Annual progress: Introduction

From April 2014 the funding of the NJR was changed from a levy on the sales of implants to a subscription-based model, with the subscription charge being based on the number of procedures submitted to the NJR.

Trusts/Local Health Boards and independent sector healthcare providers are now invoiced directly by HQIP which holds the NJR budget on behalf of the Steering Committee. A report on the transfer to the new model can be found under ‘Highlights: our work’.  

Income and expenditure 2014/15

The NJR is self-financing and from 1 April 2014 has been funded by a subscription paid by Trusts, Health Boards and independent sector healthcare providers.  Moving to this model, from the previous model based on a levy charged on the sale of hip, knee, ankle, elbow, and shoulder implants, has reduced the cost of the NJR to the NHS.  

The rate of the subscription is recommended by the NJR Steering Committee for approval by NHS England, and is subject to a Memorandum of Understanding between NHS England, Welsh Government, Health and Social Care Board Northern Ireland, and the Independent Healthcare Advisory Services.

In 2014-15, the National Joint Registry adopted a subscription based funding model which replaced the levy on surgical implants collected previously.

During 2014-15, subscriptions totalling £2,231,191 were collected from NHS and independent sector providers compared to levies of (2014: £3,378,841). Other income of £453,184 (2014: £41,826) included supplier contributions and income for a price benchmarking service. 

Expenditure on the management and development of the National Joint Registry was £3,351,502 (2014: £3,029,494). This included governance costs of £140,226 (2014: £119,342).

Below are some of the 2014-15 costs associated with major NJR project areas:

• Publication of consultant-level data £129,573 (2014: £67,147)
• Price Benchmarking £201,570 (2014: £67,995)
• Data Quality Dashboard £59,600 (2014: £58,500)
• Patient implant cards £34,998 (2014: £20,303)
• Unique Device Identifiers £65,691 (2014: £nil)

The NJR’s financial results are included in the audited accounts of HQIP (Healthcare Quality Improvement Partnership) which manages the registry. The full audited accounts are available on HQIP’s website from November 2015 (www.hqip.org.uk), and also from the Charity Commission and Companies House.

The NJR’s financial results are included in the audited accounts of the Healthcare Quality Improvement Partnership’s (HQIP) which manages the registry.

The full audited accounts are available on HQIP’s website from September 2014 (ww.hqip.org.uk) and also from the Charity Commission and Companies House.

HQIP and the NJR Steering Committee

The NJR is managed by the Healthcare Quality Improvement Partnership (HQIP) under a contract with NHS England as part of the delivery of the National Clinical Audit and Patient Outcomes Programme (NCAPOP). The NJR management team at HQIP support the work of the NJR Steering Committee and all its sub-committees.

The NJR Steering Committee, which met four times in 2014/15, is responsible for overseeing the strategic direction and running of the NJR and has the status of an NHS England Committee of Experts.

The current list of members and their declarations are listed in the online appendices and in the NJR Steering Committee report from 14/15. The Steering Committee has a lay Chairman, Mrs Laurel Powers-Freeling.

There were a number of changes in the membership of the NJR Steering Committee in 2014/15 as members’ periods of tenure expired:

• Mr Rob Hurd, Chief Executive of the Royal National Orthopaedic NHS Trust, appointed as the NHS Management Representative from 6 May 2014.
• Mr Peter Howard, Consultant Orthopaedic Surgeon, Royal Derby Hospital, Derby Teaching Hospitals NHS Trust, as a Surgeon Member from 27 May 2014.
• Professor Andrew Price, Consultant Orthopaedic Surgeon, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, as a surgeon member from 27 May 2014.

NJR Sub-committees

Eight sub-committees supported the work of the NJR Steering Committee in 2014/15:

• Executive Committee ~ Chairman, Mrs Laurel Powers-Freeling
• Medical Advisory Committee ~ Chairman, Mr Martyn Porter
• Editorial Board ~ Chairman, Mr Martyn Porter 
• Implant Performance Sub-committee ~ Chairman, Mr Keith Tucker 
• Surgeon Outliers Sub-committee ~ Chairman, Mr Peter Howard 
• Research Sub-committee ~     Chairman, Professor Mark Wilkinson 
• Data Quality Sub-Committee ~ Chairman, Mr Martyn Porter 
• Regional Clinical Coordinators’ Sub-committee ~ Chairman, Mr Peter Howard 

NJR services

The NJR services continue to be delivered under three separate contracts, managed and monitored by the NJR management team:

• The NJR Centre, managed and staffed by Northgate Public Services (UK) Ltd. Northgate is responsible for the management and development of the NJR’s IT infrastructure, software applications, data management and reporting services. This work is complemented by the NJR Service Desk, a team who provide day-to-day information and support to stakeholders, and the NJR Regional Coordinators (RC), an eight-strong team providing on-site support to orthopaedic units in hospitals. 
• The NJR statistical support, analysis and research team is based at the University of Bristol. The team is responsible for the delivery of statistical analyses of NJR data and data from other sources, and for developing the statistical methodologies for the identification of potential outlier performance. Their role also includes ad hoc data analyses, in addition to those included in the NJR Annual Report, that are central to the work of the Implant Performance Group and the Surgeon Outliers Sub-committee.
• NJR Communications are managed by HQIP. This is a programme of stakeholder and multi-media communication to support the delivery of the strategic plan including the publication of the Public and Patient Guide to the NJR Annual Report. The HQIP communications team also support the Editorial Board and Regional Clinical Coordinators’ Sub-committee.

The NJR continues to change the way in which the annual report is published and presented to readers. Last year Parts One, Two and Four were published online for the first time, with Part Three continuing to be published as a printed report.  This year, there are more ‘Clinical Activity’ reports under Part Two and they are now interactive, enabling users to view the data in a number of different ways through the use of built-in filters.  The reports and accompanying text can also be downloaded as pdf files.  Readers are encouraged to let us know what they think of the new approach using the link included with the reports.

Part One ‘Executive summaries, annual progress and highlights 2014/15

These sections provide a general outline of the work of the NJR undertaken in the financial year from 1 April 2014 to 31 March 2015.  As well as providing summary information about the NJR’s key data quality indicators of compliance, consent, and linkability, this section includes brief summaries of the work undertaken by the NJR throughout the year and the individual NJR sub-committee reports.

Part Two ‘Clinical activity 2014’

This section provides reports about clinical activity as reported to the NJR as at 28 February 2015.  All reports are based on the calendar year 1 January to 31 December 2014.  This year, the number of reports has increased slightly and the reports are now interactive, enabling the user to look at different views of the data.  Previously, Part Two has only included data for the latest year of activity but the reports now enable the user to look at data from previous years.  Included with each report is a link to an online survey and readers, once they have viewed the reports, are encouraged to leave their feedback via the survey.

Part Three ‘Outcomes after joint replacement 2003 to 2014’

These sections provide an analysis of survivorship for hip, knee, ankle, and shoulder replacements undertaken between 1 April 2003 and 31 December 2014.  Unfortunately, as was the case last year, the NHS Health and Social Care Information Centre (NHS HSCIC) was unable to provide the NJR with any data from either the Hospital Episodes Statistics (HES) service or the NHS England Patient Reported Outcomes Measures (PROMs) study.  This has, unfortunately, restricted the types of analyses that the NJR would have wished to undertake using NJR data linked to these two datasets.  Part Three is provided both as a printed and an online, electronic document.

Part Four ‘Implant and unit-level activity and outcomes 2014’

This section provides a series of indicators about clinical level activity and the outcomes of surgery at both a Trust/Local Health Board and hospital level.  These include indicators of potential outlier performance for both mortality and hip and knee revision rates.  No PROMs indicators are included as no data could be obtained from the NHS HSCIC.

This information was also published online for the first time in January 2015 and can be viewed as part of the hospital dashboards at www.njrsurgeonhospitalprofile.org.uk.

This year we have also included data on implant performance, contrasting between the better performing implants and those that have higher than expected rates of revision and were reported to the MHRA. 

The National Joint Registry (NJR) for England, Wales, Northern Ireland, and (from July 2015) the Isle of Man has collected joint replacement data on:

• hip and knee surgery since April 2003
• ankle surgery since April 2010 and 
• elbow and shoulder surgery since April 2012

Northern Ireland started to submit data in February 2013 and the Isle of Man will start submitting the data from July 2015. 

The NJR still continues to be the largest register of its kind in the world, with 1.88 million procedure records submitted to it as at 31 March 2015. The NJR’s purpose is set out in its strategic plan and is summarised below:

Mission statement

‘The purpose of the National Joint Registry for England, Wales, and Northern Ireland is to collect high quality and relevant data about joint replacement surgery in order to provide an 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 outcomes, and support and enable related research.’

Strategic goals

1. Monitor in real time the outcomes achieved by brand of prosthesis, hospital and surgeon, and highlight where these fall below an expected performance in order to allow prompt investigation and to support follow-up action
2. Inform patients, clinicians, providers and commissioners of healthcare, regulators and implant suppliers of the outcomes achieved in joint replacement surgery
3. Evidence variations in outcome achieved across surgical practice in order to inform best practice
4. Enhance patient awareness of joint replacement outcomes to better inform patient choice and patients’ quality of experience through engagement with patients and patient organisations
5. Support evidence-based purchasing of joint replacement implants for healthcare providers to support quality and cost effectiveness
6. Support suppliers in the routine post-market surveillance of implants and provide information to clinicians, patients, hospital management and the regulatory authorities.