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Quality Improvement Activity

QI/Clinical Audit Activity - September 2018 Update

As you will no doubt be aware, there are now only 10 months to go until the end of the current QI/Clinical Audit Cycle on 31 July 2019. Whilst this might appear to be a long time away, there are some earlier deadlines that we wish to make you aware of.

If you are considering submitting an audit project or peer review project of your own design for review and approval, NES will be able to accept new submissions until 14 December 2018.

If you wish to join one of the national audit projects, you must do so by 31 January 2019.

These dates are the latest possible in this QI/CA cycle which allow for review, approval, projects to be carried out, reports to be submitted and certification to be issued.

Enhanced SEA submissions will be accepted up to 31 July 2019, providing the significant event analysed, occurred no more than six months prior to the project being submitted.

The more detailed update, originally published in June 2018 can be found here.


Quality Improvement activity in Dental Practice is a NHS terms and conditions of service requirement. Most dentists working in the GDS are eligible to claim funding for certified Quality Improvement activity.

All Quality Improvement applications seeking approval from NES are managed through the NES Dental Portal, so the first step is to make sure that you remember to regularly check the email address linked to your Portal account. We recommend that you use your NHS Mail email address for Portal and that you do not use one of the commercial email providers, some of which divert email sent from the NHS into spam or junk folders. To receive email communications about your Quality Improvement application, the Portal requires all participants to enable “marketing emails” in their account. This can be done via “account settings” in the top left toolbar; scroll down to “marketing preferences” and choose this option. Don’t worry, NES will not disclose your email to third parties so you won’t get loads of spam emails. You will only be sent information/reminders about up and coming CPD courses which are run by NES, about Quality Improvement, and about others matters related to NES education and training.

The aim of this site is to provide access for practitioners to the information needed in order to begin, or continue, to use various types of Quality Improvement activity to help them make improvements to their clinical practise.  We would encourage participation in whatever type of Quality Improvement activity is most relevant to each dentist, their team and their practice.

The ideas and topics included in these pages are the tip of an iceberg and are not meant to be prescriptive.  All forms of Quality Improvement activity are of more value if they are based on a real need for improvement, identified in day to day work or as the result of appraisal.


Enhanced Significant Event Analysis (eSEA)

Enhanced SEA is a NES innovation which aims to guide health care teams to apply human factors thinking when performing a significant event analysis, particularly where the event has had an emotional impact on staff involved. Taking this approach will help individual clinicians and teams to openly, honestly and objectively analyse patient safety incidents, particularly more difficult or sensitive safety cases by ‘depersonalising’ the incident and searching for deeper, systems-based reasons for why the significant event happened.

Significant events happen routinely in dental practice, often highlighting areas where improvement could be made in practice systems, however because of a lack of time, commitment, or knowledge, opportunities to correct deficiencies are often missed.  Carrying out an eSEA will help to identify and prioritise the underlying issues which have contributed to the significant event, by encouraging you to undertake a structured analysis of the event.

By undertaking a few eSEAs, you will come to understand the importance and role of eSEA as a non-threatening flexible tool for reflective learning.  The introduction of regular team-based discussion and analysis, will encourage teamwork and lead to improved patient care.



Many dental professionals wish to monitor the quality of certain aspects of their role within the team, such as the

quality of radiographs or record keeping. Whilst these types of projects can be undertaken as an individual and

can be used as a driver in developing personal development plans, there is often more benefit to them being done by the whole practice team.

Projects are expected to be led by dentists but would be of greater benefit to the whole practice if extended to incorporate the entire dental team.  Using this type of QI activity to cover issues relating to clinical governance and best practice would encourage dental team members to develop their individual knowledge and skills further and to become more reflective.



Under the new arrangements for Quality Improvement activity, participation in many of the dental practice-based research projects carried out by the Scottish Dental Practice Based Research Network (SDPBRN), universities and health boards will be eligible for up to five hours QI credit in each three year QI cycle.

Eligible projects will be practice-based and will explore the quality of dental care: including projects that focus on the safety, effectiveness, person-centredness, timeliness, efficiency or equity of dental care.  Dental research QI hours will be administered by SDPBRN via the NHS Education for Scotland (NES) Portal.  More details about these new arrangements are available here.

Further information can be located on the SDPBRN website here.


Other sources of information

Many sources of guidance are available to dental professionals, including:

The evidence based guidance produced by SDCEP is particularly relevant to all who work in Primary Dental Care and is user friendly and regularly updated. 


Peer Review

Peer Review provides an opportunity for groups of dentists to get together to review aspects of practice.  Groups are comprised of between four to eight dentists and there must be at least two different practices involved.  The project can consist of two or three meetings, with a variety of different topics being considered.  The meetings should take place with the practices of those involved in the group.


QI project projects

Quality Improvement methodology will be new to most dental teams. Knowledge and skills in QI methodology are essential before a project can be undertaken. The Model for Improvement works best when variations in practice have been identified across an aspect of care. Quality Improvement methodology is about making small changes, checking that the change has worked and there is evidence of sustainable continuous improvement. This includes collecting small amounts of data at regular intervals over a period of time. Identifying changes that will improve patient care will need input from all members of the team to enable application and sustainability.

NHS Education for Scotland, along with Healthcare Improvement Scotland, intend to provide QI educational options for dental teams in the future. Completion of some essential learning will be required before being able to access and undertake an introductory QI project that has already been used in pilot practices across Scotland.

As dental teams gain more experience and understanding of how QI can work for the benefit of patients and practices, they will become competent to undertake QI projects of their own. Please check the NES Dental website for future updates about QI in Dental Practice.


NES's role in supporting Quality Improvement Activity

The following list, agreed with the Scottish Government Health and Social Care Directorate summarises NES’s roles and responsibilities:

  1. NES will continue to receive and process submissions from GDPs and PDS dentists seeking approval for Quality Improvement projects and upon receipt of satisfactory final reports, provide certification.  In the case of GDPs this will allow them to claim QI Allowance. N.B. PDS Dentists are not eligible for QIA.
  2. NES will continue to receive and certify satisfactory Enhanced Significant Event Analysis reports.
  3. NES will collate data on Quality Improvement activity at an individual GDP and PDS dentist level.
  4. NES will provide reports on the collated Quality Improvement activity to Health Boards so that they can check compliance with the requirements set out in the Terms and Conditions of Service.
  5. NES will provide information on how to undertake Quality Improvement projects via its website.
  6. NES will, from time to time, and as demand requires, provide CPD courses on Quality Improvement.
  7. NES will, from time to time, publish National audit projects, normally in relation to national priorities such as Infection Control and Decontamination, Radiological Compliance, Record Keeping including Medical Histories etc which Dentists are able to join and complete.

It should be noted that while NES intends to deal with Quality Improvement reports in strict confidence, please be aware that where there are overwhelming clinical or ethical reasons to do so, NES may be obliged to take further action which may include sharing information with relevant professional bodies. This action may include the processing of reports and supporting documentation using plagiarism checking software.