Domain 2:

Safety and Quality

For Domain 2, Core Elements B (Quality Improvement Activities) and C (Significant Events) - are required for every appraisal.

Core Element B:  Quality Improvement Activity (required every appraisal)

You are asked to provide details of a Quality Improvement Activity (QIA) each year, unless it is a year in which you undertook Multi-Source Feedback (MSF) or a Patient Survey.

Examples of this include:


Audit as a sessional doctor is often harder because you may need to undertake all the design, data collection and analysis yourself. Topics are more limited because you may not have access to the same group of patients to do a second audit cycle.

However, you may be in a longer term locum - or be able to choose a topic that involves immediately necessary care - and the templates in the main toolkit will be suitable.

Also remember that you need to be one of the doctors involved in the activity being audited, but not necessarily to perform the data collection or analysis - as long as you can learn and have the potential to change what you do.

Also consider:

  • Emergency equipment/drugs check list
  • Audit your use of investigations
  • Management plan proforma: as for prescribing, perhaps including other aspects of management


As a sessional doctor you probably won't have a cipher number. It may still be possible to be involved in practice-based prescribing work, however. For example:

  • Auditing the practice computer to compare your prescribing with others in the practice
  • Taking part in implementing a new prescribing guideline and providing an account of what you did and how you changed your practice
  • A review of 50 acute prescriptions: antibiotics or analgesics are suggested as suitable topics
  • Management plan proforma: this focuses your use of a prescribing protocol or guideline with a single patient
  • Case report proforma: this allows you to reflect on a patient who presents a difficult prescribing problem
  • Implementation at a personal level of a guideline or formulary

Out Of Hours work

If you undertake any OOH work, you will find addtional worked examples to cover prescribing, audit and referals in the OOH toolkit.


As a sessional doctor you will usually be able to review the quality of your referral letters, and the templates for review of content and efficiency of letters will be of some help. The increasing use of electronic referral may reduce the value of reviewing some aspects of the contents template.

You may find it more difficult to review the effectiveness of your referrals. You will need to get access to the patient records possibly three months or more after the referral has taken place - it is worth discussing this with the employing practice at the time to make sure this will be possible.

Also consider:

  • Referral letters (1): review of ten referrals - referral rate, reasons for referral, potential alternatives
  • Referral letters (2): review of the outcome from five referrals

Core Element C:  Significant Events (required every appraisal)

You are asked to provide an average of two accounts of SEA annually over the five year cycle.

The SEA process is a method of reflective learning which can be used to analyse incidents where patients are unintentionally harmed - or could have been - as part of the care process. The SEA process can also be used to analyse examples of high quality care.

Ideally SEA meetings should involve all those who had a role in the event. If at all possible you should ask any practice where you have worked whether you can attend their SEA meeting if there has been an event that involves you.

If this is not possible, an alternative would be to discuss the event with a group of your peers - for example a small study group. Although this may still be valuable, it runs the risk of missing vital information from some of the others involved in the event.

If you are not able to take part in a small study group, you could still write up an event of personal significance, present it as a reflective study, and discuss it with your appraiser.

SEA including Child Protection

This really DOES require working with somebody else, but if all else fails you might use a case report proforma.

This is an important part of any doctor's work, and the Child Protection section in the main toolkit encourages you to ensure your training is up to date and to reflect on any child protection cases that you come across. You could write up an anonymised discussion on one of these as a case review, but clearly you will need input from the practice team members involved.

This page was last updated on: 18/08/2016