Before the first complaint: first response review as a practical governance teaching method in GP speciality training

Clinical governance is taught during GP training, but practical exposure is uneven. A trainee may complete learning event analyses without ever receiving a complaint or being shown what to do immediately after a serious concern is raised. This Teaching Exchange describes First Response Review, a 30- to 45-minute tutorial method developed through routine one-to-one supervision. The trainer uses one anonymised closed case or a short composite scenario and asks the trainee to work across four lanes: patient, process, record and practitioner. Each lane is considered across three clocks: now, today and next. Six steps structure the conversation: separate fact from allegation, identify continuing risk, name every relevant pathway, assign ownership, protect communication and documentation, and locate support. A Complaint-Harm Grid helps trainees understand that complaints and patient harm are related but separate dimensions of care; either may occur without the other, and responses may run in parallel. The exercise is formative, not an investigation, significant event analysis or legal rehearsal. It requires one printed page and knowledge of local routes. First Response Review offers a simple way to teach governance as actions before a trainee has to learn it during a real complaint in independent practice.