Appraisal and revalidation support for medical professionals

Quality Improvement

What needs to be done to meet appraisal requirements for quality improvement?

It’s easy to complicate this, but the answer is very simple. Ten significant event or case review reflections and one audit over a five-year cycle.

Significant Events and Case Reviews

Significant events can be significant untoward events (SUIs), in which patients come to harm or near to harm, but they don’t have to be. Most won’t be. Events ideally include personal involvement, discussion with colleagues and some type of improvement. Improvement can be within the practice systems or in personal knowledge. Reflections are best structured using the significant event template.

Opportunities for improvement can also stem from interesting cases. These reflections are best structured using the case review template. The RCGP does not distinguish between significant events and case reviews. It sees them as one and the same. It’s fine to do any combinations of significant events and case reviews over the five years so long as they add up to at least ten: for example, five of each.


It is easy to complicate audit for medical appraisal. But in truth, it’s child’s play. Here is a quick and simple guide.

It starts with an idea. Something you are currently not very good at and want to improve. Let’s say that is the punctuality for starting your afternoon surgeries. That is known as the audit criterion, it is the thing you are going to measure.

So you measure it and find that only 70 per cent of your surgeries start on time.

It is a good idea to have a target. In this case shall we say that you think 90 per cent of your surgeries should start on time. This 90 per cent target is known as the audit standard.

Next comes the improvement part. This is essential for appraisal as audit comes under quality improvement. Don’t audit something you know you are good at and which leaves you no room for improvement! In this case, the improvement part could be talking with colleagues to bring forwards some mid-day meetings and delegating some admin tasks to allow you to start afternoon surgery on time.

Finally, you re-measure and find you are now starting 85 per cent of your surgeries on time. So you just missed your standard, but no matter, you improved! That is what you are really trying to show.

You can use the audit reflection template to write it up. And remember, ideally, you should do this at least once in every five-year revalidation cycle.

Please find some ideas for audit here.



All content © Bill Laughey 2015