CPD PDSA guide
A Plan, Do, Study, Act (PDSA) implementation guide for GP practices
A worked PDSA cycle for preparing your practice for the National Lung Cancer Screening Program, identifying eligible patients, building a reliable referral and reminder pathway, and meeting CPD requirements as a whole practice team.
A completed PDSA generates up to 9 hours of CPD across EA, RP and MO categories, applicable to all GPs in the practice. Submitted as a practice-based or group activity, one GP can record the activity for the team.
Structured team quality improvement activities contribute to a positive practice culture and are associated with GP and staff retention.
Systematic smoking history recording and eligibility assessment supports earlier detection of lung cancer, Australia’s leading cause of cancer death.
Integrating screening into routine care builds a recall cohort, supports smoking cessation, and positions the practice as the gateway to the program.
The National Lung Cancer Screening Program (NLCSP) launched on 1 July 2025. It offers free low-dose computed tomography (LDCT) scans to eligible Australians at high risk of lung cancer based on age and smoking history, with the aim of detecting lung cancer at an earlier, more treatable stage.
Lung cancer is Australia’s leading cause of cancer death, accounting for approximately 17% of all cancer fatalities. The five-year survival rate is 27% (AIHW 2017 to 2021 data; 22.7% for men, 33.0% for women), up from under 10% three decades ago but still the lowest among the major cancers. Late-stage presentation is the primary driver of poor outcomes. Smoking is responsible for approximately 90% of lung cancer cases in men and 65% in women in Australia (Cancer Australia).
GPs are the gateway to the NLCSP. Eligibility assessment, referral for LDCT, results management and follow-up all sit with the GP. For most practices, effective participation requires a systematic review of smoking history recording and a recall and reminder system capable of identifying eligible patients.
This PDSA documents one practice’s preparation for program launch. The worked example reflects a cycle conducted February to May 2025, prior to the July 2025 launch date. The clinical knowledge base reflects current program specifications.
Up to 9 hours when submitted as a practice-based or group activity: 3 EA (review of the program specifications, eligibility criteria and the practice knowledge base), 3 RP (reviewing smoking history recording and eligibility identification against practice targets), 3 MO (tracking smoking histories, discussions, eligible patients and reminders across the data collection periods). The RACGP classifies PDSA activities under Measuring Outcomes.
| Category | Focus | Hours |
|---|---|---|
| Educational Activities (EA) | Review of the program specifications, eligibility criteria and the practice knowledge base | 3 |
| Reviewing Performance (RP) | Reviewing smoking history recording and eligibility identification against practice targets | 3 |
| Measuring Outcomes (MO) | Tracking smoking histories, discussions, eligible patients and reminders across the data collection periods | 3 |
| Total | 9 |
GPs must complete 50 hours of CPD annually under the Medical Board of Australia registration standard. This includes at least 12.5 hours of Educational Activities, a minimum of 25 hours combined Reviewing Performance and Measuring Outcomes with at least 5 hours each, and the remaining 15 hours allocated to either as suits scope of practice. The RACGP classifies PDSA activities under Measuring Outcomes. This PDSA may be submitted as a group or practice-based activity.
Grey boxes with a red left border are worked examples drawn directly from Dr Chris Mitchell’s practice. They describe what the practice did, what was measured and what was learned. Off-white boxes with a dashed red border are insert boxes for your own practice. Fill these in as you complete each stage. They become the basis for your CPD submission.
The following worked example documents a practice-based PDSA conducted February to May 2025 in preparation for the NLCSP launch. Individual clinician data has been de-identified. Aggregate figures across the practice are used to illustrate the cycle findings.
The NLCSP launch in July 2025 created an immediate task for practices: identify eligible patients and establish a referral pathway before program demand arrives. For most practices, this required two things: a way to search the clinical database by pack-year history, and a recall and reminder system using a consistent name across all GPs. This PDSA addressed both. It began December 2024, with data collection from February to April 2025, covering 14 GPs over three collection periods.
Three objectives:
Data collected across three periods: Period 1 (10 to 28 February 2025), Period 2 (5 to 21 March 2025), Period 3 (22 March to 29 April 2025). Database searches planned for 10 February, 5 April and 22 April 2025. Practice meetings: 5 December 2024 (planning), 19 December 2024, 13 January 2025, 19 March 2025, 10 April 2025. Data tracked per GP per period: smoking histories updated, program discussed, eligible patients identified, reminders added, enrolled in program.
Practice meetings ran from December 2024 through April 2025. Key actions:
Aggregate results across 14 GPs over three collection periods:
Record your practice data in the table below. Complete this table for each collection period and add rows for each GP in your practice.
| Doctor name | Smoking history updated | Program discussed | Eligible identified | Reminder added | Enrolled |
|---|---|---|---|---|---|
| What worked well? | |
| What did not work as expected? | |
| Barriers identified |
Changes implemented at this practice:
| Changes to implement | |
| Responsible person | |
| Review date |
Effective use of the NLCSP requires reminders that can be searched across the patient database. Core principles:
Lung cancer screening advice:
You are eligible for the program if you:
Once a patient is assessed as eligible:
Eligible patients are current or recent smokers. Integrating smoking cessation into the screening conversation is a practical opportunity to improve outcomes regardless of screening result. Resources for patients:
Local health district tobacco treatment specialists are available in most districts and can provide support for complex cessation cases. Contact your local PHN or LHD health promotion unit for referral options.
Submit this PDSA via the RACGP CPD portal at portal.racgp.org.au/CPD. Select GP-led activity (individual or group) and PDSA as the activity type.
Submit as a group or practice-based activity via the RACGP portal for each of the participating GPs, consider the time committed to each cycle, but submit collated times, averaged across each GP to reduce the administrative burden.
| Doctor’s name | QI and CPD number |
|---|---|
| Resource | Detail |
|---|---|
| NLCSP, DoHAC | health.gov.au/our-work/nlcsp |
| National Cancer Screening Register | ncsr.gov.au |
| NLCSP, for healthcare providers | health.gov.au/our-work/nlcsp/for-healthcare-providers |
| Quitline | 13 7848 |
| My QuitBuddy app | health.gov.au/resources/apps-and-tools/my-quitbuddy-app |
| RACGP HANDI, smoking cessation apps | racgp.org.au/clinical-resources/clinical-guidelines/handi |
| NELSON trial (NEJM 2020) | doi:10.1056/NEJMoa1911793 |
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This section forms part of the Educational Activities (EA) component of your CPD submission. Read it before or alongside the PDSA cycle to build the knowledge base for the program.
All criteria must be met for NLCSP eligibility:
Your healthcare provider will also assess whether the patient can lie flat comfortably for the LDCT scan. This criterion may be temporary for some patients.
A pack-year is calculated by multiplying packs smoked per day by years of smoking. One pack equals 20 cigarettes.
| Example | Calculation | Pack-years |
|---|---|---|
| 1 pack (20 cigarettes) per day for 30 years | 1 × 30 | 30 pack-years |
| 2 packs (40 cigarettes) per day for 15 years | 2 × 15 | 30 pack-years |
| 1 pack per day for 1 year | 1 × 1 | 1 pack-year |
| 2 packs per day for 6 months | 2 × 0.5 | 1 pack-year |
Patients often need help calculating this figure. Recording the number of cigarettes per day and years smoked allows the calculation to be done at the consultation.
| Step | Who | What |
|---|---|---|
| 1 | GP or healthcare provider | Eligibility check: assess age and smoking history |
| 2 | GP | Issue LDCT referral to a registered radiology provider |
| 3 | Patient at radiology | LDCT scan: approximately 10 to 15 minutes, no injections or procedures. Patient lies flat while chest is imaged. |
| 4 | GP with patient | Results: radiologist reviews images and enters results in the NCSR. Results sent to GP and NCSR notifies patient of next steps. |
Follow-up depends on what the scan finds:
| Finding | Next step | MBS item |
|---|---|---|
| Negative, no findings | NCSR sends reminder to patient and GP in 2 years | MBS 57410 at next screen |
| Nodule, monitoring required | Repeat LDCT at 3 or 12 months depending on nodule characteristics | MBS 57413 (mandatory bulk billing) |
| Highly suspicious | GP refers to respiratory physician with lung cancer expertise or appropriate MDT. Conversation involves possible lung cancer requiring prompt specialist assessment. | Standard referral MBS items |
The NLCSP uses volumetric nodule assessment (consistent with the NELSON trial methodology), designed to reduce the false positive rate compared to earlier diameter-based approaches.
The NCSR manages participant records and follow-up reminders for the NLCSP (as well as the National Bowel Cancer Screening Program and National Cervical Screening Program). Participants access their record via myGov. Participants can update personal details, manage participation, update communication preferences, and view screening information. The NCSR sends reminders for next screens and notifies participants of results where no follow-up is required. Patients can choose to remain in the NLCSP but opt out of NCSR communications (such as reminders).
A combination of patch (long-acting) plus a short-acting form (gum, lozenge, inhaler or spray) is more effective than single-agent NRT.
| Comparison | Finding |
|---|---|
| Combination NRT vs single NRT | Combination NRT (patch plus inhaler or lozenge) performed better |
| Varenicline vs single NRT | Varenicline performed better |
| Varenicline vs bupropion | Varenicline performed better |
| Overall ranking | Varenicline at least equal to combination NRT, both above single NRT or bupropion |
The NELSON trial (de Koning et al., New England Journal of Medicine, 2020; doi:10.1056/NEJMoa1911793) is the largest randomised controlled trial of CT-based lung cancer screening. Using volumetric assessment of nodules:
These figures inform the NLCSP’s volumetric approach, which is designed to minimise unnecessary investigation while maintaining sensitivity.
| Indicator | Figure | Source |
|---|---|---|
| Estimated new cases (2025) | Approximately 15,100 | AIHW |
| Five-year survival (all) | 27% (AIHW 2017 to 2021 cohort) | AIHW |
| Five-year survival, men | 22.7% | AIHW |
| Five-year survival, women | 33.0% | AIHW |
| Attributable to smoking, men | Approximately 90% | Cancer Australia |
| Attributable to smoking, women | Approximately 65% | Cancer Australia |
| Deaths prevented (program, annual) | More than 500 once established | DoHAC |
| Category | Minimum annual hours | Notes |
|---|---|---|
| Educational Activities (EA) | 12.5 | Reading, online learning, structured education, knowledge base review |
| Reviewing Performance (RP) | 5 minimum | Part of combined RP and MO minimum of 25 hours |
| Measuring Outcomes (MO) | 5 minimum | RACGP classifies PDSA under MO |
| Total annual requirement | 50 | Remaining RP and MO hours allocated as suits scope of practice |