12 eligible patients. 7 attended (58%). Patient feedback was positive. The main barrier identified was work commitments — 3 patients said they could not attend during the day. PDSA cycle 2 introduced a Saturday morning option, and attendance rose to 9/12 (75%)."
5️⃣ Reflection: What Will I Maintain, Improve, or Stop?
+This is the section where trainees most commonly underdeliver. Good reflection is specific, honest, and future-oriented. Avoid generic statements.
"This project taught me the importance of communication and teamwork. I learned that involving others is important in quality improvement."
"I underestimated how much the timing of sessions affected uptake. In future projects, I will pilot two or three different session times from the outset rather than adjusting reactively. I also did not anticipate the need for language support — three patients declined because no interpreter was available. I have now added this to the referral template as a standard question."
Consider linking your reflection to the RCGP Professional Capabilities — particularly OML (Organisation, Management and Leadership), TW (Team Working), and CHES (Community Health and Environmental Sustainability).
6️⃣ Sustainability and Next Steps
+Address whether the new service has been embedded into routine practice or whether it depends on your presence to continue. The RCGP wants to see that quality improvements outlast the trainee who started them.
- Has the service been added to the practice's operational plan?
- Who is responsible for maintaining it after you leave this post?
- Has a process document or SOP (standard operating procedure) been created?
- Is there a review date built in?
Common Pitfalls & Trainee Traps
What Trainees Actually Say
These insights come from recurring themes in UK GP trainee discussions, deanery forums, and peer-to-peer sharing communities. Every point has been cross-checked against RCGP guidance to make sure it is accurate, safe, and helpful.
💬 "I Wish Someone Had Told Me This Earlier..."
🎯 What Your Assessor Is Actually Looking For
The RCGP QIA marking guidance is clear on this — but most trainees have never read it. Here is what matters most, translated into plain English.
| What assessors want to see | What trainees typically write instead | Why the difference matters |
|---|---|---|
| Your personal involvement, described clearly "I collected the data, I approached the nursing team, I adapted the plan..." |
"We implemented a new service and it improved outcomes." | Assessors need to see your contribution, not just the team's. Use "I" — not "we" — throughout. |
| Honest reflection on what went wrong Naming real problems and what you learned from them |
"The service was successful and patients responded well." | A perfect report raises suspicion. Honest self-evaluation signals maturity. Problems + learning = strong portfolio evidence. |
| Data before AND after the intervention Even rough numbers are better than none |
"The team felt the service was an improvement." | Feelings are not data. Even a simple count of attendance rates before and after is solid evidence. |
| Sustainability — who keeps it going after you? Named handover, written process document, review date |
"This service will continue once I leave." | Saying it will continue and showing how it will continue are very different things. Name the person responsible. |
| Links to Professional Capabilities OML, TW, CHES, HPHS at minimum |
(Not mentioned at all) | Many trainees do excellent work but forget to connect it to the RCGP framework. One paragraph is all it takes. |
😬 "Things That Catch People Out..." — A Trainee-Experience Warning List
UK GP educators who have taught QI to hundreds of trainees consistently highlight the same structural advice. These points are drawn from UK GP training video content and deanery teaching materials — presented here in clean, practical form.
Write your driver diagram before you do anything else. It forces you to think clearly about what you are trying to achieve and how — before you start doing things at random. It also makes a compelling visual to include in your write-up.
The RCGP QIP template has a specific structure — follow it. The sections are: introduction, aim, baseline data, driver diagram, PDSA cycles (with data), patient and staff feedback, summary of change, personal learning, and future development. Trainees who follow this structure clearly produce stronger entries.
Collect both staff feedback AND patient feedback. Many trainees only collect patient feedback. But staff feedback — even from a brief conversation — shows that you understand the team perspective, which is exactly what the OML and TW capabilities require.
Your QIA write-up can and should describe what you would do differently. The "future development" section is not a formality — it is one of the areas assessors find most revealing. A trainee who can clearly see what they would change demonstrates the highest level of reflective practice.
SMART aims must be measurable — or they are not SMART. "To improve diabetes care" is not a SMART aim. "To increase attendance at diabetes group education from 0% to 70% of newly diagnosed patients within 6 months" is. The measurable part is what makes the difference.
Include a run chart — even a hand-drawn one. A line graph showing your data over time, with a vertical line where your change happened, is simple to create and immediately makes your project look like proper QI methodology. You do not need statistics software. Excel or Google Sheets is fine.
🔑 The Three Questions Every QIA Must Answer
These three questions are straight from the IHI Model for Improvement — the framework underpinning all RCGP QI requirements. If your write-up clearly answers all three, you have the foundations of a strong entry.
🗓️ Timing Your QIA — A Simple Timeline
For a standard 16-week GP post. Adjust proportionally for LTFT posts — discuss timing with your ES first.
Insider Wisdom
🔥 The "Already Frustrated" Rule
The most successful new service projects solve problems the practice team is already frustrated about. Instead of inventing a topic, go to your next practice meeting and listen for the things people complain about. That's your QIA gold mine.
🏆 Small and Finished Beats Big and Half-Done
A group education session for 8 patients, fully evaluated with patient feedback and a completed PDSA cycle, is better portfolio evidence than an ambitious practice-wide transformation that ran out of steam after month two.
🤝 Win the Practice Manager Early
The practice manager holds the keys — to the room, the scheduling system, the admin team, and sometimes the budget. A trainee who wins them over in week one will find the rest of the project surprisingly smooth. Bring coffee.
📸 Document As You Go
The best QIA write-ups are written progressively — a few bullet points after each meeting, after each PDSA cycle, after the first session. Trying to reconstruct everything from memory at the end of your rotation is painful and produces thin, vague reflections.
🔗 Link to NICE Guidance
Almost every service gap you could identify has a NICE guideline behind it. Referencing the specific NICE recommendation your service aims to implement immediately frames your work as evidence-based and gives you automatic credibility in your write-up.
🌍 Think About Health Inequalities
Any new service that addresses health inequalities — access for non-English speakers, services for deprived populations, proactive outreach for underserved groups — will impress your educational supervisor and demonstrates CHES capability in a meaningful way.
Trainer & TPD Pearls
🔮 Common Learner Blind Spots on New Service QIAs
- Confusing "idea generation" with "implementation" — trainees often think proposing a service counts as doing QI
- Under-estimating the importance of stakeholder engagement — working in isolation and wondering why the service doesn't survive their rotation
- No baseline measurement — making it impossible to demonstrate change
- Generic reflection — describing QI principles rather than personal learning
- Starting too late — not factoring in the time needed for PDSA cycles and evaluation
📋 Tutorial Ideas
- Present a real anonymous new service example — ask trainees to critique the write-up against RCGP criteria
- Run a "problems in practice" exercise — brainstorm with the trainee what service gaps exist in the surgery
- Work through a driver diagram together for the trainee's chosen topic
- Review PDSA cycle planning — ask: "What is the smallest possible test of this change?"
- Use Bradford VTS example write-ups (download section) for peer critique
🔍 Reflective Questions to Use
- "What evidence do you have that this gap actually exists in your practice?"
- "Who else needs to be involved for this service to keep running after you leave?"
- "What is the smallest possible test you could run in the next two weeks?"
- "How will you know if it's working? What will you measure?"
- "What RCGP Professional Capabilities does this work demonstrate?"
- "If this service didn't achieve its aim — what would you learn from that?"
Frequently Asked Questions
Can I do my new service QIA in a hospital post?
+Yes — QIAs can be done in hospital posts, provided the work has a personal connection to your practice and involves real action. However, you should discuss with your Educational Supervisor first. For a QIP (the larger project), the RCGP requires it to be in a primary care setting unless agreed otherwise in advance.
Does the new service have to still be running when I write it up?
+Not necessarily — but you do need to have evidence that it was implemented and evaluated, not just planned. A service that ran for 4 weeks, was evaluated, and then was handed over to another team member is a perfectly valid QIA. A service that was only ever a proposal is not.
Can a new service also count as my Leadership activity?
+No. The RCGP requires that the QIA and the Leadership activity are separate activities. You cannot log the same piece of work as both. However, a new service could provide strong evidence for Leadership in your ePortfolio narrative, even if it is formally logged only as a QIA.
Do I need a formal PDSA cycle structure in my write-up?
+Not mandated — but highly recommended. Using PDSA language in your write-up signals methodological awareness and QI literacy. Even if you only ran one informal cycle, framing it as Plan–Do–Study–Act in your write-up will significantly strengthen the entry. It takes five minutes and makes a genuine difference to how sophisticated your reflection appears.
Can my new service be something very small?
+Yes — and in fact, the RCGP guidance encourages keeping QIAs "simple and small scale." A new system for communicating test results, a brief advice card for patients on long-term medications, or a structured handover process for OOH visits are all valid new service QIAs. Size is not the criterion — systematic implementation, engagement, and evaluation are.
What if the service did not achieve its aim?
+This is one of the most valuable QIA outcomes — if you handle it well. A service that did not meet its target, honestly evaluated with analysis of why and clear learning for the future, demonstrates far greater quality thinking than a superficial success. Write it up honestly. Educational supervisors are far more impressed by intellectual honesty than by inflated outcomes.
Where do I record my QIA in the 14Fish ePortfolio?
+Record it as a Quality Improvement Activity reflective learning log entry in your 14Fish (FourteenFish) ePortfolio. It is not recorded in the same section as the QIP. Your Educational Supervisor will review it and can add comments. Make sure you clearly label it as a QIA in the title — supervisors reviewing dozens of log entries appreciate a clear label.
Final Take-Home Points
🎯 Bottom Line — Before You Go
- A new service QIA requires implementation AND evaluation — not just a plan
- Start in week 1 of your GP post — not week 16
- Involve the team from the very start — nurses, admin, and practice manager
- Set a SMART aim before you begin, not retrospectively
- Use PDSA cycles — even just one formal cycle transforms your write-up
- Collect baseline data — you cannot show improvement without it
- Evaluate honestly — imperfect results with good analysis impress more than inflated ones
- Write up progressively — notes after each step, not a reconstruction at the end
- Link to Professional Capabilities: OML, TW, CHES, HPHS are the obvious ones
- Ensure the service can survive your rotation — sustainability is the mark of genuine quality improvement
"The best new service QIAs are those where the trainee genuinely cared about the problem, involved the whole team in solving it, and left the practice with something that is still running six months after they left. That is what quality improvement really means — and it is entirely within your reach."
Bradford VTS — For Everyone, Not Just Bradford
This page is part of the Bradford VTS Quality Improvement section. Explore audit, PDSA cycles, literature reviews, and more at bradfordvts.co.uk/quality-improvement