Improving NHS orthopaedic care in England: Evaluation of GIRFT

The Getting It Right First Time programme (GIRFT) aimed to deliver improvements in quality and reductions in the cost of orthopaedic care in England. 

The team looked at data from over 700,000 patients who underwent primary hip or knee replacement surgery at 126 NHS Trusts between April 2009 and March 2018 and interviewed over 50 NHS staff. This mixed methods approach supported a comprehensive analysis of the impacts of GIRFT in orthopaedics from different perspectives and at both national and local levels. This included a statistical analysis of linked national datasets to measure the impact on both processes and outcomes of care, an economic analysis, and qualitative methods to understand staff perceptions of GIRFT’s impact.

Qualitative methods were used to understand the GIRFT approach and the effect of different ‘implementation tools’ intended to promote changes in practice. Quantitative methods were used to examine ‘what works and at what cost?’

The GIRFT approach is currently being rolled out across over 40 other clinical specialities.

They found that there have been some substantial improvements over the past decade. When comparing 2009-2012 and 2015-2018, the number of uncemented hip implants in over 65s was reduced by 29 per cent,  and knee arthroscopy prior to a knee replacement dropped by 58 per cent.

The study also found that mean length of stay reduced by just over one day for both hip and knee patients between 2009-2012 and 2015-2018. Overall, post-operative quality of life and functional status also improved. However, many of the improvements seen began before the GIRFT programme started.