Do you have to do at least one clinical audit in the five year cycle for your medical appraisal?
This Blog clears the myth that you have to do at least one clinical audit in the five year cycle for your medical appraisal.
Clinical audit is not a revalidation requirement – although it can form part of quality improvement activities or a quality improvement project. 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. Earlier RCGP guidance recommended that you should complete two examples of reflection on your significant event analysis and/ 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.
The RCGP has accepted feedback that that the former recommendation (above) was too restrictive for many GPs who were doing excellent quality improvement activities from a whole range of different types that were more appropriate to their circumstances. The RCGP has broadened its former recommendation to make clear that there are many different types of quality improvement activity, other than audit, that are equally acceptable as quality improvement activities, in showing that you have:
- thought about the quality of care you are actually providing
- reviewed your care in the context of current guidance on good practice
- made changes where necessary or appropriate in order to improve (or celebrated the fact that what you have measured has shown that there are no changes that you need to make)
- revisited the question to see whether the changes you have made have resulted in an improvement (or maintained your existing high standards) – the quality assurance stage
It is important that you routinely review the effectiveness and appropriateness of the care that you provide in order to keep patients safe. Demonstrating that this is a professional habit is a matter of choosing appropriate examples, that show what you do and how you do it, not documenting every review of your work that you do. Depending on your circumstances, different quality improvement tools will be helpful, including reflective case review, Significant Event Analysis, review of personal outcome data, ’Search and Do’, ’Plan, Do Study, Act’ and clinical audit (among many others). The RCGP, and others, provide many useful resources for quality improvement activities.
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 very unusual, you may wish to discuss it with your appraiser, and agree it with your responsible officer, before deciding to include it.
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