The difference
| QIA | QIP | |
|---|---|---|
| Size | Small, often weeks | Larger, usually months |
| Method | Any QI approach: audit and re-audit, search and recall, a process review, a patient-feedback change | Formal QI method: aim, measures, change ideas tested in PDSA cycles, data over time |
| When | Each training year in which you do not do the QIP | Once, in a GP post during ST1 or ST2 |
| Write-up | Reflective learning log entry | RCGP QIP template, assessed by your GP supervisor |
| Total | 2 over training | 1 over training |
The numbers by year
| Requirement | ST1 | ST2 | ST3 |
|---|---|---|---|
| Quality Improvement Project (QIP) check current RCGP guidance | 1 in ST1 or ST2, in a primary care post | (see ST1) | Not required |
| Quality Improvement Activity (QIA) | 1 unless the QIP is done this year | 1 unless the QIP is done this year | 1 per year |
Full time, per training year unless stated. Less than full time: per-year totals stay the same and each 6-month review needs a pro rata share; 6-monthly ESRs and 12-monthly certificates are not pro rata. Check with your deanery and educational supervisor.
Notes on these numbers
- Quality Improvement Project (QIP), LTFT: Once during training, in a GP post.
- Quality Improvement Project (QIP), confidence: high (requirement); medium (two PDSA cycles). Our sources were partly secondary for this item: check current RCGP guidance.
- Quality Improvement Activity (QIA), LTFT: One per training year.
QI in five steps
- Pick a problem that matters locally and is small enough to change. Ask the practice manager what keeps going wrong.
- Write an aim: specific, measurable and dated. "Increase the proportion of patients on a high-risk drug with in-date monitoring from 70% to 90% within 3 months."
- Choose measures: an outcome measure (the aim), a process measure (are the steps happening?) and a balancing measure (is anything getting worse elsewhere?).
- Test changes with PDSA cycles: Plan (what, who, when, prediction); Do it small; Study the data against the prediction; Act (adopt, adapt or abandon) and plan the next cycle. At least two cycles is a common VTS expectation. check current RCGP guidance
- Show data over time on a run chart with each change annotated. Put anonymised data on the form itself.
Good topics in general practice
- Monitoring for a high-risk drug (for example methotrexate, lithium, DOACs with renal function).
- Pregnancy prevention reviews for valproate or other teratogenic drugs.
- Reducing short-acting beta-agonist over-ordering and the inhaler carbon footprint.
- Coding of a condition (for example CKD or AF) and treatment gaps.
- Follow-up of abnormal results or urgent suspected cancer referrals.
- Antibiotic prescribing for sore throat or UTI against local guidance.
- Accessibility: interpreter booking or reasonable-adjustment flags.
Free and private: everything stays in this browser. Do not enter patient-identifiable information.
Common ARCP pitfalls
- A one-off data collection with no change tested.
- No repeat measurement.
- Doing everything yourself: QI is a team activity.
- Using the QIA or QIP as your leadership activity, or counting an LEA as your QIA.
- No ST1/ST2 GP post on your rotation: talk to your TPD early about how the QIP will be done.