🛠️ 101 QIA/QIP Ideas for GP Registrars

    

So, you’ve got a QIA or QIP on your to-do list but don’t know where to start. Don’t worry, we’ve got you covered.

Whether you’re ST1 looking for a quick QIA or ST3 aiming to lead a more ambitious improvement project, the ideas below are designed to be:

✅ Relevant to real GP work
✅ Simple to get started
✅ Flexible enough for either QIA or QIP routes

Let’s dive into 101 ideas to inspire your next project. 

Even if you don’t find the perfect project, it should give you an idea or at least a bit of inspiration to come up with another..

            

📋 How to Use This List

• Each idea in this list can be completed as either a 
  • Quality Improvement Activity (QIA) - typically a one-off review, or reflective project
  • or a Quality Improvement Project (QIP), which involves a more structured process with data collection, stakeholder engagement, planned interventions, and re-audit.
• 🔁 QIAs are often quicker and less formal; a useful way to demonstrate engagement with improvement.
• 🔧 QIPs are more in-depth and must be completed in a primary care placement as part of your GP training requirements.
• Pick one that suits your practice context, interests, or recent clinical experiences.
• Don’t forget to discuss with your supervisor early on = they may help you access EMIS searches, engage the team, or refine your aim.

    

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🌿 Prescribing, Safety & Monitoring

1. Asthma Reviews
   Audit how many patients are overdue their asthma check. Implement a recall strategy to book them in. Re-measure.
2. Review of Inhaler Prescriptions for Greener Alternatives
   Assess MDI vs DPI use and switch where appropriate in line with low-carbon, green prescribing.
3. Improving eGFR Monitoring in Patients on ACEi/ARBs
   Check 6–12 monthly renal function monitoring and introduce system flags/pop-ups or recall processes.
4. Optimising Statin Prescribing in Secondary Prevention Patients
   Find patients with IHD/stroke/PVD not on high-intensity statins and encourage appropriate prescribing.
5. Review of Gabapentinoid Prescribing Against Local Policy
   Identify patients on pregabalin/gabapentin and assess whether continued prescribing is justified.
6. Reducing Benzodiazepine Prescribing in Long-Term Users
   Audit long-term use, identify patients will to taper, trial deprescribing protocols.
7. Appropriate Prescribing of PPIs
   Identify patients on PPIs without clear indications and consider step-down or stop trials.
8. Reviewing Aspirin Use in Patients Over 75 Years Old
   Audit co-prescription of PPI for gastroprotection and trial pop-ups or template warnings.
9. Review of Antibiotics for Sinusitis Against CKS Guidelines
   Audit antibiotic use vs guideline-recommended nasal steroids/douching and run an awareness campaign to reduce antimicrobial resistance. 

      

🩺 Chronic Disease Management

1. Assessment of QRISK3 Recording in Cardiovascular Risk Management
   Measure how many patients 50+ have a QRISK3 in the last 5 years; trial batch-coding or prompts.
2. Promoting Weight Recording in Annual Reviews
   Audit BMI documentation in LTC templates and increase via staff training and pop-ups.
3. Improving Blood Pressure Control in Hypertensive Patients Under 80
   Identify patients above target and trial medication intensification or HBPM engagement.
4. Improving Assessment of Frailty Using eFI and Rockwood Scale
   Audit frailty coding in >65s and improve use through MDT training or template nudges.
5. Improving Asthma Control Reviews by Using ACT Score
   Audit use of ACT scores and encourage consistent completion during reviews.
6. Improving Annual Review Completion in Asthma Patients
   Audit completeness of coded reviews (e.g. technique, ACT, action plan) and trial a checklist.
7. Monitoring Frequency of Spirometry in COPD Patients
   Check how many patients had spirometry in the last 2 years and address any scheduling gaps.
8. Optimising Management of Gout with Uric Acid Monitoring
   Audit if patients with recurrent gout are having urate levels monitored and treated accordingly with allopurinol. 
9. Monitoring of HbA1c in Patients on Atypical Antipsychotics
   Review metabolic screening in patients on olanzapine/risperidone/quetiapine.
10. Improving Monitoring of Liver Function in Statin-Treated Patients
    Ensure patients starting statins get a 3-month and 12-month LFT check as per NICE. 
11. Improving Statin Prescribing 
    Ensure patients starting statins get a 3-lipid recheck - did they reach the 40% reduction in non-HDL target? If not, was treatment intensified as per NICE?

     

🧬 Screening & Preventive Health

1. Improving Uptake of NHS Health Checks in Eligible Patients
   Find patients aged 40–74 not coded as declined/received and test text/phone invites.
2. Increasing Uptake of Cervical Smear Tests in Non-Attenders
   Trial different invitation strategies (SMS/letters/phone calls) to increase screening uptake.
3. Improving Shingles Vaccine Uptake in Eligible Cohort
   Audit patients aged 70–79 and implement recall or opportunistic vaccination.
4. Improving Compliance with PSA Monitoring in Men with LUTS on Finasteride
   Check whether new baseline PSA + annual PSA is being done as per NICE; create a recurring task/reminder system.
5. Improving Detection of Anaemia in Men Over 60
   Audit if abnormal Hb is followed up with appropriate investigations (e.g. FIT, iron studies).
6. Improving Childhood Immunisation Uptake Before School Entry
   Identify under-vaccinated 3–5-year-olds and pilot recall, education or opportunistic offering.
7. Reviewing Compliance with T2DM Foot and Eye Screening
   Identify DNAs and test whether recall processes are robust and equitable.
8. Ensuring Annual ECG in Patients with Diabetes Over 65
   Audit how many older patients with diabetes have an ECG code in the past 12 months.
9. Improving Screening for Postnatal Depression at 6–8 Week Checks
   Audit PHQ-9/Edinburgh scale use and improve prompts in mother and baby 6-week checks.

    

🧠 Coding & Long term conditions 

1. Improving Recording of Alcohol Intake Using AUDIT-C
   Audit how often alcohol is quantified using a structured tool (not just “drinks occasionally”) and encourage AUDIT-C use in reviews.
2. Improving Documentation of Smoking Status in Medical Records
   Identify patients without a coded smoking status and opportunistically update this during any contact.
3. Improving Coding of Palliative Patients for Better Care Planning
   Audit the completeness of coding for palliative patients and encourage anticipatory care planning and DNACPR discussions.
4. Ensuring Weight Recording Prior to DOAC Initiation
   Audit whether patient weight is coded before apixaban/rivaroxaban prescriptions, to ensure safe dosing.
5. Improving Identification and Management of Vitamin D Deficiency in Care Home Residents
   Audit care home residents on vitamin D supplements and assess compliance with bone health guidelines.
6. Improving Use of Emergency Asthma Plans in Children
   Audit personalised asthma action plan documentation and standardise use across asthma reviews.
7. Improving Contraceptive Counselling in Women Over 40
   Identify women aged 40+ on COCP or with contraception needs and ensure annual counselling is documented.
8. Improving STI Screening in Under-25s Attending for Contraception
   Audit how often STI screening is offered at contraceptive consultations and increase opportunistic testing.
9. Optimising Emergency Contraception Access and Follow-Up
   Audit how often emergency contraception is followed up with longer-term contraception planning.

      

🗂️ Templates, Admin Systems & Safety Netting

1. Enhancing Safety Netting Advice Recording in Consultations
   Audit documentation of safety netting advice and introduce a coded template or consultation checklist.
2. Reviewing Quality of MSK Physio Referrals
   Audit MSK referrals for inclusion of red flags, conservative measures, and duration of symptoms.
3. Reviewing Documentation of Social History in LTC Reviews
   Check how often social factors (carer status, employment, housing, etc.) are included in reviews.
4. Improving Documentation of Driving Advice in Chronic Conditions
   Audit consultations where DVLA guidance should be given (e.g. epilepsy, syncope) and standardise prompts.
5. Ensuring Medication Review Post-Hospital Discharge
   Audit how quickly discharge meds are reviewed in primary care and introduce admin process improvements.
6. Improving Follow-Up of Raised LFTs
   Check whether patients with ALT >60 or abnormal LFTs have been followed up or appropriately investigated.
7. Monitoring of Patients on Methotrexate in Line with Shared Care Protocols
   Audit whether patients have timely FBC, U+Es, and LFTs, and act on gaps via tasking or templates.
8. Improving Follow-Up of Positive Coeliac Serology
   Audit patients with raised TTG or EMA and assess whether gastro referral or repeat testing occurred.
9. Reviewing Management of Acne in Adolescents
   Audit long-term antibiotic use and assess whether topical treatments were offered first.
10. Improving Follow-Up of Patients Discharged from Secondary Care
    Check whether actions from discharge summaries are completed within 14 days - and improve the admin system if not.

       

❤️ Women’s Health, HRT, Pregnancy & Menopause

1. Improving HRT Safety Monitoring (BP, BMI, breast check)
   Audit whether patients on HRT have annual safety checks and implement template prompts.
2. Ensuring Timely Cervical Screening Following Pregnancy
   Audit postnatal patients who missed smears during pregnancy and establish a robust follow-up protocol.
3. Improving Pre-Conception Advice in Women with Epilepsy
   Check how often folic acid and risks are discussed with women of childbearing age on antiepileptics.
4. Reviewing Management of Heavy Menstrual Bleeding Before Referral
   Audit if treatments like tranexamic/mefenamic acid or LNG-IUS are tried before gynaecology referral.
5. Improving Management of Perimenopausal Symptoms
   Audit documentation of menopause symptoms and assess access to information, HRT, or specialist advice.
6. Improving Detection of Postnatal Depression at 6–8 Week Checks
   Audit how often the PHQ-9 or Whooley questions are asked — and improve 6-week baby templates.
7. Improving Proactive Thyroxine Dose Adjustment in Pregnancy
   Check how many pregnant patients on levothyroxine had their dose increased promptly after confirmation.
8. Optimising Contraception Use in Postnatal Women
   Audit contraception offered within 6–12 weeks postpartum and whether this is documented.
9. Improving Screening for Gestational Diabetes in Future Pregnancies
   Audit whether patients with previous GDM are flagged for early OGTT in subsequent pregnancies.
10. Improving Coding and Recall of Women with PCOS
    Ensure women with PCOS have appropriate diagnosis coding and annual reviews for metabolic risk.

      

🧩 Learning Disability, SMI & Health Inequalities

1. Ensuring Accurate Coding of Learning Disabilities
   Audit patients with LD mentioned in free text only and apply correct SNOMED coding for inclusion in annual health checks.
2. Improving Annual Health Checks in Patients with Severe Mental Illness (SMI)
   Audit completion rates and components (weight, BP, bloods, lifestyle) and engage clinicians with standardised reviews.
3. Improving Documentation of Reasonable Adjustments for Patients with LD
   Audit what reasonable adjustments (longer appt, quiet room, easy-read info) are documented for LD patients.
4. Improving Access and Awareness of Social Prescribing Services
   Audit how many patients are referred and increase use through posters, staff prompts, or EMIS pop-ups.
5. Improving Identification and Support for Young Carers
   Audit coding and documentation of patients aged 16–25 who are carers, and increase registration/signposting.
6. Reviewing Missed Appointments in Mental Health Patients
   Audit DNA rates in patients with SMI or depression and implement flexible appointment or follow-up approaches.
7. Improving Detection and Management of Post-Stroke Depression
   Identify stroke patients not screened for low mood and use PHQ-9 during post-stroke reviews.
8. Improving Screening for Hearing Loss in Older Adults
   Audit how often hearing loss is documented in LTC reviews and trial opportunistic audiology referrals.
9. Improving Detection and Monitoring of Anaemia in Women of Reproductive Age
   Audit ferritin checks in women with fatigue, menorrhagia, or hair loss, and improve follow-up consistency.
10. Improving Patient Access to Online Services for Housebound Patients
    Audit how many housebound patients are set up for online repeat prescriptions or proxy access, and trial training/carer engagement.

      

🧪 Cancer, Screening & Acute Presentations

1. Reviewing Delays in 2WW Referrals for Cancer Symptoms
   Audit time from first documented red flag to referral, identify delays, and improve admin or clinician pathways.
2. Improving Safety Netting in Patients with Red Flag Symptoms
   Audit how often red flag symptoms are clearly safety-netted and use templates to ensure follow-up is booked.
3. Optimising Use of FIT Testing in Low-Risk GI Symptoms
   Audit patients with vague abdominal symptoms or anaemia and check if FIT testing was considered before referral.
4. Improving Recording of Family History of Cancer
   Audit free-text entries that mention family history of breast, bowel, or ovarian cancer and code appropriately to support screening.
5. Improving Follow-Up of Patients with Non-Diabetic Hyperglycaemia
   Ensure patients with HbA1c 42–47 are coded correctly, and that annual recall and lifestyle advice are in place.
6. Ensuring Prompt Investigation of Raised Platelets
   Audit how many patients with persistently raised platelets had further workup or reactive causes documented.
7. Reviewing Monitoring of Patients on Testosterone Therapy
   Audit men prescribed testosterone and assess whether haematocrit and PSA are checked regularly per guidelines.
8. Improving Identification of Anaemia in Men Over 60
   Audit whether men with low Hb are having appropriate investigations such as FIT or endoscopy referrals.
9. Improving Recording of Travel Vaccination Histories
   Audit how often travel vaccines (typhoid, hepatitis A/B etc.) are recorded using structured codes.
10. Improving Diagnosis of Coeliac Disease in IBS Patients
    Audit whether patients with IBS symptoms had TTG testing as per NICE guidelines.

      

💉 Immunisations & Long-Term Conditions

1. Improving Shingles Vaccine Uptake in Eligible Patients
   Audit patients aged 70–79 and trial better recall systems or opportunistic offers.
2. Improving Pertussis Vaccination in Pregnancy
   Review uptake rates and pilot better reminders, midwife involvement, or weekend vaccine clinics.
3. Improving Childhood Immunisation Rates Before School Entry
   Identify under-vaccinated 3–5-year-olds and run a catch-up campaign or flag in reception/admin notes.
4. Improving Influenza Vaccine Uptake in At-Risk Adults Under 65
   Audit uptake in chronic disease patients aged 18–64 and trial different methods (texts, calls, clinician reminders).
5. Improving Influenza Vaccine Uptake in Children Aged 2–3
   Audit vaccine uptake and identify missed opportunities during consultations.
6. Ensuring Pneumococcal Vaccination in At-Risk Groups
   Audit patients with chronic lung, heart, liver or kidney disease, diabetes, or asplenia — and offer vaccination if overdue.
7. Monitoring for Hepatitis B Immunity in Healthcare Workers
   Audit whether patients with a coded occupation as HCW have completed their hepatitis B series and titres.
8. Improving Recall for HPV Vaccination Catch-Up
   Audit patients aged 16–25 who may have missed their school-based HPV vaccine and offer catch-up.
9. Reviewing Vaccine Uptake in Recently Arrived Refugees/Asylum Seekers
   Audit coded patients from overseas and assess vaccine history, offering catch-up where needed.
10. Ensuring B12 Injections are Appropriately Indicated
    Audit how many patients on long-term B12 injections have had IF antibodies or alternative causes explored.

      

📋 Prescribing, Medication Safety & Monitoring

1. Rationalising Routine LFT Requests in Statin Users
   Audit whether stable patients are having more frequent LFTs than NICE recommends and improve prescribing confidence.
2. Improving Monitoring of Antipsychotic Prescribing in Primary Care
   Audit patients on olanzapine, risperidone, or quetiapine for metabolic and ECG monitoring.
3. Optimising Bisphosphonate Prescribing in Osteoporosis
   Audit which patients with confirmed osteoporosis are not yet on bisphosphonates and offer treatment.
4. Improving Blood Pressure Control in Patients with Hypertension
   Identify patients not meeting QOF targets and trial nurse-led review or intensification clinics.
5. Improving Use of Home Blood Pressure Monitoring (HBPM)
   Audit how often HBPM is offered or recorded and incorporate into templates for long-term condition reviews.
6. Reviewing Polypharmacy in Elderly Patients on >10 Meds
   Audit patients over 75 on 10+ drugs and trial pharmacist-led or structured GP reviews.
7. Optimising Gabapentinoid and Opioid Co-Prescribing
   Audit patients on both gabapentin/pregabalin and opioids — assess risks, alternatives, and tapering options.
8. Improving Monitoring of SSRIs Prescribed Long-Term
   Audit patients on SSRIs for over 12 months and review annual monitoring and effectiveness.
9. Improving Use of ‘Sick Day Rules’ for High-Risk Medications
   Audit whether patients on ACEi/ARBs or diuretics are given guidance about stopping during illness.
10. Improving Controlled Drug Prescribing Oversight
    Audit patients on Schedule 2/3 drugs and check that review intervals, quantities, and monitoring align with guidance.

      

🚑 Acute Illness, Referrals & Clinical Safety

1. Improving Post-COVID Follow-Up for Patients with Long-Term Symptoms
   Audit how many patients with ongoing breathlessness, fatigue or mental health issues were followed up after COVID.
2. Ensuring ECGs are Coded Correctly in EMIS
   Audit how often ECGs are written in free text instead of using the structured code — fix for audit and QOF tracking.
3. Improving ECG Monitoring in Patients Over 65 with Diabetes
   Audit if annual ECGs are being offered to older patients with diabetes to detect silent ischaemia or AF.
4. Improving Early Diagnosis of Atrial Fibrillation via Opportunistic Pulse Checks
   Run a flu clinic or health check QI project where pulses are checked in those over 65, with ECG follow-up for any irregularities.
5. Improving Assessment of Frailty Using eFI and Rockwood Score
   Audit which over-65s have a frailty score recorded and integrate this into chronic disease templates.
6. Improving Timely Action of Hospital Blood Results or Letters
   Audit how often abnormal hospital results are actioned within 5 days and improve tasking/tracking workflow.
7. Optimising Use of Out-of-Hours/Extended Hours Appointments
   Audit uptake of extended access appointments and address barriers to booking, e.g. awareness or telephone systems.
8. Reviewing Access for Housebound Patients to Face-to-Face Reviews
   Audit how many housebound patients have not had a face-to-face contact in the last year and consider home visit QI pathway.
9. Improving GP Response to Abnormal Screening Letters (e.g. Bowel Screening DNA)
   Audit if DNAs or abnormal results from NHS screening programmes prompt GP follow-up or contact.
10. Improving Consistency of Triage Documentation in Duty Clinics
    Audit telephone triage records for safety netting, red flag screening, and consistent templates.

      

🧭 Patient Access, Health Literacy & Equity

1. Improving GP Website Navigation for Common Tasks
   Audit how easy it is for patients to request prescriptions, book appointments or see services — then improve clarity or layout.
2. Improving SMS Communication for Patients with Learning Disabilities
   Audit how many patients with LD receive standard SMS messages, and implement easy-read or carer contact pathways.
3. Increasing Awareness of Interpreter Services Among Staff
   Audit how often language barriers are documented and whether interpreters are offered or used.
4. Improving Access to Video Consultations in Patients with Hearing Impairment
   Audit how many patients with hearing impairment have access to appropriate consultation formats.
5. Improving Uptake of Online Prescription Services in Vulnerable Groups
   Audit patients on regular repeat meds who still use paper requests, and support them to register for online access.
6. Reviewing Telephone Access and Missed Callbacks
   Audit how many patients had missed callbacks or phone consultations — and trial improvements in booking or alerting systems.
7. Improving Continuity of Care in High-Attending Patients
   Audit patients with >12 consultations in 6 months and trial continuity models or personalised care plans.
8. Improving Equity of Access to Routine Appointments by Time of Day
   Audit appointment use by time and employment status to identify if working-age adults are under-served.
9. Improving Health Literacy Resources on the Practice Website
   Audit if your website links to appropriate resources (e.g. EasyRead, NHS Choices, YouTube explainers) and add them if not.
10. Improving New Patient Registration Packets for Health Promotion
    Audit if new registrants get information about online services, cancer screening, social prescribing — and redesign if needed.