Improving joint replacement The National Joint Registry for England, Wales and Northern Ireland

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@jointregistry

www.njrcentre.org.uk

NJR in numbers

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Steering Committee, supported by expert sub-committees

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NJR Patient Network

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Our contribution to improvement in joint replacement surgery UK territories covered, collaborating internationally

NJR mission statement:

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Advanced feedback services for surgeons, hospitals and suppliers

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Published Annual Reports since 2004

The purpose of the National Joint Registry for England, Wales and Northern Ireland is to collect high quality and relevant information about joint replacement surgery in order to provide early warning of issues relating to patient safety. In a continuous drive to improve the quality of outcomes and ensure the quality and cost effectiveness of joint replacement surgery, the NJR will monitor and report on the outcomes and support and enable related research.

1,000s of colleagues

across the NHS and independent orthopaedic sector

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Joint replacement procedures recorded

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of research papers and scientific posters using NJR data

1,600,000+ million records and growing

The National Joint Registry (NJR) has grown significantly since its inception in 2002, collecting and monitoring data on the hundreds of thousands of hip, knee, ankle, elbow and shoulder operations that take place each year. The registry, by applying appropriate and robust methodologies to this information, provides the orthopaedic sector with a measurement of joint replacement implant survivorship. These insights, within a rich pool of supporting data, provide a robust evidence-base for best practice and poor practice in orthopaedic surgery. Through the provision of world-leading online feedback services and publication of high-profile research, the NJR continues to support the long-term improvement of implants, hospital services and surgical practice. Over the next decade, the potential for the registry’s impact grows even further. NJR’s data will support national initiatives – Getting It Right First Time – and world-first patient safety projects – Beyond Compliance. The registry has adopted a progressive economic model that will, through subscription, ensure a fairer burden of costs to the NHS and enable cost-savings through a price benchmarking service. Importantly, there will be an ever-increasing link to patient reported measures of outcome and experience so that we can help build a broader picture of success in joint replacement.

www.njrcentre.org.uk

Achievements since 2003

2002

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NJR establishes as the data collector for joint replacement procedures in England and Wales

Lord Philip Hunt, Parliamentary Under Secretary of State for Health (Lords) said of the launch: “The National Joint Registry provides an exciting opportunity to understand more about the performance of hip and knee implants, improve surgery through learning from best practice, and essentially, improve the quality of care to patients. With these benefits I am sure that surgeons, nurses, managers, support staff and everyone else involved in the registry will work to make it a success”

2003

2004

2005

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NJR starts recording hip and knee replacement procedures, supported by the British Orthopaedic Association (BOA), British Hip Society, British Association for Surgery of the Knee and the Royal College of Surgeons of England (RCS)

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NJR Regional Coordinators established to work with hospitals on improving the volume and quality of operation data submitted

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NJR Regional Clinical Coordinators (orthopaedic surgeons) established to help grow understanding of registry process and findings

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First development of the outlier monitoring process where information is examined closely to identify poor performance for implants, hospitals and surgeons. This process has since been developed by the NJR in partnership with the BOA, the Medicines and Healthcare Products Regulatory Agency (MHRA) and the Association of British Healthcare Industries

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Collaboration with the Orthopaedic Data Evaluation Panel and National Institute for Care Excellence begins – getting NJR data to work alongside other national standards and requirements

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NJR StatsOnline – a website facility for viewing and downloading NJR statistics – launches and is open to everyone

2006

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NJR ReportsOnline – a data entry system facility – launches. This provides surgeons and hospitals with information about operations, patient characteristics and implant use

2007

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The NJR website (www.njrcentre.org.uk) is developed to act as a hub for the growing number of resources available

2008

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Management of the NJR was transferred from the Department of Health, to the Healthcare Quality Improvement Partnership (www.hqip.org.uk)

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NJR Clinician Feedback – a secure, surgeon-only data website – launches. Surgeons are able to view reports and indicators about procedures that have been recorded in their name and analyse this within the context of hospital, regional and national benchmarks

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NJR’s extended Patient Reported Outcome Measures (PROMs) are agreed for a group of 50,000 hip and knee patients. Overseen by the NJR Research Sub-committee, these patients will be contacted at one, three and five years after their operation to ask for their views about the surgery and its success

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NJR Supplier Feedback – a world first, secure website supporting manufacturers in the monitoring of their own implant products – launches

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NJR starts recording ankle replacement procedures, supported by the British Orthopaedic Foot and Ankle Society

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NJR Implant Performance Sub-committee reports concerns of early failure rates for metal-on-metal hip replacements to government body the MHRA

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The first NJR Fellowship programme establishes to deliver greater research into joint replacement using NJR information. A second programme has since been developed in partnership with the RCS England

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Data submission to the NJR becomes mandatory under the NHS Acute Services Contract

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NJR publishes its first Public and Patient Guide to the Annual Report – working with patients to translate NJR data into patientfriendly information

2009

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2011

www.njrcentre.org.uk

2012

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NJR starts recording elbow and shoulder procedures, supported by the British Elbow and Shoulder Society

The House of Commons Science and Technology Committee states that the NJR ‘should serve as the gold standard for implant registries’ as part of their regulation of medical implants in the EU and UK report

2013

2014

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NJR establishes its Patient Network to bring patient ideas and comments to the heart of ongoing projects and publications

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Significant research on stemmed metal-on-metal and resurfacing hip replacements publishes in The Lancet and BMJ

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NJR Surgeon Outlier Sub-committee publishes Annual Clinical Reports to hospitals for the first time. Along with the secure NJR Management Feedback website, these reports give hospitals a picture of how they are performing based on the data they have reported to the NJR

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NJR extends to Northern Ireland

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NJR hosts the International Society for Arthroplasty Registries second annual congress

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NJR publishes consultant surgeon-level information for the first time at www.njrsurgeonhospitalprofile.org.uk in partnership with the BOA, specialist surgical societies, HQIP and NHS England

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Overseen by the Editorial Board, the 10th Annual Report publishes, along with the third edition of the accompanying Public and Patient Guide

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Benchmarking Award win for the NJR joint replacement implant pricing pilot study, completed in partnership with the Department of Health

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Future Plans

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Implementation of the new NJR economic model to reduce, through subscription, the overall cost burden to the NHS. This includes sharing operational costs appropriately with implant suppliers

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Development of a price-benchmarking service for the NHS supply chain to enable hospitals to identify areas for cost savings when buying joint replacement implants

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Supporting national initiatives such as Getting It Right First Time and Beyond Compliance through provision of NJR data

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Greater international collaboration through membership of the International Society of Anthroplasty Registries (ISAR), the International Consortium of Orthopaedic Registries (ICOR) and through Unique Device Identifiers (UDI) initiative

Focus on NJR 2014-2016 Patient safety and patient outcomes The NJR will continue to improve methods to collect, verify and monitor data as well as identify areas of good practice and poor performance. Data quality initiatives are a keen focus and the NJR will be examining new ways to support hospitals in achieving mandatory compliance and the required standards of data completeness. Maintaining and strengthening professional relationships across the orthopaedic sector will too enable the success of innovative projects and partnerships. NJR data is an integral part of the national professional pilot Getting It Right First Time, examining the best and most cost-effective way of achieving high quality orthopaedic care and; Beyond Compliance, a world-first initiative assessing more closely the entry of new joint replacement implants into the UK market. These national collaborations will continue to grow, along with the merits of the international surveillance of joint replacement surgery through ISAR, ICOR and the international classification system for orthopaedic devices using (UDI).

Supporting information availability Further advancement of the NJR’s worldleading online feedback services will continue to ensure that timely information is provided to meet the needs of surgeons, hospitals and suppliers. A new digital NJR Annual Report will see a dedicated website launch, improving access to national trends and analysis to all. Growing the NJR Patient Network will be a crucial part of building on and developing patient-specific resources. Focus here is on the Public and Patient Guide and NJR Surgeon and Hospital Profile, a world-first

in the publication of orthopaedic consultant surgeon activity and outcomes. Other key developments in this area will include a new implant price-benchmarking service to enable NHS procurement teams to identify cost-savings in buying activity.

Facilitating research Expanding the ways in which NJR data is used for and within research is another important focus. Research maximises the registry’s ability to evidence trends and techniques that could improve outcomes and experience for joint replacement patients. The NJR Research Fellow programme will continue, complemented by the in-depth studies carried out as part of the annual report process. Analysing the national and extended NJR PROMs programme will be increasingly important, in order to complement survivorship analysis (how long implants last) with other crucial measures of performance (what patients say about their outcomes).

Governance and leadership With such a wealth of important work, the registry’s governance and funding structure are also progressing to allow for greater efficiency and responsiveness. In addition to new appointments to the NJR Steering Committee, the registry is also delighted have appointed a Medical Director to strengthen clinical leadership in decision-making and our work programme. In 2014, a new approach to funding will begin through a subscription service that will significantly reduce the cost to the NHS and share, in an appropriate way, the cost of developing services specifically for implant suppliers.

www.njrcentre.org.uk

“As the National Joint Registry moves into the next ten years of growth and development, so too does the richness of data and information at its heart. In the years to come, this unrivalled evidence-base will enable the NJR to protect patients and support surgeons, hospitals and suppliers in new and innovative ways. We are proud to work alongside all our colleagues in the orthopaedic sector to continue to drive forward quality in joint replacement surgery.” Elaine Young National Lead for the NJR at the Healthcare Quality Improvement Partnership

To find out more about the NJR: Visit our website at www.njrcentre.org.uk Call the NJR helpline on 0845 345 9991

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Send an email to [email protected] Write to: NJR Centre, Peoplebuilding 2, Peoplebuilding Estate Maylands Avenue, Hemel Hempstead HP2 4NW

© National Joint Registry. September 2014.