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Getting it right first time – Prof Tim Briggs

We don’t get a second chance to get it right first time

On March 10, 2016, Professor Tim Briggs, Consultant Orthopaedic Surgeon at the Royal National Orthopaedic Hospital Trust, and National Director of Clinical Quality and Efficiency, spoke to Medical Technology Group members. Here, he explains more about his Getting it right first time (GIRFT) report and how its findings are being used to improve patient outcomes and make significant savings for the NHS.

In 2012, I wrote a report – Getting it right first time: Improving the quality of orthopaedic care within the National Health Service in England – into ways that NHS hospitals in England might be able to make extensive improvements and savings in elective orthopaedics: in brief, to improve patient outcomes and reduce costly hospital bed days.

This was followed by the NHS England and Department of Health’s consequential joint pilot (1) that drilled more deeply into existing practices and outcomes at over 220 hospitals providing orthopaedic services. It reported last March, noting that – despite GIRFT being estimated to have already inspired changes in work practices that have saved the NHS around £60 million to date – clinical offers and patient outcomes still vary widely from Trust to Trust. Moreover, there is a lack of consensus, possibly even confusion, on what constitutes best practice where there is no formal guidance from the National Institute for Health Care Excellence (NICE) or from the BOA (British Orthopaedic Association).

The result is, to give just one example, a huge variation in the infection of hip and knee replacements. The average range lies anywhere between 0.2% and 5% of patients, yet I have seen an example where it was 15% in some Trusts. Surely no-one should find this acceptable? So how can we fix what is so clearly broken?

Firstly, there is nothing we can do about the ageing population. We will only see an increase in demand for orthopaedic interventions. Ever cheaper, more durable, more reliable kit will be required. 3D photocopying has caught the media’s imagination, but its brittle creations are not the answer. Manufacturers need to take a product development lead in robust and fairly priced but still gold standard prosthetic solutions.

Secondly, as a percentage of GDP health spend in the UK is continuing to fall, forcing purchasing decisions to be made by managers based on the up-front unit cost of medical technologies rather than by clinicians on the longer-term efficacy and benefits for positive patient outcomes. A change in attitude from ‘cheapest available’ to ‘best value for money’ – not the same thing – is required.

Finally, we need to address NHS structural issues, starting with appropriate national orthopaedic guidelines for referral and treatment. This will give a single benchmark against which the individual Trusts can measure their performance, and which should naturally lead to the development of specialist orthopaedic units with experts working to quality assured standards and uniform treatment protocols. This will solve the current problem of surgeons undertaking high cost, low volume procedures, as well as partly address the increasing demand and budget challenges too, by standardising and reducing the costs of bought-in technologies as the wider NHS collaborates to bulk buy for its specialist units.

What will work for orthopaedics will also work across other specialisms. I am working with the Department of Health to extend GIRFT learning to ten other clinical areas, with projected savings of more than £5 billion already identified.

(1) NHS England and the Department of Health funded the GIRFT pilot. The project was hosted on behalf of the BOA (British Orthopaedic Association) at the Royal National Orthopaedic Hospital (RNOH) in Stanmore

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