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 the Healthcare Quality Improvement Partnership (HQIP) which hosts the registry's accounts. A report from the NJRSC Chairman can be found here.  

Income and expenditure 2016/17

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.

During 2016/17, subscriptions totalling £2,755,317 were collected from NHS and independent sector providers (compared to 2015/16 subscriptions: £2,938,280). Other income of £554,425 (2015/16: £523,580) included supplier contributions and income from the NJR’s price benchmarking service. 

Expenditure on the management and development of the National Joint Registry was £3,710,542 (2015/16: £3,239,13). This included governance costs of £143,612 (2015/16: £143,817).

Full 2016/17 accounts

The NJR’s financial results are included in the audited accounts of HQIP which hosts the registry. The full audited accounts are available on HQIP’s website from November 2016 (www.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 2016/17, 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 16/17. The Steering Committee has a lay Chairman, Mrs Laurel Powers-Freeling.

There current list of members can be found on the NJR's main website here.

NJR Sub-committees

Nine sub-committees supported the work of the NJR Steering Committee in 2016/17:

• Executive Committee ~ Chairman, Mrs Laurel Powers-Freeling
• Medical Advisory Committee ~ Chairman, Mr Martyn Porter
• Editorial Board ~ Chairman, Mr Martyn Porter 
• Implant Performance Committee ~ Chairman, Mr Peter Howard
• Implant Scrutiny Committee ~ Chairman, Mr Peter Howard
• Surgeon Performance Committee ~ Chairman, Mr Peter Howard 
• Research Sub-committee ~ Chairman, Professor Mark Wilkinson 
• Data Quality Sub-Committee ~ Chairman, Mr Martyn Porter 
• Regional Clinical Coordinator Sub-committee ~ Chairman, Mr Matthew Porteous

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), a six-person 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 Performance 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 Coordinator Sub-committee

The National Joint Registry (NJR) for England, Wales, Northern Ireland and 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 from July 2015. 

The NJR still continues to be the largest register of its kind in the world, with over 2.35 million procedure records submitted to it as at 31 March 2017. 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.