Patient Safety and Quality of Care

Delivering safe, high-quality care is at the core of every general practitioner’s role. As a GP, you are uniquely positioned to influence not only the health outcomes of your patients but also the standards of care within your practice and the wider healthcare system. This chapter explores how patient safety and quality improvement are fundamental to effective general practice, and how these principles can be embedded in everyday clinical work. Through reflective practice, collaboration with patients and colleagues, and the use of structured tools and frameworks, you can contribute to a culture of continuous improvement. Central to this is listening to patients; their experiences, insights, and expectations are vital to shaping services that are responsive, effective, and safe. As you progress through training and into independent practice, developing a deep understanding of patient safety and quality of care will not only enhance your clinical effectiveness but also strengthen your role as a leader in healthcare improvement. 

• PS1: Identify common causes of harm in healthcare settings and recognize differences between hospital and general practice environments.
• PS2: Understand and apply quality healthcare standards, clinical guidelines, and referral protocols, with reference to HIQA’s National Standards for Safer, Better Healthcare and the National Referral Guidelines.
• PS3: Maintain high-quality medical notes to enhance patient care, data integrity, and clinical decision-making.
• PS4: Demonstrate an understanding of the importance of continuing professional development (CPD) in maintaining and enhancing clinical competence, supporting patient safety, and contributing to a culture of continuous quality improvement in general practice.
• PS5: Consider patient safety through both person-based and systems-based approaches, fostering a culture of safety and collaboration with relevant organizations.
• PS6: Demonstrate competence in handling adverse events, including open disclosure, clear communication, empathy, and patient support, in line with the Medical Council Guide to Professional Conduct and Ethics.
• PS7: Manage and analyse adverse events and near misses through structured reflection and critical analysis, identifying contributory factors and implementing corrective actions to reduce the risk of recurrence.
• PS8: Implement effective medication safety practices, including adverse drug reaction reporting and safe prescribing.
• PS9: Develop and apply safety-netting strategies, ensuring patients receive appropriate follow-up and risk communication in consultations.
• PS10: Outline strategies for quality improvement, including evaluating systems, analysing metrics, involving patients, and implementing strategies to enhance the quality of care.
• PS11: Consider methods for obtaining and utilizing patient feedback to improve care quality and enhance patient experience.
• PS12: Appraise how technology can enhance patient safety, including call/recall systems, electronic booking systems, and other digital tools.
• PS13: Consider the impact of human factors on patient safety and performance including workload, environmental factors, stress and fatigue on healthcare professionals and develop strategies for maintaining well-being and safe performance.
• PS14: Promote a culture of safety and accountability by addressing performance issues and fostering high professional standards within the practice team.
• PS15: Demonstrate competency in initiating medicines with a clear explanation of indication, expected benefits, risks, and alternatives, including quantifying and communicating benefits and harms—particularly for preventive therapies—to support shared decision-making.
• PS16: Conduct structured medication reviews that assess effectiveness, risks, and patient factors such as adherence and treatment burden, and demonstrate the ability to de-prescribe safely where appropriate, including the prevention and management of adverse drug withdrawal effects.
• PS17: Recognise prescribing cascades, particularly in older adults with multi-morbidity and polypharmacy, where new symptoms the possibility of adverse drug reactions should be considered before initiating additional medicines.
• PS 18 Demonstrate competency in delivering evidence-informed, person-centred care that balances potential benefits, harms, and treatment burden in clinical decision-making. 
• PS 19 Identify and avoid low-value investigations, treatments, and referrals, particularly where they offer minimal benefit or risk causing harm, burden, or over-medicalisation. 
• PS 20 Apply shared decision-making skills to communicate uncertainty, risks, and expected outcomes in a clear and meaningful way, supporting patients to make informed choices aligned with their values and goals. 
• PS 21 Demonstrate the ability to recognise rare, serious, or high-risk conditions, identify red-flag presentations, and make timely, appropriate referrals to ensure safe patient care.

Wherever possible learning resources included here are peer reviewed and externally maintained. This is to ensure that trainees have access to quality assured information that is kept up to date.

Self-Directed

HSE Quality Improvement Guide

RCPI QI Learning Hub

AAFP Quality Improvement

BMJ Clinical Update

Irish College of GPs Clinical Audit Tools

Medisec Fact Sheets

MPS Factsheets

Blended Learning Resources (Education Platform)

Introduction to Audit and Quality Improvement Methodologies in General Practice

IPC and Antimicrobial Prescribing

Workplace Based Learning

Learning about patient safety and quality of care in the workplace is most effective when it is integrated into everyday clinical practice. This can be achieved through active participation in clinical audits, significant event analyses, and quality improvement projects. Observing and reflecting on how your team responds to safety incidents, near misses, or feedback from patients provides valuable insight into systems-based thinking and risk management. Regular discussions with your trainer and practice team about safety protocols, prescribing habits, communication strategies, and patient feedback help build a strong foundation for understanding and applying quality improvement principles. Engaging in multidisciplinary meetings and contributing to practice development initiatives further enhances your ability to identify areas for improvement and implement practical solutions, fostering a culture of safety and continuous learning.

Day Release

Learning about patient safety and quality of care during day release sessions provides a unique opportunity to step back from the busy clinical environment and reflect on experiences in a supportive, peer-led setting. These sessions allow trainees to share real-life cases, discuss challenges, and explore different approaches to improving care in their practices. Structured teaching on topics such as clinical audit, significant event analysis, and quality improvement methods can be reinforced through group activities and discussions. Hearing how others have applied safety and quality principles in their own settings helps to build confidence and stimulate new ideas. Importantly, day release encourages a culture of openness, reflection, and collaboration - all key components in developing a strong understanding of patient safety and delivering high-quality care.

Registrar Tutorials

Registrar tutorials offer a focused and personalised environment to deepen your understanding of patient safety and quality of care. These sessions provide protected time to explore real cases in detail, with guidance from an experienced GP who can offer insights into both clinical decision-making and system-based thinking. Topics such as significant event analysis, communication errors, and risk management can be tailored to your learning needs and linked directly to situations you've encountered in practice. Through reflective discussion, you can identify what went well, what could be improved, and how to apply these lessons in future care. Registrar tutorials also create a safe space to explore complex or sensitive issues, helping to build both clinical confidence and a proactive mindset around continuous quality improvement.

Assessment – How this area of practice may be examined

Audit / Quality Improvement / Research Project

https://www.irishcollegeofgps.ie/Home/Lifelong-Learning-PCS/Professional-Competence-Scheme/Frequently-Asked-Questions/Clinical-Audit/TabPath/318
https://www.irishcollegeofgps.ie/Home/Lifelong-Learning-PCS/Research/TabPath/142
https://www.icgpeducation.ie/course/view.php?id=334
https://www2.healthservice.hse.ie/organisation/qps-improvement/quality-improvement-guide-and-toolkit/
https://assets.hse.ie/media/documents/HSE_Quality_Improvement_Guide_and_Toolkit_2024.pdf

Entrustable Professional Activities (EPAs) underpin workplace-based assessment in this curriculum. Each EPA represents an integrated clinical task that General Practitioners must perform safely and independently, assessed through direct or indirect observation in real clinical settings.

The curriculum and EPA framework are closely aligned: the curriculum defines the required knowledge, skills, and professional behaviours, while EPAs assess their application in practice. Together, they create a coherent approach to developing and demonstrating readiness for independent clinical work.

The examples show how specific activities within general practice & chapters of the curriculum align with particular EPAs.

EPA 13: Patient Advocacy

Supporting a patient who has experienced harm, ensuring they feel heard, and clearly explaining the next steps exemplify professional advocacy and compassionate care. This approach reflects EPA 13, demonstrating the GP’s role in safeguarding patient welfare and promoting trust within the doctor–patient relationship.

Core Knowledge Test (CKT)

• Choosing the most appropriate immediate action after discovering a missed abnormal X-ray result.
• Selecting the best open disclosure approach following a medication error that did not result in harm.
• Identifying the most effective system change to prevent recurrence of a near miss in prescribing. 

Clinical Competency Test (CCT)

• A patient has an abnormal blood test on file but is unaware of this result when you see them, implications for the patient, the practice and others.
• A patient develops a rash following the prescription of a new medication.
• A medication error leads to an adverse patient outcome, the patient is in to discuss.

Disclaimer: The examples provided within this section are intended to be indicative only and are included to illustrate how elements of the curriculum may be assessed in the Clinical Competency Test (CCT).

Examination questions in the CCT test the ability of candidates to integrate knowledge, skills, and professional behaviours across multiple curriculum areas to address the challenges posed by the question.

The indicative content should therefore be used solely as a general guide as to some of the topics that may be introduced. Actual examination questions will assess a greater depth and complexity of understanding than the illustrative examples provided.

Please note that a number of CCT questions will require candidates to undertake a physical examination of the simulated patient. In some circumstances, for example in the case of an intimate examination, candidates may be required to display their examination skills through use of a manikin or other device.