Introduction to NJR Reports

The NJR Annual Report comprises four parts 

Parts One (annual progress), Two (clinical activity data) and the enhanced Part Four (Implant and Trust-, Local Health Board- and unit-level outcomes) are published online here at the registry’s dedicated Annual Report website. The NJR’s Annual Report website is part of a long-term strategy to share our annual dataset in a more accessible, responsive and timely manner. Part Three (the analyses of outcomes after surgery) continues to be published as a printed report.

Part One: executive summaries, annual progress and highlights 2016/17

These sections provide a general outline of the work of the NJR undertaken in the financial year from 1 April 2016 to 31 March 2017.  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 2016

This section provides reports about clinical activity as reported to the NJR as at 28 February 2017.  All reports are based on the calendar year 1 January to 31 December 2016.  Clinical activity reports under Part Two are 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.

Part Three: outcomes after joint replacement 2003 to 2016

These sections provide an analysis of survivorship for hip, knee, ankle, and shoulder replacements undertaken between 1 April 2003 and 31 December 2016.  Unfortunately, as was the case last year, NHS Digital is 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 PDF document.

Part Four: implant and unit-level activity and outcomes 2016

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 revision rates in both hip and knee.

This information is also published online as part of the hospital dashboards at www.njrsurgeonhospitalprofile.org.uk.

We continue to include 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. 

Chairman’s foreword 

Laurel Powers-Freeling, National Joint Registry Chairman

The National Joint Registry’s Steering Committee (NJRSC) oversees the work programme of the registry. As Chairman it is always a pleasure to offer a foreword to our Annual Report, now in its 14th edition, and to update on the substantial developments during the previous financial year.

Key work and developments

Improving data quality remains our number one overall strategic priority. With our ever-maturing dataset, it is critically important that the registry is collecting the most relevant, high quality data in order to provide robust evidence to support decision-making in regard to patient safety, standards in quality of care and overall cost effectiveness in joint replacement surgery.

The NJR’s national programme, which is aimed at assessing data completeness and quality within the registry, is now in its second year and underpins the NJR’s ‘Supporting Data Quality Strategy’. The data quality audit has allowed the NJR to compare the records in local hospitals’ databases to the registry’s records, with the aim of ensuring the accuracy of the number of arthroplasty procedures submitted when compared to the number carried out. 

I’m delighted we were able to extend the programme this year to check the quality of data in independent healthcare organisations, giving all hospitals – now in both the NHS and independent sector – the opportunity to demonstrate the highest possible standards of clinical governance, which all are striving to achieve.

We are now able to fully report the audit’s findings in year one.  These findings can be found on pages 18-20.  I would like to offer my thanks on behalf of the NJR to all staff who have worked to complete this important audit and who I hope will enact upon its findings.

Elsewhere, monitoring continues to be a key function of the NJR. Registry data now provides an important source of evidence for regulators, such as the CQC, to inform their judgements about services, as well as being a fundamental driver to inform improved quality of care for patients. As such, this year we have further reviewed the NJR’s processes in monitoring implant and surgeon performance as part of the development of the NJR’s ‘Accountability and Transparency Model’. 

As part of the new model, ‘prevention’ is now a key element of the NJR’s monitoring process. Implemented for the first time this year, ‘borderline outlier’ notifications were issued, acting to prevent surgeons from becoming ‘outliers’ by alerting them to deteriorating outcomes and thus enabling them to correct substandard practices and reduce or eliminate poor outcomes. This new function should ensure even greater public confidence in the NJR monitoring process across the orthopaedic sector.

Looking ahead, ‘practitioner reflection’ will also become a key pillar in the NJR’s monitoring process. A bold new approach, which has the endorsement of the BOA and NHS Improvement, will see the NJR monitoring surgeon engagement and reflection on their own practice and performance data. This new process will allow joint replacement surgeons the unique opportunity to demonstrate and record, via the NJR’s Clinician Feedback tool, that they have reviewed their NJR data as part of their appraisal and revalidation, and importantly reflected upon the data. At the time of writing, we are at an exciting juncture but once implemented it will be ground-breaking for the NHS and for patient safety and reassurance.

An additional area of national policy that the NJR continues to support is the ongoing work surrounding the Getting It Right First Time (GIRFT) initiative.  GIRFT essentially aims to bring about higher-quality care in hospitals, at lower cost, by reducing unwanted variations in services and practices.  The NJR's implant price-benchmarking data has from the outset underpinned the initiative for orthopaedics.

NJR pricing data gives providers the opportunity to benchmark the price they pay for orthopaedic implants against the ‘best’ national prices achieved.  Importantly, NJR data also helps ensure an important clinical context is built into the initiative by providing surgeons access to their individual-level price-benchmarking data.  All these services are now inclusive of the NJR’s annual subscription charge.

A recent King’s Fund report  into GIRFT highlighted that clinicians were engaging with the data and acting on the evidence provided.  This is an area of work that the NJR will continue to support and work closely with NHS Improvement and the GIRFT team.

Future plans for the coming year 2017/18

Patients and the public can be assured that the NJR is working hard to collect and report upon the most complete, accurate data possible across all hospitals in England, Wales, Northern Ireland and the Isle of Man.  In addition to our core schedule of activities, we will:

• Continue to develop NJR information systems, including enhanced Clinician Feedback to aid surgeon appraisal, Supplier Feedback, Management Feedback and Annual Clinical Reports
• Rollout a dedicated NJR data access and research portal to allow researchers to access the NJR dataset via secure access
• Undertake a complete redevelopment of the NJR’s main website (www.njrcentre.org.uk) 
• Provide further analyses and investigation of NJR PROMs at 3 and 5 years

Acknowledgements

During this reporting period, there have been some changes to the membership of the NJRSC. Professor Andrew Price stepped down from his role as a surgeon member of the committee as he formally became part of the NJR’s statistical analysis contractor team. My sincere thanks to Andrew for his valuable contribution in his NJRSC role, we are fortunate to retain his services and abilities in a new capacity. Work is underway with the Department of Health’s appointments team to find Andrew’s replacement and also to appoint a senior specialist practitioner with an interest in orthopaedics. Mr Martyn Porter, NJR Vice Chair and Medical Director, and Sue Musson, patient representative member, were both granted extensions to their membership of the NJRSC until March 2018 and October 2017, respectively.

This year I have also appreciated the significant contribution made by both Mr Tim Wilton and Mr Ian Winson. As immediate past-BOA president and BOA president respectively, Tim and Ian’s engagement as co-opted members of the NJRSC – particularly during this period of change and review of the NJR’s monitoring process – has been invaluable. This September when a new president takes up post, I look forward to welcoming him and hope to maintain the support and close links developed with the profession.

Importantly, I would like to end by thanking all members of the NJRSC, and NJR sub-committees, for their valuable contribution and enthusiasm. In particular, my thanks to Mr Martyn Porter, NJR Vice Chair and Medical Director, and to the chairs of each of the NJR sub-committees for their contribution, hard work and insight.  Without their dedication, the NJR would not be the world leading and ground-breaking arthroplasty register that it is. I would encourage you to read and review the reports from each committee chairman at www.njrreports.org.uk where they provide strategic oversight and professional awareness into key work areas.

Finally, my thanks to the NJR management team, in particular our Director of Operations, Elaine Young. Thanks also go to our NJR contractors, Northgate Public Services (UK) Ltd., the University of Bristol, and the communications team based at the Healthcare Quality Improvement Partnership, for all their hard work and efforts throughout the year in progressing the NJR work agenda.