Getting It Right First Time (GIRFT)

16-01-2017

By Paul Carey-Kent, Policy Manager, CIPFA

The NHS Five Year Forward View sets out an ambitious savings target totalling £22m. Delivery of efficiencies on this scale necessitates major transformational themes, not mere cheeseparing. The tools to deliver transformation are emerging, though given their scope, prosecuting delivery won’t be easy in the timescales required. One could point to:

Aim  Programme / tool
Generate better whole system working Integration / Better Care Fund
Minimise demand and choose the right interventions RightCare/ NICE
Ensure interventions carried out in the best way GIRFT
Deliver best value investments
Future Focused Finance – Best Possible Value
Minimise the cost of inputs Carter Review

Within that landscape, Getting It Right First Time (GIRFT) has a major part to play, as Professor Tim Briggs (National Director of Clinical Quality and Efficiency) explained at the annual HFMA Conference in December. His work to date has concentrated on orthopaedics, but its principles are potentially applicable to all procedures. 

Professor Briggs has visited 170 Trusts and spoken to 1,700 surgeons, identifying unacceptable variations in practice costing circa £6bn annually in musculoskeletal services. For example he informed delegates that:

  • the cost of the implants chosen for hip replacements vary from £600 to £5,000 with little justification. Expensive un-cemented prostheses are common in over 65’s – but not needed
  • a significant proportion of back surgery is carried out with minimal evidence of effectiveness
  • too many surgeons do too low a volume of complex cases, eg only one hip replacement per year. Similarly, hospital expertise is too dispersed for best economy or outcomes
  • revision rates vary unacceptably between Trusts
  • the deep infection rate varies from 0.1% to 5%. Professor Briggs pointed out the major distress caused to the patient and increases in costs of up to £100,000 for each case. High rates are linked to a lack of ring-fenced beds
  • there is major variation in the level of theatre productivity: any theatre not capable of undertaking four joint operations per day should be shut, he said
  • litigation claims and settlements have been increasing significantly for preventable errors.

Such variations are driven by a number of factors including insufficient training, consultants’ desire to differentiate themselves, and failure to generate/learn from comparative data. There is scope to improve quality and reduce cost through a series of clinically led actions. 

Early results show that practice is starting to improve in response to his discussions, linked to the presentation of data to all Trusts and the introduction of a national surgery dashboard. The cost of litigation in orthopaedics fell last year after many years of steady growth. 

This area of work is now seen as one of the key planks for the NHS efficiency programme, with the team under Professor Briggs increasing from 8 to over 100, in order to cover a much wider range of 11 surgical specialities.

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