Update on the GIRFT project and how it relates to orthopaedic procurement issues

1. “Getting it Right First Time” Update on the GIRFT project and how it relates to orthopaedic procurement issues Professor Tim Briggs MBBS (Hons) MD, MCh (Orth) FRCS, FRCS(Ed) Vice President of the BOA Chair of National Clinical Ref Group in Specialist Orthopaedics Chair Federation of Specialist Hospitals

2. Introduction • The ‘Getting it right first time’ (GIRFT) report suggests ways to improve pathways of orthopaedic care, patient experience, outcomes - all with significant cost savings. • The Secretary of State and NHS England have funded a national professional pilot of this approach across England. • This will be a management consultancy service led by senior frontline clinicians and will involve a national review of baseline data and meetings with providers. • Leading to the development of bespoke peer to peer advice regarding the configuration of elective orthopaedic pathways. • Taking close look at procurement is a vital part of this project.

3. Context • The annual budget for musculoskeletal disease is £10 billion • 25% surgical interventions in secondary care are for musculoskeletal disease. • Provision of care accounts for 80% of the cost • Increased referrals of 7- 8% per annum • Ageing population – 15.3M >65yrs by 2031 • Population living longer and expecting to remain active • Increasing BMI – by 2050 60% men and 50% women classified as obese

4. Objectives • To support the following objectives in elective orthopaedic care: • Improved patient experience • Re-empowering clinicians • Improved patient safety • Better outcomes in terms of joint longevity, infection – SSI and acquired, complications, readmissions and mortality • Significant savings for the taxpayer from reduced complications and infections, readmissions, length of stay and litigation; better directed care pathways; reduction in loan kit costs; and the introduction of evidence based procurement and procedure selection.

5. Progress/Process • Funding approved and received. • Project began in May, data collation and analysis is ongoing and we are about commence a first wave of visits. • Final report by April 2014. • Reports to assist service providers, commissioners and clinical senates in improving elective orthopaedics. • The next stage will rely on the participation of providers, commissioners and NHS England • Participation cannot be forced.

6. Data sources • Data accumulation and collation is underway • A comprehensive orthopaedic dashboard will be created for each provider. Data sources include: • NJR (disappointingly not all data is available by provider – e.g. Longevity/revision rate by different prosthesis/weight bearing surface etc) • HES • HSCIC • NHS Comparators • NHS Indicators • Productivity Metrics • PROMS • National data sources – waiting times etc • National Hip Fracture Database • NHS Litigation Authority • NHS Atlas of Variation • Arthritis Research UK Musculoskeletal Calculator

7. Data sets - 1

8. Data sets - 2

9. Data sets - 3

10. National Joint Registry • For all Providers separately for 2011/12 & 2012/13: • Primary and revision procedure number for each of hips, knees and ankles (and shoulders if available): • Split by age band • Split by ASA band. • Primary procedure number and 5-year revision rate –ideally split by the fixture and bearing surface (hips) and fixation, constraint and bearing type (knees) however this is not currently available at provider level • Mortality rates • For all Providers separately for each of 5 years – 2008/09 to 2012/13 • Primary procedure (number only) • Revision procedure (number and rate) • Mortality (rate only) for hips and knees – not currently available at provider level • Compliance, consent and linkability • ODEP 10A compliance – hips and first year of knee data • The outlier metrics – mortality, hip revision rate and knee revision rate • Funnel plots for the three outlier metrics (mortality, hip revision rate and knee revision rate), with outlier Providers identified.

11. Format & purpose of visits • Meetings to review provider report with management, clinical management and clinicians • Validate data – prior to meeting and again at the meeting • Understand local networks – current and planned • Understand the stories behind the data • Clinical Directors to act as ‘hosts’ for each visit

12. Rolling out the project • Review experiences of trial phase and plan next wave of visits • Region by region approach where possible • Seeking a collaborative approach – in early discussions with: Leicester, Southampton, Devon, Bristol and Birmingham/West Midlands

13. The Challenge • Number of providers by NHS Region • North – 42 • Midlands & East – 45 • London – 20 • South – 38 • Total - 145 Meetings will be with Providers and CCGs

14. Reporting • 145 (approx) provider reports – analysis of data, commentary and suggestions for collaboration, service improvement and configuration. • 27 LAT report – compilation of provider reports and a review of the nature, format and quality of provision in this area. • 12 senate region reports – compilation of provider reports and a review of the nature, format and quality of provision in this area. Will make specific comments regarding networks. • 4 NHS England region report • 1 national report for Bruce Keogh and the Secretary of State

15. Next steps • The project is designed to complement the creation of Clinical Senates and the introduction of Specialised Commissioning in its new format. The pilot will support the agendas of both these processes. • Collaborating with CCGs to review the data is the next phase of the project and will begin during this year and, subject to future funding, extend into the next. • We have had interest from providers in Wales and are in the process of seeking funding for a project from the Welsh Government.

16. Benefits • Quality led • Clinically led • Already has “buy-in” from all interested groups • Significant potential for savings in terms of changing the governance around procurement, procedure selection and reducing infection and litigation. • Other specialities keen to do same

17. Thank you