Practice review is the PCS category in which you review evidence about your own practice and plan improvements. If you practise medicine, you need one clinical audit, quality improvement or practice evaluation project of at least 10 hours each scheme year. Good examples include a prescribing audit with re-audit, a handover improvement project, a structured significant event review or a patient feedback survey you act on.
Key points
- Since 1 May 2025, practice review has replaced the old audit requirement; quality improvement and practice evaluation now count too.
- The 10 hours sit within your 50. Each category has its own minimum, so surplus hours elsewhere will not cover a missing practice review.
- Expect one substantial project, not ten loose hours: ICGP wants 10 hours on a single project, and RCPI records a project as 10 credits.
- Significant event reviews, complaint reviews, multisource feedback and patient surveys are on the Council's list, with operator conditions attached.
- Data alone is not enough: you need a standard or goal, analysis, a change and a re-check.
- Keep patient-identifiable information out of everything you upload.
What counts as practice review for the Medical Council PCS?
The Medical Council (Maintenance of Professional Competence) Rules 2025, S.I. No. 176 of 2025, came into operation on 1 May 2025. They require at least 50 hours of CPD each scheme year (1 May to 30 April) and define an hour as "sixty consecutive minutes" of CPD activity. The Rules do not name practice review; the category comes from the Council's May 2025 Guidelines and information booklet.
The Council's booklet describes practice review as reviewing "evidence relating to their practice" and planning improvements. Doctors engaged in the practice of medicine "must undertake a clinical audit, quality improvement, or practice evaluation project to review and enhance practice": one activity of at least 10 hours.
Clinical or practice audit
A clinically led quality improvement process: review care against explicit criteria, change what falls short, then re-evaluate.
Quality improvement
Define a problem, study its variation, set a goal and test changes on a small scale, for example in PDSA cycles.
Practice evaluation
A systematic assessment of a doctor's or group's performance by peers, team members or patients.
The Guidelines' indicative list adds review of critical incidents and significant events, review of compliments and complaints, practice visits, performance appraisal, multisource (360) feedback, structured feedback from colleagues, patients or students, and patient satisfaction surveys. The list is "not exhaustive", and training bodies may expand or modify it, so your own scheme's rules decide the detail.
If you are not engaged in the practice of medicine
Only doctors who practise medicine must complete the 10 hours. If you declared at retention that you will not practise in Ireland, you need at least 25 hours from a mix of practice review and work-based learning instead. If unsure, ask your scheme operator. Our guide to work-based learning credits explains that category in detail.
For all four categories and the domain rule, see our Medical Council CPD requirements page, and our guide to the eight domains of good professional practice shows how one audit or QI project can be tagged to several domains.
One 10-hour project or several activities? How scheme operators differ
All operators apply the same 10-hour minimum but record it differently, which matters when you wonder whether something small, such as one M&M presentation, is enough. If you are not sure which operator's rules apply to you, our guide to PCS enrolment and choosing your scheme operator matches roles to schemes.
| Operator | How the 10 hours are framed | Notable rules |
|---|---|---|
| Irish College of GPs | "At least 10 hours on a single practice review project each year." Upload a short summary report and tag the domains. | A re-audit alone is not an audit. Group projects count if each GP takes part actively and records the project individually. A course-based project counts only if it uses your own practice data, involves at least 10 hours and is finished by 30 April. |
| RCSI | 10 credits within the 50, collected in the relevant PCS year. | Data collected without formal comparison to published standards is not clinical audit. A 360 review with reflection may count once in every three-year cycle. Some RCSI templates need sign-off by the clinical director or head of department. |
| RCPI | Recording a practice review project in the ePortfolio earns 10 CPD credits. | In MyCPD you pick the Practice Review (Audit) category, then one practice review type. Specialty example lists are published. |
| College of Anaesthesiologists | At least 10 hours per year. Guidance posted in 2026 also says at least one activity should involve review against an external standard. | Passive attendance at M&M or audit meetings does not ordinarily qualify; presenting or contributing to the action plan can. Patient feedback and MSF need a validated instrument. Audits need a verification form. |
A note on the anaesthesiology documents
The College's 2026 documents are marked "Version 2.0, Consultation Draft", so check with the College before relying on any single detail.
The rules of the scheme you are enrolled on are the ones that apply.
Choosing a method: audit, quality improvement or practice evaluation
Start with a real question; it points to the method.
| If your question is… | Use | What you will need |
|---|---|---|
| "Am I meeting a published standard?" | Clinical audit | A standard, explicit criteria, a representative sample, re-audit |
| "This process keeps going wrong. Can we fix it?" | Quality improvement | An aim, a measure, small tests of change, data on improvement |
| "How do patients or colleagues experience my care?" | Practice evaluation | A structured (often validated) tool and a documented response |
| "What did we learn from what went wrong?" | Significant event review, framed as practice evaluation or QI | A structured method, an action plan, follow-up |
Two tests help. Is there a written standard to measure against? If not, a QI project is more honest than an audit with invented criteria. And can you collect enough data in the time you have? For part-time and locum GPs, ICGP suggests an acute condition rather than a chronic disease.
Name the method, and ideally the topic, in your Professional Development Plan; our PCS development plan guide covers that step.
Planning your first audit or QI project?Our course Quality Improvement and Clinical Audit (3 hours estimated learning time) covers designing an audit, analysing the quality gap, running PDSA cycles and re-auditing. It teaches the method; it is not a practice review itself.
See what's coveredPractice review examples: 25 audit and QI project ideas
These ideas draw on examples published by the Medical Council, ICGP, RCSI, RCPI and the College of Anaesthesiologists. Each has a credit note. The standard you use must be current and fit your scope, and your operator decides whether a project qualifies.
A Clinical audit
1. Antibiotic prescribing for acute sore throat
Compare prescribing with the current guideline, feed back, re-audit.
Credit note: ICGP names acute-condition audits as suitable for part-time and locum GPs.
2. Flu vaccination of eligible patients
Check eligible patients you see, offer the vaccine, re-measure.
Credit note: an ICGP example built around routine consultations.
3. HbA1c outcomes in diabetes reviews
Audit results against target, not just whether tests were done.
Credit note: ICGP says a process measure can be included, but an audit cannot be built only around processes.
4. VTE prophylaxis adherence
Measure admission risk assessment and prophylaxis against hospital policy.
Credit note: an RCSI example. Present the results at department level, as RCSI expects.
5. Pre-operative fasting documentation
Audit fasting instructions and times against a published guideline.
Credit note: the CAI worked example, which the College says is not a template to copy word for word.
6. Consent documentation for procedures
Check records for documented risks and alternatives against your consent policy.
Credit note: an audit only if the policy gives explicit criteria.
7. Taking part in a national audit
Contribute to a national programme and act on your unit's report.
Credit note: ICGP needs active engagement; RCSI says a local abstract may suffice.
B Quality improvement
8. Safety-netting advice
Test a safety-netting prompt in PDSA cycles and measure each one.
Credit note: ICGP lists safety-netting as a QI focus on your own work.
9. Structured clinical handover
Introduce a handover tool on one ward and measure omissions before and after.
Credit note: QI needs a measure and a demonstrable result, not just a new form.
10. Waiting list assignment
Map referral triage and test changes that cut delays for urgent cases.
Credit note: an RCSI example of a practice review topic.
11. Test result follow-up
Track time from result to action and test a workflow change.
Credit note: suits QI where no single written standard sets the timeframe.
12. Confidentiality in virtual clinics
Review identity checks and privacy in remote consultations, then improve them.
Credit note: RCSI cites patient confidentiality in telemedicine outpatients as an example.
C Significant event and incident review
13. Structured review of a near miss
Analyse a near miss with a structured method and agree actions.
Credit note: on the Medical Council list. CAI accepts it when the method and analysis are documented.
14. Aggregate review of minor incidents
Review a year of low-harm medication incidents together for patterns.
Credit note: mirrors the HSE's aggregate review level for minor incidents.
15. M&M case with an action plan
Present a case and lead the agreed actions to completion.
Credit note: at CAI, active presentation or action-plan work can count; passive attendance may count as work-based learning instead.
16. Audit triggered by an M&M signal
Where M&M suggests a cluster, such as wound infections, audit the rate.
Credit note: RCSI gives this as an example of M&M highlighting an audit topic.
D Patient, colleague and student feedback
17. Patient satisfaction survey
Survey a patient group, change one thing, repeat the survey.
Credit note: CAI wants a validated instrument, a benchmark and a documented QI response.
18. Multisource (360) feedback
Collect colleague and staff feedback, reflect and act on one need.
Credit note: RCSI allows a 360 review with reflection once in every three-year cycle.
19. Twelve months of complaints and compliments
Categorise each one, look for trends and agree changes.
Credit note: CAI accepts this where categorisation is systematic and trends are analysed.
20. Student and trainee evaluations
Use teaching evaluations as evidence to change how you teach.
Credit note: an ICGP idea for clinical teachers. RCSI also lists teaching style as an example.
21. Colleague observation of consent discussions
A colleague observes with a structured tool; you act on the findings.
Credit note: "structured feedback from colleagues" is on the Medical Council list.
E Practice evaluation and non-clinical roles
22. Peer practice visit or appraisal
Act on the development points a structured visit or appraisal raises.
Credit note: both appear on the Medical Council's indicative list.
23. Your outcomes compared with peers
Compare an outcome with departmental, peer or national data.
Credit note: on the RCPI and Medical Council lists of audit-type activity.
24. Quality of medico-legal reports
Audit a sample of reports against a content checklist.
Credit note: RCSI's guidance includes a medico-legal audit template.
25. Data management processes
Review data handling in your role and test improvements.
Credit note: ICGP suggests this focus for GPs in non-clinical roles.
Sources for the idea bank: and the documents cited above.
Picking a topic from what patients complain about
The HSE's Your Service Your Say report for 2024 recorded 16,400 new complaints across HSE and voluntary services, up 11% on 2023. A complaint can fall under more than one category.
These figures cover all health services, not doctors alone, but they are a useful prompt. The Council's Guide also sets measurable duties, such as accurate, up-to-date records (paragraph 38.1) and never altering clinical notes (paragraph 38.2). A records audit built on those duties pairs well with our course on clinical documentation for healthcare professionals.
| Theme | Possible project | Method |
|---|---|---|
| Communication and information | Survey on how well results and next steps were explained, repeated after a change | Practice evaluation |
| Records | Audit of a sample of your notes against your local record-keeping standard | Clinical audit |
| Consent | Colleague observation of consent discussions, plus a documentation audit | Practice evaluation and audit |
| Safe and effective care | Structured review of incidents in one area, followed by a targeted audit | Significant event review and audit |
If the theme is communication, our Effective Communication for Healthcare Professionals course can support the learning around such a project.
Using a significant event review as your practice review
The Guide asks doctors to report an incident, learn from it and take part in any review (paragraph 2.2). A significant event review can meet your practice review minimum if it is structured and leads to action. The College of Anaesthesiologists accepts critical incident and significant event reviews that use "a structured audit methodology with documented analysis".
In HSE services, the Incident Management Framework 2020 sets review levels by harm: a comprehensive review for Category 1, a concise review (which may use an after action review) for Category 2, and an aggregate review for Category 3.
Choose the event and confirm your role
Pick one you were involved in, without cutting across any formal employer review.
Gather the facts, not the blame
Build a timeline from records and accounts, without patient identifiers.
Analyse contributory factors
Look at task, team, environment and organisation as well as individual decisions.
Agree specific actions
Give each action an owner and a date; prefer system changes over "be more careful".
Check the actions worked
Re-measure the change. This turns a discussion into practice review.
Write the summary and reflect
Record, in general terms, what you learned, what changed and how you know.
A hypothetical consultant physician finds an abnormal outpatient result was not acted on for three weeks. A structured review finds results went to a shared inbox with no leave cover. The team routes results to a named clinician with cover, and two months later she audits 40 consecutive abnormal results for time to action. Her ePortfolio summary contains no patient details.
Our Root Cause Analysis course covers finding contributory factors, avoiding hindsight bias and writing strong safety actions using HSE systems analysis.
How a 10-hour audit adds up: a worked hour log
The HSE National Centre for Clinical Audit's 2025 practical guide describes seven stages: select topic; set criteria and standards; design the audit tool and collect data; analyse data and compare results with standards; write the clinical audit report; QI plan and action; and re-audit. Logging time against them shows the 10 hours are real.
| Stage | What was done | Hours |
|---|---|---|
| 1. Select topic | Reviewed prescribing data; agreed topic with team | 1.0 |
| 2. Criteria and standards | Wrote three measurable criteria from the current guideline | 1.5 |
| 3. Tool and data collection | Built a data sheet and reviewed 50 consecutive consultations | 3.0 |
| 4. Analysis | Compared results with the targets and identified the main gaps | 1.0 |
| 5. Report | Wrote a two-page summary with no patient identifiers | 1.0 |
| 6. QI plan and action | Presented to the team and agreed changes | 1.0 |
| 7. Re-audit | Same method, 50 new consultations, four months later | 1.5 |
| Total | 10.0 | |
The HSE guide says re-audit must use the same method and standards, follow the changes, and happen within a maximum of 12 months of the changes being recommended; if all standards were met first time, re-audit is not required. The CAI draft suggests a typical interval of 6 to 18 months. Where they differ, follow your operator and explain your timing. ICGP's recording deadline is 30 April.
Patient data, ethics and the Patient Safety Act
The Guide says that clinical audit, quality assurance, education and training are essential, and that patient information used for them should be anonymised or coded where possible before it is shared outside the healthcare team (paragraph 28.3). ICGP says not to include identifiable patient information in anything uploaded to the ePortfolio.
What the HSE audit guide says
- Ethical review is not required for clinical audit, but ethical issues should still be screened.
- Complete a DPIA risk threshold assessment first.
- Collection tools must not capture identifiable data; never use personal email.
What ICGP adds for GPs
- Ethical approval is needed if data leave the practice or will be published.
- Upload a summary report only, with no identifiable information.
Part 6 of the Patient Safety (Notifiable Incidents and Open Disclosure) Act 2023 protects clinical audits whose data are collected solely to improve patient safety and quality, collected and analysed by the provider or practitioner, published in aggregated form and used for improvement. Under section 61, information from such an audit is not an admission of professional misconduct or poor professional performance by a practitioner, and cannot be used as evidence of them in related complaint or disciplinary proceedings. The Act, apart from section 68, came into operation on 26 September 2024.
The protection is no reason to skip anonymisation; for a specific legal concern, talk to your medical defence organisation.
Why practice review projects fall short
| Problem | Why it falls short | Fix |
|---|---|---|
| Data collected but never compared with a standard | RCSI says this is not clinical audit | Name the guideline and criteria before you collect data |
| Submitting only a re-audit | ICGP says a re-audit alone is not an audit | Record the full cycle, including the first measurement and the change |
| Sitting in on M&M or audit meetings | At CAI, passive attendance does not ordinarily qualify as practice review | Present, analyse or own an action, or log attendance as work-based learning |
| The same audit every year | ICGP says this is unlikely to be acceptable | Rotate topics and domains over several years |
| Relying on surplus hours elsewhere | Each category has its own minimum | Treat practice review as a fixed 10-hour block |
If the year is ending and your practice review is not done, contact your scheme operator before 30 April. Our article on PCS non-compliance and exemptions explains what happens when requirements are not met. Keep the summary, data tool and action plan for the six years the Rules require; the Council may audit compliance for up to five years after a scheme year ends.
Planning this year's PCS practice review: a checklist
For the 2026/27 year, ending 30 April 2027:
For a structured overview of how practice review fits with your PDP and the rest of the 50 hours, our Medical Council Practice Review and PDP course covers the cycle. Like any course, it supports your project rather than counting as one, and the same applies across our online CPD courses for doctors and other health professionals.
Courses that build your audit and improvement skills
Online learning on the methods behind a good practice review. Courses support your project; they do not replace it.
- Medical Council Practice Review and PDP3 hrs est. learning · plan your 50-hour PCS year and pick audit, QI or practice evaluationSee what's covered
- Quality Improvement and Clinical Audit3 hrs est. learning · design an audit, run PDSA cycles and re-auditCourse details
- Root Cause Analysis3 hrs est. learning · contributory factors and strong safety actions using HSE systems analysisCourse details
- Clinical Incident Reporting2 hrs est. learning · report on NIMS, write factual reports and apply open disclosureExplore this course
- Effective Communication for Healthcare Professionals3 hrs est. learning · patient-centred communication and an improvement planExplore this course
Check with your scheme operator whether and how learning can be recorded in your ePortfolio.
Frequently asked questions
Does a significant event analysis count as practice review?
It can. Review of critical incidents and significant events is on the Medical Council's indicative list of practice review activities. Operators add conditions: the College of Anaesthesiologists, for example, expects a structured method, documented analysis and an action plan.
Can the 10 practice review hours be split across several activities?
It depends on your scheme. The Medical Council describes one practice review activity of at least 10 hours. ICGP expects at least 10 hours on a single project, and RCPI records a practice review project as 10 credits. The College of Anaesthesiologists' 2026 guidance talks about a range of activities. Check your own operator's rules before planning several small pieces.
Can a group or departmental audit count for everyone involved?
Usually, yes, if each doctor takes an active part. ICGP accepts group and national audits where each GP is actively engaged, meets the 10-hour requirement and records the project individually.
Does a re-audit on its own count as my practice review?
Not at ICGP, which states that doing a re-audit does not constitute an audit in itself. Record the full cycle: the first measurement against a standard, the change you made and the re-measurement. The HSE audit guide says re-audit should use the same method and standards and take place within a maximum of 12 months of the changes being recommended.
I work part-time or as a locum. What practice review can I do?
ICGP suggests auditing an acute condition, such as antibiotic prescribing or sore throat management, building an audit around your own consultations (for example, flu vaccination of eligible patients), or joining an audit run by the practice where you work.
Do I need ethics approval for a clinical audit?
The HSE National Centre for Clinical Audit says ethical review is not required for clinical audit, although ethical issues should still be considered and a data protection threshold assessment completed. ICGP advises GPs that ethical approval is needed if data leave the practice or will be published. Follow your employer's governance process.
Can an online course count as my PCS practice review?
Only if the course includes a real project on your own practice. ICGP says a course audit or quality improvement project can count if it uses data from your own practice, involves at least 10 hours and is completed by 30 April. A course that teaches audit or QI methods, including ours, is not a practice review in itself.
Official sources used in this guide (24)
- Government of Ireland (Irish Statute Book), S.I. No. 176 of 2025: Medical Council (Maintenance of Professional Competence) Rules 2025 (2025)
- Medical Council, Maintenance of Professional Competence Guidelines (May 2025)
- Medical Council, Updates to annual CPD requirements under the Maintenance of Professional Competence Framework: information booklet for doctors (May 2025)
- Medical Council, Key differences between current and new MPC Framework (2025)
- Irish College of GPs, Practice Review FAQs: part-time, locum and non-clinical roles (2025)
- Medical Council, Guide to Professional Conduct and Ethics for Registered Medical Practitioners, 9th edition (2024)
- Irish College of GPs, Practice Review FAQs (2025)
- Irish College of GPs, CPD Requirements and Categories (2025)
- RCSI, Your PCS requirements (2025)
- RCSI Professional Competence Scheme, Practice Review (April 2025)
- RCPI Help Centre, What is Practice Review (accessed 2026)
- RCPI Help Centre, Example Practice Review Activities (accessed 2026)
- RCPI Help Centre, MyCPD: How to record your Practice Review (accessed 2026)
- College of Anaesthesiologists of Ireland, Professional Competence Requirements (2026/27)
- College of Anaesthesiologists of Ireland, Professional Competence FAQs (accessed 2026)
- College of Anaesthesiologists of Ireland, PCS Practice Review and Work-Based Learning Guidance, v2.0 consultation draft (posted 2026)
- College of Anaesthesiologists of Ireland, Standards for Acceptable Clinical Audit Activity within the PCS, v2.0 consultation draft (posted 2026)
- HSE National Centre for Clinical Audit, Clinical Audit: A Practical Guide, version 3 (May 2025)
- HSE National Centre for Clinical Audit, Clinical audit toolkit (accessed 2026)
- HSE, Incident Management Framework (2020)
- HSE, Your Service Your Say: Managing Feedback within the Health Services, 2024 activity report (2025)
- Law Reform Commission, Revised Acts: Patient Safety (Notifiable Incidents and Open Disclosure) Act 2023, section 59 (revised)
- Law Reform Commission, Revised Acts: Patient Safety (Notifiable Incidents and Open Disclosure) Act 2023, section 61 (revised)
- Government of Ireland (Irish Statute Book), S.I. No. 482 of 2024: Patient Safety Act 2023 (Commencement) Order 2024 (2024)
Checked against the official sources above in October 2026. Rules and fees change, so confirm current requirements with your regulator or scheme.