Objective: The aim of this study was to develop a comprehensive framework of quality improvement competencies for use in continuing professional development (CPD) and continuing medical education (CME) for European general practice/family medicine physicians (GPs/FDs). Methods: The study was carried out in three phases: literature review, consensus development panels, and Delphi technique. An initial competencies framework was developed from an extensive literature review focusing on literature in English from 2000 to 2011 and addressing quality improvement competencies for general practitioners in continuous education programs. Two rounds of reviews by consensus development panels were undertaken to evaluate and make changes to the initial draft competency framework. Then two rounds of Delphi surveys were carried out in an effort to reach consensus on the domains and competencies included in the framework. Our goal was for 90% to 100% consensus. Both surveys were presented through SurveyMonkey, an online survey service, and sent by e-mail to members of the European Association for Quality and Patient Safety in General Practice/Family Medicine (EQuiP), a network organization of Wonca Europe. Results: The Quality Improvement Competencies Framework was developed. It consists of a list of 35 competencies organized into the following domains: Patient Care & Safety, Effectiveness & Efficiency, Equity & Ethical Practice, Methods & Tools, Leadership & Management, and Continuing Professional Education. Conclusion: We believe that the framework can serve as a useful tool for identifying gaps in knowledge and skills and guiding the development of CPD and CME curricula for GPs/FDs not only in Europe but also in other regions, including the United States and Canada, on the assumption that many of the core tasks of quality improvement would be relevant across multiple contexts. (Contains 1 table and 1 figure.)