Practice Review

In May 2025 the Medical Council launched a new framework for Professional Competence which has broadened the audit requirement into a practice review requirement which offers a choice of quality improvement, practice evaluation or clinical audit. You can continue to conduct an audit as before, or undertake one of these other types of review instead. You are expected to spend at least 10 hours on a single practice review project each year.

• Clinical audit involves the selection of aspects of the structure, processes and outcomes of care which are then evaluated against explicit criteria. If required, improvements should be implemented at an individual, team or organisation level and then the care re-evaluated to confirm improvements.
• Quality improvement is the defining of a problem, studying the variation within that problem, formulating a goal, and then developing a hypothesis about the potential interventions or changes that might work to achieve this goal. These changes or interventions are then tested on a small scale to verify whether they have achieved the predicted outcome.
• Practice evaluation is a systematic assessment of the performance of individual or a group of registered medical practitioners by members of the same profession or team, or by patients.

Source: Medical Council Guidelines

Yes, we have a number of templates and samples available on our website: see the links on our Resources and Supports page.

If you require further assistance, please Contact Us.

The ePortfolio will ask for the total number of hours (must be at least 10 to meet Medical Council requirements), the type of project, and which of the Eight Domains of Good Professional Practice your project relates to. 

You will need to upload a short summary report outlining all the stages of your project when recording. We have templates for each type of practice review project (audit, quality improvement, practice evaluation) to give you an idea of what kind of information you should include. See the Practice Resources and Templates page or the sections dedicated to each project type. The report can be uploaded in Word or PDF format as you choose. Do not include any identifiable patient information in anything uploaded to the ePortfolio.

The Medical Council requires at least 10 hours spent on Practice Review each year, however, it is not specified that it must be prolonged over the year and depending on the topic chosen could be done over a condensed period (e.g. 3 months). The amount of time spent on Practice Review is self-recorded and regulated at this time.

We advise that you start as early as possible in the PCS year. This is to allow yourself enough time to complete all steps in advance of 30 April.

It depends on the activity chosen but you are required to record at least 10 hours each year in Practice Review activity.

Practice reviews do not have to be clinically focused. The project should reflect your practice of medicine, which means your work, the patients you see or the non-clinical role you are involved in, eg. educator, mentor or board member. If you work part-time in a clinical role and part-time as an educator, you can conduct a practice review on either of these work practices. However, you should ensure that all your practice reviews do not concentrate on one aspect only. Likewise, if you don't see patients at all, then your audit should reflect the work that you are involved in, eg. educator, medico-legal, researcher, etc. Even if you are in full-time clinical practice you can undertake an audit or quality improvement process focusing on your data management processes for example.

The purpose of a practice review is to act as a mechanism for you to reflect on your practice and to document improvements as a result. In an audit, you are asking “Am I doing what I am supposed to be doing?", and therefore it assumes that standards, guidelines or evidence exists. In a quality improvement or practice evaluation, you are asking “Am I doing things the best way possible?” This is in comparison to research which asks "What should we be doing?" and focuses on other doctors’ practice.

Some modules offered by the College or other institutions include a quality improvement or audit project. You are welcome to submit this as your PCS practice review as long as it meets the requirements:

• It must be focused on data/evidence of your own practice of medicine.
• It must represent at least 10 hours of activity.
• It must be completed by the PCS recording deadline, i.e. 30 April.

You can engage in a practice review with other GPs (e.g. other members of your practice, local colleagues) if you wish to do so. In this instance, all GPs taking part in the project should be actively engaged in the process and should fulfil their individual time requirements (10 hours per annum). Each GP should record the project individually to their own ePortfolio. Group projects may present an opportunity to form a local audit group and to have meetings to discuss analysis/results.

Please note that if audit data is leaving the practice or will be published, and therefore is not only being used for internal practice purposes, ethical approval should be obtained.

Doctors who qualify as ‘not engaged in the practice of medicine’ for the purposes of PCS may replace the 10 required Practice Review hours with additional Work-based Learning credits.
You are ‘not engaged in the practice of medicine’ if you are not engaged in any of the following:

• Involved in the act of diagnosing, treating, or managing illnesses and medical conditions, including telemedicine consultations
• Provide medical advice
• Develop and/or deliver medical education
• Prescribe medications
• Perform medical procedures
• Develop and/or implement preventative programmes (e.g. CDM)
• Conduct relevant medical research
• Take any other actions which require medical knowledge and skills

If you qualify as ‘not engaged’ please contact us so we can update your enrolment.

All doctors registered with the Irish Medical Council retain the right to practice medicine and therefore have a legal obligation to maintain competence.

If you do not engage in any of the following activities, you qualify as ‘not engaged in the practice of medicine’ and can replace your 10 required Practice Review hours with additional Work-based Learning credits. You are ‘not engaged in the practice of medicine’ if you are not engaged in any of the following:

• Involved in the act of diagnosing, treating, or managing illnesses and medical conditions, including telemedicine consultations
• Provide medical advice
• Develop and/or deliver medical education
• Prescribe medications
• Perform medical procedures
• Develop and/or implement preventative programmes (e.g. CDM)
• Conduct relevant medical research
• Take any other actions which require medical knowledge and skills

If you do not see patients regularly but you are engaged in one or more of the other activities on this list you are still obligated to conduct a practice review and we recommend taking those activities as a starting point. 

If you do see patients, even if this is only occasionally, you can design the practice review to adapt to your consultations. For example, if you are seeing patients during the flu season, you could complete an audit on the flu vaccination guidelines - you could ask relevant patients as they attend if they have had the flu vaccination during the last flu season (data collection 1), offer the vaccination if relevant (action plan is opportunistic targeting) and record whether or not they had the vaccination during the current flu season (data collection 2/re-audit).

This poses different challenges. In order to overcome the difficulty of having very few patients it may be necessary to undertake a number of re-audit cycles of a number of criteria. You could consider starting with an audit on the management of an acute rather than a chronic illness e.g., antibiotic or analgesic prescribing, management of an acute sore throat etc.

You can design an audit to adapt to your consultations. For example, if you are seeing patients during the flu season, you could complete an audit on the flu vaccination guidelines - you could ask relevant patients as they attend if they have had the flu vaccination during the last flu season (data collection 1), offer the vaccination if relevant (action plan is opportunistic targeting) and record whether or not they had the vaccination during the current flu season (data collection 2/re-audit).

You could also design a Quality Improvement project to apply to some aspect of your individual work, such as record-keeping, safety netting advice, or handover.

Alternatively, you could approach the practice in which you are conducting the locum work and ask them if you can join their audit or have access to conduct your own audit in their practice. In all instances, the relevant confidentiality, ethical and data protection requirements should be adhered to.

Practice Review involves reflection on your practice - whatever that constitutes. In any line of work there are guidelines to how you carry out your work/duties and you can take those guidelines which relate to an aspect of your work, and use them as a starting point. As of 2025, the Medical Council has broadened the annual requirement from clinical audit to Practice Review which encompasses any of the following methodologies: 

• Clinical audit involves the selection of aspects of the structure, processes and outcomes of care which are then evaluated against explicit criteria. If required, improvements should be implemented at an individual, team or organisation level and then the care re-evaluated to confirm improvements.
• Quality improvement is the defining of a problem, studying the variation within that problem, formulating a goal, and then developing a hypothesis about the potential interventions or changes that might work to achieve this goal. These changes or interventions are then tested on a small scale to verify whether they have achieved the predicted outcome.
• Practice evaluation is an assessment of the performance of individual or a group of registered medical practitioners by members of the same profession or team, or by patients.

You are welcome to apply whichever of these methodologies make sense in the context of your work.

Clinical teachers may benefit from the practice evaluation option for practice review, using student and peer teaching evaluations as evidence to improve their teaching. They are also welcome to apply the principles of audit or quality improvement to some aspect of their work as well.

If you have taken 3 or more months of statutory leave in a PCS year you must notify the PCS Team. You will have a reduced PCS requirement, and you will not be expected to make up missing credits or activities in future PCS years. Please get in touch with the dates of your leave at your earliest convenience.

If you have already completed the topics included on our sample audit page, past Audit Prize winners may give you more ideas for potential audits. If there are topics you last audited many years ago consider whether it could be useful to re-audit one of them and see how your practice is doing now.

You might also wish to explore the Quality Improvement or Practice Evaluation options instead. Have a look at the resources on our website for more about these project types: Resources and Supports.

Clinical audit is recognised as having three elements:

1. Measurement - measuring a specific element of clinical practice.
2. Comparison - comparing results with the recognised standard (in circumstances where comparison is possible).
3. Evaluation - reflecting on outcome of audit and changing practice accordingly.

Write and retain a copy of the audit report for each clinical audit you take part in. This is the official record of what was done and as such can be revisited for ongoing review. The re-audit forms an essential part of the audit. After change has been implemented, the practice audit cycle is completed by repeating the process to examine whether the implemented changes were effective or not. 

It is evident that GPs are investing a lot of time and effort into undertaking an audit, sometimes under challenging circumstances or where little opportunity for audit appears to exist. However, we still receive queries about what constitutes an audit. Some key pointers are included below to guide you:

In essence, a clinical audit is a "quality improvement process that seeks to improve the patient care and outcomes through systematic review of care against explicit criteria and the implementation of change".

Clinical audit is recognised as having three elements:

• Measurement – measuring a specific element of clinical practice
• Comparison – comparing results with the recognised standard
• Evaluation – reflecting on outcome of audit and where indicated, changing practice accordingly

It is common that when undertaking an audit, doctors leave out the following key steps so be mindful to include these:

• Comparing your activity against a guideline
• Carrying out a re-audit

Should there come a time that the Medical Council starts requesting copies of the evidence of the CPD activities you record it will be expecting that your audits satisfy the above steps. Please refer to the audit toolkit and sample audits on the PCS webpage, which are there to practically demonstrate the audit cycle.

No specific guidance has been given on this by the Medical Council. However, it is likely that in the event of scrutiny of compliance with the requirements of professional competence, you should be able to demonstrate that you have measured your audit activity against a reasonably up-to-date guideline or protocol.

Given that no specific guidance has been given, it is reasonable to assume (until directed otherwise by the Medical Council) that if the initial audit fulfilled the recommended time requirements in that year, the re-audit could be conducted the following year in full/part fulfilment (depending on size) of that year's requirements. However, it is unlikely that it will be acceptable to continue repeating the same audit each year. Another suggestion is that you have a five-year cycle of audits with each of five audit topics completed once in a five-year cycle.

In some audits, it will be necessary or preferable to include some process elements so these do not have to be excluded; however, the entire audit cannot be based around processes for the purpose of fulfilling your professional competence requirements. For example in an audit of diabetes, review HbA1c levels rather than simply whether a blood test for HbA1c has been taken.

Source: Irish College of GPs Director of Research

When carrying out a clinical audit, it is advisable to check if you are following the audit cycle as set out in each of our samples.

The key elements of a full audit cycle are:

• Initial measurement – measuring a specific element (or elements) of your practice
• Comparison – comparing the results with the recognised standard/guideline
• Evaluation – reflecting on the outcome of the above and where indicated, changing your practice accordingly
• Post-change measurement – re-measure the same element(s) to establish the level of improvement.

There is no minimum or maximum number of patients stipulated, however your sample should include current/recent patients. The purpose of audit is improved patient care through application of recognised standards and ongoing efforts to sustain this change. If you can show that you have considered the clinical management of patients with reference to an agreed standard, you have already conducted an audit. Keep in mind however that the Medical Council requires a minimum of 10 hours spent on a single Project Review each year.

If you can extract data easily from your practice management software system for your audit, it is feasible that you could conduct your audit on all relevant patients (e.g. all with COPD or all with Diabetes etc.), however, if not, you can conduct your audit on a sample of relevant patients. Since you will be basing decisions and changes on the findings of the audit, you should ensure that the sample is of sufficient size and selected in an appropriate manner so that the findings are valid and reliable.

Firstly, you should ensure that this is truly an audit and therefore there is a comparison to an existing guideline (e.g. the methadone treatment guidelines and the LARC protocols) and that criteria have been stated against which practice is being measured.

Audits such as these are externally administered and hence much of the work is taken out of the process for you as the criteria, standard and data collection tool is already created for you. However, when data is leaving the practice for external use/publication, you should ensure that the appropriate ethical approval is in place. The key issues in using these audits for your professional competence requirements are that you must have access to your own data and you must develop an action plan for your practice based on these results, which you implement and then re-audit (the quality improvement activity and re-audit aspects are not always part of such external audits). As these audits are usually quite extensive, you may wish not to consider all of the criteria used in the full external audit in terms of your action plan and re-audit.

This poses different challenges. In order to overcome the difficulty of having very few patients it may be necessary to undertake a number of re-audit cycles of a number of criteria. You could consider starting with an audit on the management of an acute rather than a chronic illness e.g., antibiotic or analgesic prescribing, management of an acute sore throat etc.

You can design the audit to adapt to your consultations. For example, if you are seeing patients during the flu season, you could complete an audit on the flu vaccination guidelines - you could ask relevant patients as they attend if they have had the flu vaccination during the last flu season (data collection 1), offer the vaccination if relevant (action plan is opportunistic targeting) and record whether or not they had the vaccination during the current flu season (data collection 2/re-audit).

Alternatively, you could approach the practice in which you are conducting the locum work and ask them if you can join their audit or have access to conduct your own audit in their practice. In all instances, the relevant confidentiality, ethical and data protection requirements should be adhered to.

Yes. Audit is about improvement. You should be changing or improving things as a result of your audit. After you have implemented your action plan, you should re-audit to review your position in terms of your (new) target.

One of the most common errors when carrying out an audit is omitting to go back and do a re-audit. This is an essential step as part of the audit process. In essence, an audit cannot be considered as complete if the re-audit has not been undertaken. Depending on the nature of your audit, it may not be feasible for you to carry out your re-audit in the same PCS year. In this case it is fine to go back and do it at a later date but it is important that this is done. Audit is about quality improvement so it makes sense to review and check if the changes you have put in place as a result of the audit have been effective. Remember, doing a re-audit does not constitute an audit in itself and hence does not qualify as your audit for the subsequent PCS year.

The audit report or any information requested will not be such that it will compromise patient confidentiality as patients would not be identified in same. However, the records you keep must be capable of substantiating the audit. National data protection requirements will be adhered to during the validation process.

Further information related to confidentiality and data protection issues 

The GPIT group have provided step-by-step instructions on how to carry out an audit using the GP practice management software systems.

You can engage in an audit with other GPs (e.g. other members of your practice, local colleagues) if you wish to do so. In this instance, all GPs taking part in the audit should be actively engaged in the process and should fulfil their individual time requirements (10 hours per annum). Each GP should record the audit individually to their own ePortfolio. Group audits may present an opportunity to form a local audit group and to have meetings to discuss analysis/results.

Please note that if the audit data is leaving the practice or will be published, and therefore is not only being used for internal practice purposes, ethical approval should be obtained.

In response to GP demand, the Irish College of GPs have created sample audits that identify the relevant guidelines, suggest criteria and outline the data as needed. 

Please see the Audit Toolkit (PDF, 1.4MB) which provides step-by-step instructions on carrying out an audit. We also have a number of Sample Audits that can be consulted.

If you have queries in relation to your audit, please Contact Us