Completing clinical audits is a key part of training – often mandatory as part of assessments. We are often approached for guidance on what clinical audits are suitable for a trainee, as well as how to actually do one. This blog aims to answer these questions, as well as simplify the process. It is focused on GP trainees but the principles are appropriate for trainees and doctors in all specialities.

For other blogs focusing on common trainee queries, click here.

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What this Blog Contains

– Clinical Audit Suggestions for Primary Care rotations
– What is a Clinical Audit?
– The Audit cycle
– How to identify a topic
– Key Audit Tips

Our top suggestions for a clinical audit in Primary Care

• Those taking allopurinol – have they had a recent uric acid level check?
• Those taking metformin – have they had a recent GFR check?
• Those taking a statin – have they had a recent LFT check?
  • At 3 months if new start
  • At 12 months if on-going
• Those taking thyroxine – have they had their TFT levels checked annually?
• Those taking DMARDs – have they had appropriate monitoring bloods eg FBC?
• Those taking long-term steroids – do they need bone protection or have they been assessed for osteoporosis?
• Those taking regular NSAIDs – have they been offered/assessed for gastroprotection?
• Those taking ACE inhibitors – have they had recent U&Es checked?
• Those with previous Gestational diabetes – have they had an annual HBA1C check?
• Those taking amiodarone – have they had appropriate monitoring bloods eg TFTs?
• Review your last 10 antibiotic scripts against current guidance.

What is a clinical audit?

According to NHS England’s Website ‘Clinical audit is a way to find out if healthcare is being provided in line with standards’.

In essence it is a Quality Improvement (QIP) Exercise that improves patient care, through systematic review and change.

They can be small scale or large scale, involve one person or many, take a few days or several months.

The Audit cycle

Select criteria

Here you decide your topic or area that you wish to audit and potentially improve
eg I want to see whether our patients who take allopurinol have appropriate serum uric acid checks.

Set standards

Here you define the standard that you wish to measure against. This could be a standard that you decide or it could be a standard set by a National guideline or local protocol.
eg 95% of patients on allopurinol should have their uric acid levels checked in the last 12 months.

Collect and assess date

Here you carry out checks to see how you are currently performing. This could be through manually going through records or through computer-based searches.
eg on assessment 75% of our patients taking allopurinol have had their uric acid checked in the last 12 months.

Compare to standards

Here you compare what you achieved against your desired standard – in essence evaluate your current performance.
eg the 75% achieved falls below the desired standard of 95%.

Reflect, Plan, Implement change

If the result is below the required standard, here a plan is made to improve practice eg:

• Write to all patients who have not had their uric acid check and invite for a blood test.
• Add an on-screen reminder to ask patients to book for a blood test next time they come to the practice.
• Prevent the next allopurinol prescription until a blood test has occurred.

Re-audit

Here a re-assessment is done – for example 6 months after changes are implemented – to see if things have improved. If standards are still not met, further new changes are introduced etc.

How to identify a topic

There are many ways you may choose to identify a topic – and in reality sometimes audit topics are chosen for you in a training post

Often when discussing audits, the topic can be chosen based on one of the following three stages:

1. Structure of care the availability and carrying out of a blood test for particular patients
2. Process of care the waiting times to see a GP
3. The outcome of care the impact of prescribing medications on reducing HbA1C

Remember the basic premises is to assess something that is measurable and can impact patient care.

I’d also suggest to try and choose something that interests you as well. Audits can be time consuming and if it doesn’t interest you in the first place it may well drag on for a while!

If you are still struggling to find a topic have a word with your supervisor or discuss it with the practice manager. I am sure they will have a few suggestions that may help improve the quality of care provided by the practice from an organisational or patient care perspective.

Key Audit Tips

Set deadlines – eg each week I need to have gone through X number of notes, I must have finished this audit by X.

Break into chunks – eg week 1 is criteria and standards, week 2 is data collection, week 3 is change implementation, week 4 is write-up.

Set dedicated time for audit rather that trying to squeeze it in amongst everything else.

Speak to colleagues, TPDs etc – they may have great ideas for either topics or ways to simplify searches etc.

Get them done early – nothing worse than panicking when you realise you need to an audit within a week before a rotation finishes!

Look to get the published – many trainees have created award-winning posters from their audits, often presenting them at National and International Conferences.

How we can help in your Training:

1) Daily AKT and CSA Exam Preparation Emails – join #aroraDaily. Every evening we send you a free exam preparation email – a quick clinical scenario followed by a 60-90 second video with some key learning points. Join and keep your learning ticking over everyday! Plus keep up-to-date with out latest offers.

2) Our National GP Training Support Group – daily teaching and support posts for GP training.  

3) Immersion Day Courses: intense day courses focused on learning through exposure, mistakes and confidence-building. MRCGP CSA, MRCGP AKT, GP Stage 3, PLAB 2

4) Online Academy Courses: focused, syllabus-based online courses designed to cover large amounts of key material. 1, 3 or 6 month subscriptions to match your needs. MRCGP CSA, MRCGP AKT

5) Audiobook Courses: Time-Saving audio based courses allowing you to learn by maximising time eg on commutes, at the gym etc. No expiry, free updates for life as they arise. MRCGP CSA, MRCGP AKT, GP Stage 3, MSRA, PLAB 2, PLAB 1

6) Mock Exams: Full Mock Exams to take at home in exam conditions. Focus on practicing time pressure exams with high yield learning points. MRCGP AKT, MSRA, PLAB 1

And finally…

Audits may or not be part of your training, but they will certainly be part of your career going forward.

Understanding how to do them efficiently early on can save you many hours of unnecessary work.

If you are about to start one, planning each stage well in advance can lead to it being a rewarding and enjoyable process.

Good luck and get in touch if any further help needed!

Dr Pooja Arora

Dr Pooja Arora is a portfolio GP based in Birmingham. She has held local and national roles in her Medico-Political background fighting for GP trainee and GP rights. Her roles have included:

– Vice Chair Birmingham LMC
– BMA council member
– BMA General Practitioners Committee elected representative
– BMA Sessional GP committee elected representative
– BMA National Deputy Policy lead working at scale
– HEE GP ambassador
– HEE GP stage 3 assessor
– RCGP Midland Faculty AiT representative

* Blogs written by Dr Aman and Dr Pooja Arora are not for professional, financial or medical advice. Please seek appropriate professional, legal or financial advice where appropriate *