Doing a Notes Review
Because "I'm sure we're recording things properly" is not a quality improvement strategy. Let's find out for certain.
A notes review is one of the most accessible, flexible, and genuinely useful Quality Improvement Activities a GP trainee can do. It requires no special equipment, no ethical approval, and often reveals something surprising about real-world clinical practice. This page tells you everything you need to know to do one well.
Last updated: April 2026 · Content verified against current RCGP guidance
Downloads
Templates, examples, and forms — right when you need them
Handouts, templates & worked examples
Useful downloads for learning, teaching, or last-minute rescue revision. Includes blank forms, completed examples, and markers to help you understand what a good notes review looks like.
path: NOTES REVIEW
- E1. Notes Review Sample.doc
- E2. Notes Review - Marker 1.doc
- E3. Notes Review - Marker 2.doc
- E4. Notes Review - Marker 3.doc
- form - medical records.pdf
- form - notes review blank.doc
- form - notes review example.doc
- medical records example.pdf
- notes review - how to do one.doc
- notes review - uti in children.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 & RCGP
RCGP — Quality Improvement Activity (QIA)Official RCGP guidance on what counts as a QIA and how to record it on 14Fish RCGP — Quality Improvement Project (QIP)The more formal QIP requirements for ST1/ST2 GP posts RCGP — Quality Improvement in General PracticeQI modules, QOF case studies, and early diagnosis resources RCGP — WPBA Learning Log GuidanceHow to complete and document QIA reflective log entries NICE GuidanceThe gold standard for audit criteria and clinical benchmarks NICE Clinical Knowledge SummariesQuick-access summaries ideal for identifying audit criteriaGP Training & Practical Resources
Bradford VTS — Quality Improvement HubOverview of all QIA and QIP activity types with practical step-by-step guides GPnotebookRapid-access clinical reference for identifying gold standard criteria RCGP — Worked Example Log EntriesReal annotated examples of QIA reflective logs with supervisor feedback GPonline — Writing Up Your QIAPractical guide to portfolio write-up with real trainee examples NES Scotland — QI in Primary Care GuideExcellent practical QI methods guide, including notes review and trigger review methodology GP Appraisals — QIA GuidancePlain-English guide to what counts as a QIA, with wide-ranging examples HQIP — National Clinical Audit ProgrammesNational audit data you can benchmark your practice against⚡ One-Minute Recall
If you only read one section — this is it.
- Systematic review of a sample of patient records
- Check them against a defined standard or criterion
- Identify gaps → make a change → re-check
- A type of QIA for your 14Fish ePortfolio
- QIA required every training year
- Notes review counts as a valid QIA
- Log it as a QIA reflective log on 14Fish
- Must include data, action, and reflection
- Choose a topic with a clear NICE standard
- Review 10–30 records (before data)
- Identify gaps and implement a change
- Re-review the same number (after data)
- Clear before AND after data
- Genuine reflection (not just "I found X")
- Evidence of team engagement
- Link to Professional Capabilities
For International Medical Graduates (IMGs)
This section explains parts of UK GP training that differ from most other countries' systems.
🌍 Welcome — Here Is What Is Different in the UK
In many countries, a "notes review" just means looking back at a few cases and reflecting on them. In UK GP training, it means something more structured: you are measuring your practice against a published standard, showing a before and after, and demonstrating that you made a real change. The UK system is built around the idea that doctors are accountable — not just to themselves, but to the team, the practice, and the patients. That is what this activity asks you to show.
💡 A Gentle Note for IMGs
If this is your first time doing a formal notes review in the UK style, do not worry — the concept is straightforward. The most important thing to know is that the UK system values honesty, team working, and reflection above perfection. A project that found a problem, made a change, partially improved things, and reflected honestly on why full improvement was not reached will score higher than a project where everything magically worked perfectly and there is nothing to reflect on. Supervisors trust the honest version. They are suspicious of the perfect version.
Why This Matters in GP
The Reality of Primary Care Records
GP records are the backbone of continuity of care in the NHS. Every time a colleague, an out-of-hours doctor, or a hospital consultant looks at a patient's notes, they are relying on your documentation being complete, accurate, and clinically meaningful.
The uncomfortable truth is that real-world records are often incomplete. Not from carelessness — but from the sheer pace of GP work. A notes review surfaces these gaps in a structured, objective way, and gives you — the trainee — the power to do something about it.
Why Trainees Struggle With This
Most trainees find notes reviews straightforward to do, but struggle to write them up in a way that impresses supervisors. The common failure is treating the write-up as a data table with no reflection — forgetting that the RCGP is not just assessing whether you found a gap, but whether you understood what it meant and what you did about it.
The second common mistake is choosing criteria that are too vague. "Are notes complete?" is not an audit criterion. "Is smoking status recorded in the last 12 months for patients on the combined pill?" is.
🔵 Where This Sits in the Bigger Picture
A notes review is a type of Quality Improvement Activity (QIA). The RCGP requires at least one QIA per training year. In ST1/ST2 (GP post), trainees also need a Quality Improvement Project (QIP). A notes review can contribute to either — but in different ways. As a standalone QIA, it is lighter-touch and quicker. As part of a QIP, it would form one cycle of a PDSA loop within a larger structured project. Most trainees use notes reviews as QIAs, which is entirely appropriate and commonly accepted by supervisors.
💡 Insider Tip (From Trainee Experience)
Choose a topic you genuinely noticed a problem with in clinic. Supervisors love QIAs that started with a real consultation moment — "I noticed three patients on lithium didn't have recent U&Es in the notes, so I decided to check how many others were in the same position." That's QI. That's what the RCGP is looking for. It has a heart. It has a why. Projects triggered by genuine clinical curiosity consistently score better than ones that feel like box-ticking.
What Is a Notes Review?
Definition
A notes review (also called a medical records review or casenote review) is a systematic review of a sample of patient records against a predefined set of criteria or standards. You look at a group of records, check whether they meet a defined standard of care or documentation, identify gaps, make an improvement, and then check again to see if it worked.
It is a form of clinical audit — the structured "compare what you're doing against what you should be doing" methodology — applied specifically to patient records and documentation.
| Feature | Notes Review | Clinical Audit | Random Case Review | SEA / LEA |
|---|---|---|---|---|
| Scope | A sample of records on one topic | Any aspect of clinical care | One random case per session | A single significant event |
| Data type | Population-level (group of records) | Population-level | Individual case | Individual event |
| Standard needed? | Yes — explicit criterion required | Yes — essential | No formal standard needed | No formal standard needed |
| Re-measurement? | Yes — before AND after data ideal | Yes — essential for full audit | No | No |
| Counts as QIA? | Yes ✓ | Yes ✓ | Yes ✓ | Separate requirement |
| Typical time | Half a day total | 1–3 days | 15–30 minutes | 1–2 hours |
⚠️ Important Distinction — Don't Confuse These
A Learning Event Analysis (LEA) or Significant Event Analysis (SEA) does not count towards your annual QIA requirement — even though it is a separate mandatory requirement. Trainees who try to double-count their SEA as their QIA regularly get caught out at ARCP. You need both. Keep them in separate log entries on your 14Fish ePortfolio.
Visual Guides — See It, Not Just Read It
Because some things make much more sense as a picture
🔄 The Notes Review Cycle — Step by Step
Every good notes review follows this loop. The cycle never truly ends — it just gets handed to the next person to continue.
🗂 What Counts Towards What — The RCGP Requirements Map
Confusion about these three things causes more ARCP surprises than almost anything else. Here is how they fit together.
⏱ Where Trainees Spend Their Effort (vs Where They Should)
A common pattern seen across multiple UK GP training programmes. The split that leads to supervisor disappointment — and the split that leads to a strong write-up.
😬 What Many Trainees Do
✅ What Strong Trainees Do
Equal effort across all four phases produces a complete, balanced, high-scoring write-up.
✅ Is My Topic Ready? — A Decision Flowchart
Run your topic idea through this check before you start collecting data. It takes two minutes and saves two months of regret.
📐 The Criterion Quality Spectrum
Your criterion is the most important part of the whole project. Too vague and it cannot be measured. Too complex and it cannot be collected. The sweet spot is specific, simple, and answerable with a clear Yes or No.
📅 The Ideal Timeline — Within a 6-Month GP Rotation
This is roughly how the time should be spread. Starting in Month 1 means everything is relaxed. Starting in Month 5 means everything is rushed — and the re-audit often gets skipped entirely.
Topic Ideas for Notes Reviews
Can't think of where to start? Here are ideas that work well in GP settings
🔵 Choosing the Right Topic — Three Practical Tests
- Is there a clear NICE standard? If yes → proceed. If no → either find another standard or choose a different topic.
- Can your clinical system generate a patient list for this group? If yes → feasible. If data is only available by manual trawl of individual records → reconsider scope.
- Is this a genuine local concern? Talk to your trainer or practice manager. Projects that map onto a real practice problem are more valuable, more engaging, and better received at ARCP.
How To Do a Notes Review
A step-by-step guide for GP trainees
✅ The Golden Rule Before You Start
Every notes review needs a clear, specific, measurable criterion — ideally derived from NICE guidance, the BNF, or a recognised clinical standard. Without a gold standard, you have nothing to compare against. The question is not "are our notes good?" but "are specific things being documented, and are they being documented correctly?"
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Choose Your Topic and Identify the Standard
Pick a topic that is clinically meaningful, locally relevant, and has a clear NICE guideline or recognised standard to audit against. Think about a gap you've noticed in clinic — a patient group whose monitoring seems inconsistent, or a process that doesn't always seem to happen. Then find the relevant NICE CKS page and identify the specific criterion you'll check.
Example: "NICE CKS recommends that patients on lithium have their serum lithium level, renal function, and thyroid function checked every 6 months. I will check whether this is recorded in the notes for all patients currently on lithium at my practice."
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Define Your Audit Criteria Precisely
Write your criterion as a SMART statement: Specific, Measurable, Achievable, Relevant, Time-bound. Vague criteria produce vague results. Your criterion should be answerable with a simple Yes/No for each record you look at.
Good criterion: "All patients on the combined oral contraceptive pill should have their blood pressure recorded in the last 12 months." Bad criterion: "Notes should be complete."
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Select Your Sample
Run a search on your clinical system (EMIS or SystmOne) to identify your patient group. 10–30 records is standard and acceptable for a GP training QIA. You do not need to review every patient in the practice — a meaningful sample is enough. If the clinical system can run the search, ask a practice manager or a GP to help — you do not need to do all the data collection personally.
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Collect Your Baseline Data (Before)
Review each record systematically, using a simple data collection form (blank templates available in the Downloads section above). For each record, record whether the criterion was met. Calculate your percentage compliance. This is your "before" figure — the baseline against which your intervention will be judged.
Example: "Of 25 patients on lithium, 14 (56%) had all three monitoring parameters recorded in the last 6 months."
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Identify the Gaps and Their Causes
Don't just record the number — understand why compliance is below standard. Talk to your practice team. Is there no recall system? Is the monitoring done elsewhere but not documented locally? Is it coded incorrectly in the system? Understanding the root cause makes your intervention much more targeted and effective.
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Design and Implement an Intervention
Make a change. This could be: adding a recall template to the clinical system, presenting your findings at a practice meeting, creating a patient information sheet, updating a clinical protocol, or running a brief educational session for staff. The change should directly address the root cause you identified in step 5.
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Re-measure After the Intervention (After)
After a suitable interval (usually 4–8 weeks), repeat the records review using the same criteria and sample approach. Calculate your new compliance figure. This is your "after" data. Compare with your baseline. Has improvement occurred? If not — why not? This becomes part of your reflection.
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Reflect, Document, and Close the Loop
Write up your reflective log on your 14Fish ePortfolio. Reflect on what you found, what you changed, whether it worked, what you would do differently, and what you will maintain, improve, or stop. Link to relevant Professional Capabilities. Ask your Educational Supervisor to review and comment. The write-up is as important as the data.
🧠 The PDSAR Framework — Remember This
What To Look For in a Notes Review
Common domains and criteria types
What you look for depends entirely on your chosen topic and criterion. Below are the main domains that notes reviews in UK general practice typically cover, with examples of how to frame specific criteria.
| Topic Area | Example Specific Criterion | Gold Standard Source |
|---|---|---|
| Lithium monitoring | Serum lithium, eGFR, and TFTs recorded within last 6 months | NICE CKS / BNF |
| Combined OCP | BP recorded within last 12 months; smoking status documented | NICE guideline NG29 |
| Methotrexate | FBC and LFTs within last 3 months for all patients on methotrexate | NICE / BSR guideline |
| Type 2 diabetes | HbA1c, BP, cholesterol, foot exam, and urine ACR documented within last 12 months | NICE NG28 |
| Safeguarding — children | Safeguarding concern coded with appropriate review plan for all flagged cases | GMC / local safeguarding board |
| Urgent referrals (2WW) | Referral reason and clinical findings documented in all 2-week-wait referral records | NICE NG12 (cancer referral) |
| Warfarin / DOACs | INR within therapeutic range documented & bleeding risk score recorded at initiation | NICE NG196 |
| Mental health reviews | Annual physical health review (BP, BMI, smoking, glucose, lipids) documented for patients on antipsychotics | NICE QS80 |
🎯 What Trainers & TPDs Love To Hear
- "I found the gold standard in NICE CKS before I started, so I had a specific measurable criterion from day one."
- "Before I collected my data, I discussed the topic with my trainer and the practice manager to make sure it was relevant to a real local need."
- "I presented my findings at a practice meeting — it wasn't just a solo exercise, it involved the whole team."
- "My re-audit showed improvement, but I also reflected honestly on why full compliance wasn't reached — and what the next step would be."
Writing It Up for 14Fish
How to turn your data into a portfolio entry that actually impresses
🔵 The Core Principle
The RCGP is not just assessing whether you found a gap. It is assessing whether you understood what it meant, what you did about it, what happened as a result, and what you learned. A write-up with good data but poor reflection scores badly. A write-up with modest data but excellent reflection scores well. The reflection is the point.
| Section | ❌ Weak Example | ✅ Strong Example |
|---|---|---|
| Background | "I decided to look at lithium monitoring." | "During a medication review, I noticed a patient on lithium had no documented bloods in over a year. This prompted me to check practice compliance with NICE CKS monitoring standards." |
| The Standard | "Lithium needs monitoring." | "NICE CKS recommends that all patients on lithium have serum lithium, eGFR, and TFTs checked every 6 months. This formed my audit criterion." |
| Reflection | "I found that compliance was low. I will improve this." | "Compliance was lower than expected at 56%. On reflection, the main barrier was the absence of an automated recall template in SystmOne. I set up a recall template with the practice manager, which directly addressed this. After 6 weeks, compliance improved to 84%. The remaining 16% represented patients who had declined monitoring — I identified these and added a coded exception in their records. I would improve my initial intervention by also creating a patient information leaflet explaining why monitoring matters." |
✅ Professional Capabilities to Link
- OML — Organisation, Management & Leadership (the primary link for all QI activity)
- PLT — Performance, Learning & Teaching (reflection on practice)
- CM — Clinical Management (if topic is clinical)
- HPHS — Holistic Practice, Health Promotion & Safeguarding (if health promotion / safeguarding-related)
- MC — Medical Complexity (if monitoring complex patients)
⚠️ Common Supervisor Comments
- Missing clear before AND after data — single measurement not acceptable
- Reflection too thin — "I found X" without explaining why or what you changed
- No NICE/guideline source cited for the standard used
- No mention of team engagement — QI should involve colleagues
- Capabilities listed without justification for why they apply
Common Pitfalls & Trainee Traps
Things that catch people out — so they don't catch you out
⚠️ Common Trainee Mistakes
- Choosing criteria that are too vague — "Are the notes good?" cannot be measured. "Is HbA1c documented in the last 12 months?" can be.
- Forgetting the re-audit — A single data point proves nothing. You need before AND after. No re-audit = "below expectation" from your supervisor.
- Confusing a notes review with an SEA/LEA — These are completely separate. One is a population-level quality check. The other is a deep-dive into a single incident. They serve different purposes and cannot be double-counted.
- Treating the write-up as a data table — Numbers without meaning. Always explain what the data shows, why compliance was low, and what you did about it.
- Working in isolation — QI is a team sport. Not discussing findings with colleagues, not presenting at a practice meeting, not involving the practice manager in system changes. Supervisors notice this.
- Selecting a topic with no retrievable data — If your clinical system cannot run the search, the project becomes unmanageable. Always check data accessibility first.
- Setting an unrealistic standard — "100% compliance in 2 weeks" for a complex systemic change is not realistic. Set an achievable interim target and acknowledge the journey.
🔥 What Actually Gets You Good Marks
- Starting with a genuine clinical observation — a real patient moment that made you ask "is this happening everywhere?"
- Having a crystal-clear NICE/BNF-referenced standard before you start
- Presenting findings to the practice team — even a 5-minute slot at a coffee meeting counts
- Making a practical change — a template, a protocol, a patient letter, a system tweak
- Re-auditing after a realistic interval and showing honest results (even if partial improvement)
- Reflecting on what you would do differently — not just what you found
- Being honest when improvement wasn't complete — and explaining why, with what you'd try next
💡 Insider Tip (From Trainee Experience)
The single most common reason notes reviews get rejected at ARCP or returned by supervisors is not the quality of the review itself — it's the quality of the write-up. Trainees spend 80% of their effort on the data collection and 20% on the reflection. The RCGP has it the other way around. Write as you go. Don't try to reconstruct your thinking weeks later from a spreadsheet. Your future self will thank you.
Trainee Wisdom — What People Wish They Had Known
Hard-won insights from UK GP training communities, deanery forums, and registrar peer groups. All verified against RCGP guidance.
😬 The 5 Things UK GP Trainees Wish They Had Known Earlier
Recurring patterns from deanery groups, training forums, and peer feedback across multiple UK GP programmes.
✅ What a Strong Notes Review Looks Like
- ✓Topic came from a real moment in clinic
- ✓NICE criterion cited — specific and measurable
- ✓Before data: 20–25 records reviewed
- ✓Root cause explored with the team
- ✓Practical change made (e.g. recall template)
- ✓Results shared at a practice meeting
- ✓After data collected — 6–8 weeks later
- ✓Reflection explains WHY, not just WHAT
- ✓Capabilities linked with specific justification
❌ What Gets Returned by Supervisors
- ✗Criterion says "notes should be good"
- ✗No reference to any guideline or standard
- ✗Only before data — no re-audit done
- ✗Reflection is two sentences long
- ✗No mention of team involvement
- ✗No change was actually implemented
- ✗Capabilities listed without any justification
- ✗SEA used to try to replace the QIA
- ✗QIP filed in the Learning Log instead of the QIP section
💡 Insider Tip — The Pareto Principle in Action
A well-known teaching from GP educator communities goes like this: when you ask your practice team what causes problems, you will almost always find that 2 or 3 issues account for the vast majority of all problems. This is the Pareto principle — roughly 80% of the trouble comes from 20% of the causes. Use this. Ask your receptionist, nurse, and practice manager what bugs them most. That conversation often hands you the perfect notes review topic — one that is genuinely relevant, data-accessible, and team-supported from day one.
🎯 What UK GP Educators Say About Sample Size
A useful teaching point from UK GP audit guides: once you have reviewed roughly 60–70 records, adding more records to your sample gives very little extra information. So don't panic about sample size. In a GP practice, reviewing 20–25 records is perfectly adequate to get a clear picture of what's happening — and your supervisor will accept it. Audit is about getting a feel for what is happening, not statistical precision. Auditing 10% of your diabetic patients gives you large numbers but a meaningless sample. Auditing every patient on lithium — even if that's only 15 people — gives you a complete and clinically valid picture.
🔥 "The Change Is the Point" — From UK GP Training Forums
One of the most important things UK GP educators emphasise — and trainees repeatedly say they wish they had understood earlier — is this: the whole purpose of a notes review is the change, not the data. Data collection is just the tool that shows you where the change is needed. Many trainees collect excellent data and then treat that as the end of the exercise. It isn't. The change is the exercise. A small, practical, systemic change — a recall template, a protocol update, a computer alert — that outlasts your rotation is worth far more than a beautiful data table that sits in your portfolio and does nothing. Ask yourself: "When I have left this practice, will anything be different because I did this?" If the answer is yes — that's a quality notes review.
⚠️ The FourteenFish Filing Trap — Don't Fall Into It
This catches trainees out at ARCP more often than you would imagine. The QIP (Quality Improvement Project) has its own dedicated section in the FourteenFish ePortfolio — it is completely separate from the Learning Log. ARCP panels check the QIP section specifically. If you have filed your QIP as a Learning Log entry, the panel may not find it, and it will not count. QIAs, by contrast, go in the Learning Log as a reflective entry. Know which is which, and file in the right place. When in doubt, ask your Educational Supervisor — before the ARCP, not during it.
Insider Pearls & Real-World Wisdom
Things trainees wish they had known earlier
💡 Start During Your First Month
The single best time to start a notes review is during your first few weeks in a new GP post — when everything is fresh and you notice gaps that experienced colleagues have stopped seeing. That "I wonder why this patient doesn't have recent bloods" thought you have in week two? Write it down. It's your QIA.
🎯 Your Practice Manager Is a Goldmine
Most trainees design their notes reviews without talking to their practice manager first. This is a mistake. Practice managers know exactly which searches are easy to run on the clinical system, which topics are already on the practice's quality agenda, and which problems the partners have been discussing for months. One conversation can save hours of work and produce a far more relevant project.
🔥 The 80% Rule
Don't set 100% compliance as your standard when it's unrealistic. In most primary care QI work, 80–90% compliance is considered a meaningful and achievable target. If your baseline is 40% and you reach 80% after intervention, that is an excellent result. Honesty about what's achievable actually demonstrates more sophisticated QI thinking than aiming for a perfection that can never be reached.
💡 Document As You Go — Not At The End
Write brief notes throughout the project. Date each entry. Record your decisions and your reasoning in real time. When you come to write up your reflective log weeks later, you will have a memory-jog that makes the reflection richer and more specific. Trying to reconstruct a project from memory after the fact produces generic, vague reflections that supervisors see straight through.
⚠️ What Candidates Forget in Their Write-Ups
- Why the gap existed — not just that it did. Root cause analysis, however brief, shows clinical thinking.
- What the change actually was — vague "I discussed this with my team" is weaker than "I created a SystmOne recall template and added all 18 patients to it, with an alert for the next GP who opened their record."
- What you would do if improvement hadn't occurred — a good reflector considers the next PDSA cycle even when the first one worked.
- The patient perspective — how did this QI activity affect patients? Even a brief sentence acknowledging patient benefit elevates the write-up significantly.
Memory Aids & Cheat Sheet
The CRISP Notes Review Framework
✅ Quick Pre-Submission Checklist
- Topic clearly linked to a real personal or practice need
- Explicit NICE / BNF standard cited with source
- Criterion phrased as a specific Yes/No question
- Baseline ("before") data collected from ≥10 records
- Root cause of gap explored and documented
- Intervention designed and implemented
- Re-audit ("after") data collected from same-sized sample
- Findings presented to at least one colleague or at a meeting
- Reflection includes "maintain, improve, stop"
- At least 2 Professional Capabilities linked with justification
- Entered as a QIA reflective log on 14Fish ePortfolio
- Educational Supervisor notified for review and feedback
⏱ Rough Time Plan
- 🕐 Week 1: Choose topic, find standard, design criterion (1–2 hrs)
- 🕐 Week 1–2: Run system search, collect baseline data (1–2 hrs)
- 🕐 Week 2–3: Analyse results, identify root cause, present to team (1 hr)
- 🕐 Week 3–4: Implement change (variable — often just a system tweak)
- 🕐 Weeks 5–8: Wait for change to bed in
- 🕐 Week 8–9: Re-audit, collect after data (1–2 hrs)
- 🕐 Week 9–10: Write up on 14Fish with full reflection (1–2 hrs)
Total active time: approximately 6–10 hours across several weeks. Easily manageable alongside training.
For Trainers & Teaching Pearls
How to get the most out of notes reviews as a teaching tool
🎓 Common Trainee Blind Spots on This Topic
- Not understanding the difference between a QIA and a QIP — spending time designing a complex project when a simple notes review would satisfy the portfolio requirement
- Treating the criterion as an output rather than a tool — failing to connect it to a gold standard and therefore producing meaningless data
- Producing data without reflection — showing a compliance table with no sense of "so what does this mean, and what did you do about it?"
- Underestimating the value of the write-up — believing the project itself is the assessment, when the reflective log entry is equally weighted
- Not involving colleagues — treating QI as a solo activity when clinical governance is inherently a team endeavour
Tutorial Prompts & Discussion Questions
- 📌 "Tell me about a gap you've noticed in our records. What made you notice it?"
- 📌 "Where would you find a gold standard to measure against? Walk me through it."
- 📌 "What's the difference between this notes review and an SEA? Why do we need both?"
- 📌 "How would you involve the rest of the practice team in this — not just to complete the project, but to sustain the change?"
- 📌 "What would you do if your re-audit showed no improvement?"
- 📌 "Which Professional Capabilities does this link to, and why?"
Practical Tips for Trainers
- ✅ Help the trainee identify their topic during their first month in post — early start means time for a proper re-audit
- ✅ Introduce trainees to the practice manager at induction — this often unlocks QI topics the practice was already working on
- ✅ Encourage trainees to present findings at a practice or coffee meeting — even 5 minutes is good for the portfolio and great for team development
- ✅ Review the write-up before submission — thin reflection is the most common cause of supervisor disappointment
- ✅ Ask the trainee to show you their data table AND explain their reflection verbally first — this often surfaces what needs strengthening before they type it up
🟣 For TPDs — Quality Assurance Checklist
- QIA entries clustered at end of training year suggest box-ticking — prompt earlier engagement
- QIA entries that are all single-cycle with no re-measurement — trainee may not understand the before/after requirement
- Watch for trainees who substitute SEAs/LEAs as their QIA — this is a common misconception
- Strong QIA entries show genuine curiosity, team involvement, and practical change — not just data collection
- Consider featuring strong anonymised examples in induction teaching to set expectations early
Frequently Asked Questions
✅ Final Take-Home Points
The bits to remember tomorrow morning
- 1A notes review is a systematic check of patient records against a defined gold standard. It is one of the most accessible QIAs available to GP trainees.
- 2You need a specific, measurable criterion — ideally from NICE CKS, the BNF, or a recognised guideline. Vague criteria produce useless data.
- 3You need before AND after data. A single measurement with no re-audit is not sufficient for a meaningful QIA and will likely result in "below expectation" feedback.
- 4The reflection in your write-up matters as much as the data — possibly more. The RCGP is assessing your thinking, not your spreadsheet.
- 5SEAs and LEAs are separate mandatory requirements and cannot count as your QIA — even if they arose from reviewing a patient's notes.
- 6Involve your team. Present your findings. Make a practical change. QI is not a solo activity — it is a team endeavour embedded in practice culture.
- 7Talk to your practice manager before you start. They know your clinical system, your practice's data, and what problems are already on the team's radar.
- 8Start early in your post. You need time for the change to bed in before you re-audit. Starting in the last month of a rotation produces thin, rushed QIAs.
- 9Link your entry to at least 2 Professional Capabilities — OML and PLT are the most natural fits. Always justify the link, don't just list the abbreviations.
- 10Document as you go. Real-time notes about your decisions and thinking produce far better reflective log entries than reconstructed memory weeks later.
Bradford VTS — The universal GP training resource for trainees, trainers and TPDs everywhere. Created by Dr Ramesh Mehay. |
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Disclaimer
Content updated April 2026 · Always verify against current RCGP requirements at rcgp.org.uk