Presentation on theme: "“Getting it Right First Time”"— Presentation transcript:
1“Getting it Right First Time” Update on the GIRFT project and how it relates to orthopaedic procurement issuesProfessor Tim Briggs MBBS (Hons) MD, MCh (Orth) FRCS, FRCS(Ed)Vice President of the BOAChair of National Clinical Ref Group in Specialist OrthopaedicsChair Federation of Specialist Hospitals
2IntroductionThe ‘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.
3Context 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 costIncreased referrals of 7- 8% per annumAgeing population – 15.3M >65yrs by 2031Population living longer and expecting to remain activeIncreasing BMI – by % men and 50% women classified as obese
4ObjectivesTo support the following objectives in elective orthopaedic care:Improved patient experienceRe-empowering cliniciansImproved patient safetyBetter outcomes in terms of joint longevity, infection – SSI and acquired, complications, readmissions and mortalitySignificant 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.
5Progress/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 EnglandParticipation cannot be forced.
6Data 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)HESHSCICNHS ComparatorsNHS IndicatorsProductivity MetricsPROMSNational data sources – waiting times etcNational Hip Fracture DatabaseNHS Litigation AuthorityNHS Atlas of VariationArthritis Research UK Musculoskeletal Calculator
7Data sets - 1 National metrics specific to Trauma and Orthopaedics National metrics specific to proceduresAdmitted referral to treatment - Average wait (weeks)Admitted referral to treatment - Percentage within 18 weeksPre-procedure bed days - ElectiveProcedures not carried out - Ordinary electiveAverage length of stay - ElectiveNumber of T&O OP attendancesNumber of T&O Elective admissionsRatio of OP attendances to Elective admissionsNumber of surgical claims - orthopaedicValue of surgical damages paid - orthopaedicNumber of Hip replacement proceduresNumber of Knee replacement proceduresNumber of Hip replacement procedures per 1,000 populationNumber of Knee replacement procedures per 1,000 populationNumber of Revisional hip replacement procedures per 1,000 populationEmergency re-admission in 28 days following hip replacementHip - Adjusted average healthcare gain - EQ-5D VAS casemix adjustedHip - Adjusted average healthcare gain - Oxford Hip score casemix adjustedKnee - Adjusted average healthcare gain - EQ-5D VAS casemix adjustedKnee - Adjusted average healthcare gain - Oxford Hip score casemix adjusted
8Data sets - 2 Non-specialist versus Specialist Activity THR procedures TKR proceduresOther proceduresNon-specialist activitySpecialist activityPercentage revisions (of total THR procedures)Percentage infections (of total THR procedures)Non-specialist length of stay (days)Specialist length of stay (days)Percentage revisions (of total TKR procedures)Percentage infections (of total TKR procedures)Split into non-specialist and specialist activity, stating volumes and average length of stay for:SpinalFoot and ankleShoulderElbowHand and wristSoft tissue sarcoma
9Data sets - 3 Estimates of case-mix complexity National Hip Fracture DatabasePercentage of T&O Elective admissions suitable for Orthopaedic specialised service PbR top-upPercentage of T&O Elective admissions specialised (CRG definition)Pre-operative assessment by an ortho-geriatricianTime to surgery within 36 hours30 day mortalityReturn home at 30 days
10National 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 bandSplit 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 levelMortality ratesFor all Providers separately for each of 5 years – 2008/09 to 2012/13Primary procedure (number only)Revision procedure (number and rate)Mortality (rate only) for hips and knees – not currently available at provider levelCompliance, consent and linkabilityODEP 10A compliance – hips and first year of knee dataThe outlier metrics – mortality, hip revision rate and knee revision rateFunnel plots for the three outlier metrics (mortality, hip revision rate and knee revision rate), with outlier Providers identified.
11Format & purpose of visits Meetings to review provider report with management, clinical management and cliniciansValidate data – prior to meeting and again at the meetingUnderstand local networks – current and plannedUnderstand the stories behind the dataClinical Directors to act as ‘hosts’ for each visit
12Rolling out the project Review experiences of trial phase and plan next wave of visitsRegion by region approach where possibleSeeking a collaborative approach – in early discussions with: Leicester, Southampton, Devon, Bristol and Birmingham/West Midlands
13The Challenge Number of providers by NHS Region North – 42 Midlands & East – 45London – 20South – 38Total - 145Meetings will be with Providers and CCGs
14Reporting145 (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 report1 national report for Bruce Keogh and the Secretary of State
15Next stepsThe 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.
16Benefits Quality led Clinically led Already has “buy-in” from all interested groupsSignificant potential for savings in terms of changing the governance around procurement, procedure selection and reducing infection and litigation.Other specialities keen to do same