SURGERY
have described the project as a ‘programme that is pursuing the holy grail of modern medicine – higher quality at lower cost’. They say that the NHS is teetering on the brink and desperately needs this programme. The NHS needs to save £22 billion in efficiency savings outlined in the Five Year Forward View - so any better value which can be squeezed from delivery of care with better quality and at lower cost, must be vital to the services which are involved in the GIRFT project.
The recent expansion into 32 other specialities, both surgical and medical across the English NHS based on the programme first led by Professor Briggs will be watched with care and hope.4
There is data which has
been selected to present to the clinicians and managers regarding the specialities, data which relates to the local service and speciality and will be presented by a credible speciality lead. The leads will, as Professor Briggs did, undertake many miles visiting hospitals to present the data, and urge local clinicians to take a view on the variations it demonstrates. Increasing productivity, reducing costs or infections or loan instrumentation, ring fencing beds, involving procurement in reducing the range of implants available – all are on the table as possible options for getting better value from the NHS budget and giving patients a better service.
Why will this project work?
GIRFT is different, it is first and foremost, clinically led therefore there is no imposition from the department or from management. Many specialities will include their MDT members and all will engage with their clinical service. The quality of the data which will have been accumulated from different datasets which clinicians do not usually access, should present data which is meaningful, local and credible. The data may cover such items as activity, costs, performance against their peers and litigation rates and much else besides. The next reason why it is likely that the engagement process will work, is that not only is it peer to peer review but also that it will be led by national leading lights in each area of care. The professional leadership and involvement of the Royal Colleges and associations gives the project greater validity from the outset. There is also consistency across units and nationally by the same team. In addition, this
is not seen as a punitive exercise but a credible professional project which could remove some of the daily frustrations and improve the quality of care each clinician can deliver. Professional review of their service, with reasonable data and including other team members and local chief executives may well remove some of the otherwise apparently intractable barriers to improving service delivery.
Morale is known to be at rock bottom with many clinicians – but where GIRFT is showing good results, morale has improved considerably as clinicians can see that they have not lost influence over their day to day work and outcomes. It potentially provides a huge boost, and a catalyst for change.
GIRFT methodology and implementation
The methodology includes collating data which is held in different datasets, the National Joint Registry in orthopaedics for example, together with local data such as Hospital Episode Statistics (HES) and surveillance data from infection reporting, plus a questionnaire issued to each Trust. The report which is sent back to the Trust by the lead clinician, includes a range of other
The NHS needs to save £22 billion in efficiency savings outlined in the Five Year Forward View - so any better value which can be squeezed from delivery of care with better quality and at lower cost, must be vital to the services which are involved in the GIRFT project.
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factors such as length of stay, patient mortality and individual service costs through to overall budgets. The report is then reviewed with the consultants and speciality teams in the Trust concerned during a visit by the clinical lead. At this point, the review can look at local data with clinical peers and facilitate a discussion around individual variations and many of the other challenges which frustrate so much of modern practice. It is also an opportunity for discussion on ideas of best practice and solutions which have worked elsewhere. Each GIRFT report which reflects the
Trust situation, is compiled with an action plan, which also provides detailed evidence and benefits of the changes. Each Trust is supported by an implementation programme. Trust data is uploaded to the Model Hospital portal which is the gateway for accessing GIRFT information for all providers and commissioners. The original orthopaedic GIRFT has delivered many millions of pounds of savings and it is to be hoped that widening the range of programmes across a variety of other specialities, will have the same effect.
A set of regional hubs will be set up by the end of this year whereby clinical leads and project delivery leads will be able to contribute regular visits and support to Trusts, commissioners and STPs advising on how to reflect national recommendations and support local change mechanisms. Through all these efforts, local and national GIRFT will strive to embody the ‘shoulder to shoulder’ ethos which has become a hallmark of the programme, to date.
Infection audit
Data on surgical site infections is not necessarily available at team or surgeon
SEPTEMBER 2017
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