Guidance on supporting information for appraisal and revalidation

Your supporting information – significant events and serious incidents

The purpose of collecting and reflecting on significant events and serious incidents

  • To allow you to review and improve the quality of your professional work.

  • To identify any patterns in the types of significant events and serious incidents recorded about your practice and consider what further learning and development actions you have implemented, or plan to implement to prevent such events happening again.

The GMC’s requirements

  1. You must declare and reflect on every significant event and significant incident you were involved in since your last appraisal.

  2. Your discussion at appraisal should focus on those significant events or serious incidents that led to a change in your practice or demonstrate your insight and learning. You must be able to explain to your appraiser, if asked, why you have chosen these events or incidents.

  3. Your reflection and discussion should focus on the insight and learning from the event or incident, rather than the facts or the number you have recorded.

What is a significant event or serious incident?

61 For the purposes of this guidance a significant event is any unintended or unexpected event, which could or did lead to harm of one or more patients. This includes incidents which did not cause harm but could have done, or where the event should have been prevented.

62 We recognise that your organisation may use a different term for these events (for example, serious untoward incident or serious incident requiring investigation) or they may have defined the term more broadly to include learning events other than those that resulted in harm.[6] For the purpose of meeting our requirements under this heading, you should focus on your learning from any events and incidents that have or could have harmed your patients.

63 Significant events and serious incidents should be collected routinely by your employer where you are directly employed by an organisation. Many organisations (including hospitals and general practices) have formal processes in place for logging and responding to all such events. If you are self-employed you should make note of any such events or incidents and review them.

Participating in significant event and serious incident reviews

64 All healthcare professionals have a duty of candour – a professional responsibility to be honest with patients when things go wrong. As a doctor you must be open and honest with patients, colleagues and your employers. The professional duty of candour guidance makes clear the need for honesty with patients after healthcare harm, and the importance of contributing to a learning culture to improve patient safety and make sure lessons are learned.

65 As a doctor you have a responsibility under the duty of candour to log incidents and events according to the reporting process within your organisation. Discussion at appraisal should include your participation in logging any incidents or events, and your participation in any clinical governance meetings where incidents or events and learning are discussed.

Reflecting on significant events and serious incidents

66 You should be able to show to your appraiser that you are aware of any patterns in the types of incidents or events recorded about your practice. You should discuss the action you have taken and any changes made to your practice to prevent such events or incidents happening again. Areas for further learning and development should be reflected in your personal development plan and CPD.

67 It is the insight and learning from the significant event or serious incident, rather than the facts or the number you have recorded, which should be the focus of your reflection and discussion at appraisal.

68 The numbers of significant events or serious incidents may vary across different specialties. If you have not been involved in any significant events or serious incidents you must declare this fact. You should either reflect on your local significant event or serious incident process or what you have been doing well to mitigate the risk of an event or incident occurring.

(6) For example NHS England Serious Incident Framework. In general practice, significant event analysis has included learning from events that did not meet the harm threshold and therefore such learning event analysis is usually considered as a form of quality improvement activity.