QIP and QIA in GP Training: Everything You Need to Know (With Ideas That Actually Work)
If you have searched for “audit ideas for GP training” or “QIP ideas for GP registrars,” you are not alone. It comes up on GP trainee forums and social media groups constantly – and it is one of the most common questions GP trainees ask when they start a new primary care post.
But here is something worth knowing before you start: the RCGP no longer requires a clinical audit as a named portfolio requirement. What you actually need to complete in GP training is a Quality Improvement Project – the QIP – and a Quality Improvement Activity, the QIA, in every year of training.
This matters because audit and quality improvement are related but not the same, and submitting something that looks like an audit without the improvement framework behind it may not satisfy what your ARCP panel is looking for.
This blog explains exactly what the QIP and QIA requirements are for GP trainees, how they differ from each other, what your supervisor assesses you against, and – because it is the question asked most often – gives you a detailed list of quality improvement project ideas that work well in primary care, with notes on which are better suited to a full QIP versus the smaller annual QIA.
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What is the QIP in GP Training?
The Quality Improvement Project, or QIP, is a mandatory, formal piece of work that must be completed once during GP specialty training. It is normally done in ST1 or ST2 and must be completed in a GP practice post. If you have no GP post in ST1 or ST2, it can be done in ST3, but this must be discussed and agreed with your educational supervisor in advance.
The QIP is more rigorous than a standard clinical audit. The RCGP is explicit about what it is looking for: what matters is not whether you achieved a dramatic outcome, but whether you can identify a problem in primary care, apply a recognised quality improvement methodology, engage your practice team in the process, and demonstrate genuine reflection on what changed and what you would do differently. The standard is not perfection – it is evidence of a genuine and structured improvement process.
Your completed QIP is uploaded to the Trainee Portfolio using the RCGP QIP template. Your educational supervisor then assesses it against a structured marking schedule, grading you as below expectation, meeting expectation or above expectation across several domains. Receiving below expectation in one section does not automatically mean the project needs to be repeated, but it will feed into your Educational Supervisor Review for that year. Failure to complete the QIP at all will directly affect your ARCP progression.
What is the QIA in GP Training - and how is it different from the QIP?
The Quality Improvement Activity, or QIA, is a separate and smaller requirement that must be completed in every single year of GP training – ST1, ST2 and ST3. By the time you reach the end of training, the RCGP requires a minimum of one QIP and two QIAs.
A QIA is intentionally less formal than a QIP. It should be systematic, robust and directly connected to your own work, but it does not require the full project write-up and formal supervisor assessment that a QIP demands. It is recorded in the Trainee Portfolio as a Quality Improvement Activity reflective learning log entry.
The RCGP states clearly that a Learning Event Analysis, a Significant Event Analysis or a reflection on personal feedback does not count towards the annual QIA requirement. These are separate mandatory requirements in their own right and cannot be used to satisfy the QIA.
The QIA should demonstrate that you identified a problem or gap, took specific action to address it, and can reflect on whether anything changed as a result. It is designed to embed quality improvement as an ongoing habit in GP practice, not simply as a one-off training exercise.
If you complete your QIP in ST1 or ST2, that QIP counts as your QIA for that training year. You still need a separate QIA in every other year of training.
What does the RCGP actually assess in a GP Trainee QIP?
Before you choose a topic, it is worth understanding exactly what your supervisor will be marking you against. The RCGP QIP template assesses several things. You need to show a clear rationale for your chosen topic and explain why it matters in the context of your practice. You need evidence that you established a baseline – in other words, what was actually happening before you intervened. You are expected to use a recognised quality improvement framework, with the Model for Improvement and PDSA cycles being the tools the RCGP explicitly recommends. The template also looks at whether you involved and communicated with relevant colleagues, what your intervention involved, whether there is any evidence that the intervention made a difference (even partial or preliminary data is accepted), and your personal reflection on the whole process.
You do not need to have transformed the practice. A modest, well-documented improvement in a clinically meaningful area will score more highly than an overambitious project that ran out of time. Choose your scope accordingly.
How to Structure a QIP in GP Training: a Practical Step-by-Step Guide
The Model for Improvement is the framework the RCGP explicitly recommends for GP trainees completing a QIP. It asks three questions before you begin: what are we trying to accomplish, how will we know that a change is an improvement, and what changes can we make that will actually result in improvement. These questions are then tested through PDSA cycles – Plan, Do, Study, Act. A PDSA cycle is a structured way of testing a small change, observing whether it worked, and deciding what to do next. One well-documented PDSA cycle with honest reflection is entirely sufficient for a GP training QIP. You do not need multiple elaborate cycles.
In practice, a sensible structure for a four-to-six month GP post works as follows. In the first two to four weeks, identify your topic through direct observation in the practice, discuss it with your educational supervisor, agree the scope and record a Touchpoint 1 meeting using the RCGP template. Between weeks three and six, gather your baseline data – how is the practice currently performing against the standard or aspiration you have identified. From weeks six to twelve, implement your intervention and begin measuring whether anything has changed. In the final four weeks of the post, analyse what happened, write up your reflection, complete the RCGP QIP template, upload everything to the portfolio and record a Touchpoint 4 discussion with your supervisor.
Starting early is the single most important practical piece of advice for any GP trainee approaching a QIP. A project started in the last six weeks of a post almost always lacks meaningful baseline data and depth of reflection. Your supervisor will be able to tell.
QIP Ideas for GP Trainees: a Full List by Theme
This is the section most GP registrars are looking for. The ideas below are drawn from real quality improvement projects completed in GP practices across the UK, including examples referenced on the RCGP’s own QIP pages and across multiple deanery resources. For each theme, there is a note on whether the idea is better suited to a formal QIP or the smaller annual QIA.
Prescribing and medicines management
Improving laxative co-prescribing for patients on regular opioids is one of the most reliably successful QIP topics for GP trainees. There is a well-evidenced gap in most practices, a clear NICE standard to measure against, and prescribing data can be extracted quickly from the clinical system. It is well suited to a full QIP.
Reviewing antibiotic prescribing for upper respiratory tract infections against the local formulary is another strong choice. Data collection is straightforward, the intervention could take the form of a team educational session, a clinical system template change or a prescribing prompt, and there is a natural re-measurement cycle. It works as either a QIP or a QIA depending on the depth and scale of what you undertake.
Improving medication review rates in patients on high-risk drugs such as lithium, methotrexate or amiodarone carries a clear patient safety rationale and there is usually an existing monitoring standard to measure against. This makes a solid QIP. Reducing inappropriate NSAID prescribing in patients with recognised contraindications – including renal impairment, previous gastrointestinal bleeding or significant cardiovascular risk – is a genuine clinical safety issue with data that is straightforward to extract.
Improving the completeness of allergy documentation in patient records is sometimes overlooked as a topic, but it is a meaningful patient safety issue, data collection is quick, and an achievable intervention is available within a short post. It works well as either a QIA or a QIP.
Long-term condition management
Improving diabetic foot review rates in patients with type 2 diabetes is one of the most popular and reliable GP trainee QIP topics. It is QOF-linked, the target is clearly defined, data is easy to extract from the clinical system, and the intervention is measurable. Improving blood pressure control rates in patients with hypertension who are currently below target is similarly strong, with multiple possible interventions including a structured recall system, pharmacist review or a proactive patient letter.
Improving annual review completion rates for patients with COPD or asthma maps directly to a QOF standard and involves the wider practice team in a natural and visible way. Improving eGFR monitoring frequency for patients established on ACE inhibitors or ARBs is a focused safety topic that works well as a QIA. Improving depression follow-up rates in patients with a new diagnosis within the first twelve weeks sits against a clear NICE standard and offers strong reflection opportunities for a QIA.
Prevention and screening
Improving cervical screening uptake in women aged 25 to 64 who are overdue is a public health topic with genuine importance, clearly measurable data and the natural involvement of the practice nurse and reception team – a good QIP. Improving flu vaccination rates in a specific high-risk cohort works particularly well in a winter post, where data is readily available and team engagement is straightforward.
Improving the identification and coding of patients who are carers is often neglected in practices and is genuinely meaningful for patient care. It typically involves a simple search, a recall process and a team conversation, making it an effective QIA or small QIP. Improving identification of patients who are current smokers and have no recorded offer of smoking cessation support maps to a clear NICE standard and is well suited to a QIA.
Patient safety and results management
Improving the safety netting process for abnormal investigation results is one of the most important topics a GP trainee can choose. It is a common gap in practice systems, carries a strong patient safety rationale, and involves developing or reviewing a protocol with the wider team. It makes an excellent QIP. Reviewing and improving the management of urgent correspondence from secondary care is closely related and equally significant.
Improving documentation of DNACPR discussions in patients identified as being in the last year of life is a more sensitive topic but one with strong national guidance through the ReSPECT process. It offers particularly rich reflection opportunities and a meaningful connection to GP practice values, making it a strong QIP for trainees in a GP post with a significant elderly or palliative population.
Improving the assessment of chest infections in primary care through consistent recording of observations including heart rate, blood pressure, respiratory rate, oxygen saturation and temperature is a topic listed on the RCGP’s own QIP page. It is clinically important, involves a template-based intervention that is easy to implement and measure, and works well as a QIP.
Systems and patient access
Improving follow-up rates for patients discharged from secondary care with a significant new diagnosis is a safety-focused topic with measurable outcomes and a genuine gap in many practices. It is a strong QIP choice. Reducing did-not-attend rates for nurse appointments through an improved reminder process is practical, measurable and involves engagement with the reception and administrative team, working well as a QIA or small QIP.
Improving the coding and follow-up of patients newly registered with complex safeguarding needs involves multi-professional engagement, important clinical governance territory and strong scope for reflection, making it a meaningful QIP.
Patient experience and communication
Improving written information given to patients with a new diagnosis of type 2 diabetes is patient-centred, measurable through patient feedback, and involves the creation or updating of resources in collaboration with the practice team. Improving the quality of outgoing referral letters for a specific clinical area is better suited to a QIA – it involves reviewing your own clinical work, seeking peer feedback and making a specific, documented change to your practice.
What Makes a Strong QIA?
A QIA does not require the full project template or formal graded supervisor assessment that a QIP demands, but it still needs to be systematic. The central question is whether you can show that you identified a gap or problem, took a specific action to address it, and reflected meaningfully on what the outcome was.
Strong QIAs for GP trainees typically involve reviewing your own prescribing against a NICE guideline and making a documented change to your practice, attending a practice meeting about a specific clinical pathway and contributing to improving it, completing a PDSA cycle around a focused process change, or reviewing patient feedback and implementing a concrete response. What does not count as a QIA – regardless of how the entry is framed in the portfolio – is a Learning Event Analysis, a Significant Event Analysis, a general reflection on personal feedback, or a clinical case review in which a systems issue happened to arise. All of these are separate mandatory portfolio requirements.
The Most Common QIP Mistakes GP Trainees Make
The most common mistake is leaving it too late. A QIP in GP training needs at least one full data cycle to produce meaningful baseline and follow-up data. Starting in the last six weeks of a GP post will not give you this, and your supervisor will recognise that the project was rushed.
The second most common mistake is choosing a topic that is too broad. “Improving diabetes care” is not a QIP topic. “Improving the rate of annual diabetic foot reviews in patients with type 2 diabetes at this practice from 62% to 80% by the end of my post” is a QIP topic. The RCGP wants specificity and measurability, and a tightly scoped project almost always produces stronger evidence than a wide-ranging one.
The third is not involving the practice team. The RCGP QIP template explicitly assesses engagement with colleagues. A project completed entirely by one person in isolation will score poorly on that domain regardless of the clinical quality of the work. Talk to your practice manager, your nurses, the reception team, your supervisor. Even presenting your findings at one practice meeting counts as team engagement.
Finally, some GP trainees confuse the annual QIA with the QIP and assume that completing a QIP satisfies the quality improvement requirement for the rest of training. It does not. The year in which you complete your QIP also counts as your QIA for that year, but every other training year still requires its own separate QIA. The RCGP QIP template is also mandatory for the project itself – uploading a written report without the completed template will require resubmission.
How Arora Medical Education can help in GP Training
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Also:
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Author Bio — Dr Aman Arora
Hi! I’m Dr. Aman Arora, a Portfolio GP with over a decade of clinical and teaching experience, dedicated to helping doctors achieve their goals with confidence. Having had the privilege of supporting more than 50,000 doctors worldwide across exams such as MRCGP AKT, SCA, MSRA, PLAB 2 and PLAB 1, I understand the challenges you face and the strategies needed to overcome them. Through personalised face-to-face sessions, engaging online courses, mocks, audio and a vibrant social media community, we’re here to guide you every step of the way.
Whether you’re looking to pass crucial exams or take the next big step in your medical career, we’re here to help you succeed. Feel free to get in touch with any thoughts, questions, or ideas — I look forward to working with you and being part of your journey.
Author Bio — Dr Pooja Arora
Dr Pooja Arora is a GP with a background in Medical Politics, where she passionately focuses on improving the opportunities and working conditions for junior doctors. She is proud to hold FRCGP (Fellow of Royal College of General Practitioners).
You can find out more about Pooja’s previous roles and qualifications here.
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