The NJR is funded by subscriptions from NHS trusts, Health Boards, and by independent sector health companies. This model replaced the previous model of raising a levy against the cost of implants and was introduced to reduce the cost of the NJR to the NHS and ensure a fair and proportionate contribution from other key stakeholders, including the orthopaedic device industry.
The subscription model was implemented in 1 April 2014 and is now it in its fourth year. Subscriptions are based on the number of procedures submitted to the NJR or, if higher, the number of procedures recorded on the Hospital Episodes Statistics (HES) service in England or the Patient Episode Database Wales (PEDW) service in Wales. The previous complete financial year’s submissions are used to calculate the subscription for the forthcoming financial year.
Now in its fourth year, the early issues associated with the non-payment of the subscriptions, mainly due to procurement systems not being set up to handle the invoices, have reduced significantly. There remain, however, a very small number of trusts who have failed to respond to requests for payment and, in these cases, members of the NJR’s Regional Clinical Coordinator (RCC) network are asked to assist.
Last year it was reported that the NJR had explored the possibility of NHS trusts being able to reclaim the VAT element of the subscription. However, a claim submitted by a high volume orthopaedic trust as a test case was rejected by HMRC.
The current subscription rate is £15.60 per procedure (net £13).
Included in the subscription are access to a number of services, including reporting services such as NJR Clinician Feedback and NJR Management Feedback. NJR Clinician Feedback is a secure online service that enables surgeons to compare and contrast their clinical practice, including outcomes, with that of their colleagues at a local and national level. NJR Management Feedback is aimed at Trust, Health Board, Company, and hospital management, and includes an annual report on activity and outcomes and for, NHS England trusts and NHS Wales health boards only, price benchmarking reports.
There are two levels of price benchmarking service: INFORM and EMBED. INFORM has, until now, been provided as part of the NJR subscription, and EMBED was provided as an additional, voluntary subscription of £5,000 per year. However, following a review of the economic model by the NJR Steering Committee, it has been decided that the advanced reporting service, EMBED, should also be included in the annual NJR subscription at no extra charge. This will be made available to all NHS England trust and NHS Wales Health Boards in 2017/18.