NJR Structure & Governance

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 each hospital has submitted into the Registry.

Trusts, health boards and independent sector healthcare providers are now invoiced directly by HQIP which hosts the NJR’s accounts.

Income and expenditure 2019/20

The NJR is self-financing and moving to the new subscription model, from the previous model based on a levy charged on the sale of hip, knee, ankle, elbow, and shoulder implants, has removed any of the costs of the NJR from the NHS. 

The actual yearly rate of the subscription charge 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 2019/20, subscriptions totalling £3,236,330 were collected from NHS and independent sector providers (2018/19: £3,376,379). Other income of £703,912 (2018/19: £687,320) included supplier contributions and income from the NJR’s price benchmarking service.
     
Expenditure on the management and development of the National Joint Registry was £3,775,741 (2018/19: £3,676,664). This included governance costs of £184,965 (2018/19: £186,570).
 
Full 2019/20 accounts

The NJR’s financial results are included in the audited accounts of HQIP whom host the registry. The full audited accounts are available on HQIP’s website from December 2020, and also from the Charity Commission and Companies House.

The NJR reviews its three year strategic plan regularly to ensure that it is supporting the priority improvement areas for joint replacement surgery.  The plan was developed in consultation with the NJR Steering Committee following a review, and subsequent revision of, the aims that were set out for the NJR when it was established in 2002.

The plan identifies a number of strategic themes for the NJR, along with the work programmes necessary to support those themes. The broad areas covered in the plan are:

• Patient safety
• Understanding patient outcomes
• Cost effectiveness
• Research
• Data quality
• Patient and public involvement
• Stakeholder engagement and communication
• Enabling access to data and information
• Partnerships and international collaboration
• Operations model and governance of the NJR

The strategic plan is supported by Annual Plans which identify the work required to deliver the strategy based on priorities set by the Steering Committee.  Following review and approval by the NJR Steering Committee, the annual plans are used to monitor the progress of key activities on a quarterly basis.

For further details on the work of the NJR Steering Committee, please see the Work of the NJR Committees.

The NJR Strategic Plan for April 2018 to March 2021 is available as a download from the NJR website on the General publications and leaflets page.

NJR Steering Committee

The NJR is hosted by the Healthcare Quality Improvement Partnership (HQIP) and overseen by a Steering Committee (NJRSC), which is designated as an NHS England (NHS E) ‘Expert Committee'. The NJRSC Chairman reports directly to the NHS England Medical Director.

The NJR Steering Committee, which meets quarterly, is responsible for overseeing the strategic direction and running of the NJR. The Steering Committee has a lay Chairman, Mrs Laurel Powers-Freeling.

The current list of members and their declarations are listed in the online appendices.

NJR Sub-committees

Eight sub-committees supported the work of the NJR Steering Committee in 2019/20:

• Executive Committee - Chairman, Mrs Laurel Powers-Freeling
• Medical Advisory Committee - Chairman,  Mr Timothy Wilton
• Editorial Board - Chairman, Professor Mike Reed
• Implant Scrutiny Committee - Chairman, Mr Peter Howard
• Surgeon Performance Committee - Chairman, Mr Peter Howard
• Research Committee - Chairman, Professor Mark Wilkinson
• Data Quality Committee - Chairman, Mr Matthew Porteous
• Regional Clinical Coordinators Committee - Chairman, Mr Matthew Porteous 

NJR Management Team (NJRMT)

The NJR Management Team is hosted at HQIP's London office and is responsible for overall operational and contract management of the NJR and for supporting the work of the NJRSC and its sub-committees.

The NJR Management team is led by the NJR Director of Operations for all NJR operational activity and contracts including NJR Communications and Stakeholder Engagement which is overseen by an associate director within the NJR Management Team, to support the delivery and communication of the strategic plan. As well as working closely with the Editorial Board, the communication function also works with the Regional Clinical Coordinators Committee and the NJR Patient Network.

NJR Service Delivery

The NJR’s services are delivered under two separate contracts which are overseen, managed and monitored by the NJR Management Team:

- NJR Service Centre

The NJR’s Service Centre is contracted to a team within Northgate Public Services (UK) Ltd (NPS). NPS has contracted responsibility for the management and development of the IT infrastructure, software applications, data management and reporting services for the NJR. NPS is also contracted to facilitate the ‘NJR Service Desk’, a team who provide day-to-day information and support to NJR stakeholders.  The current team of six Regional Coordinators responsible for providing on-site support to orthopaedic units in hospitals will soon be replaced with a team of four NJR Compliance Officers and a Data Quality Officer.

- NJR statistical support, analysis and research

The NJR’s statistical work is contracted to a combined team from the Universities of Bristol and Oxford. The team is responsible for the delivery of statistical analyses of the NJR’s data and also 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 Scrutiny Committee and the Surgeon Performance Committee.

The National Joint Registry (NJR) collects joint replacement data for England, Wales, Northern Ireland, the Isle of Man and the States of Guernsey. It has collected 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 States of Guernsey joined in November 2019.

The NJR still continues to be the largest Registry of its kind in the world, with over 3.06 million procedure records submitted to it as at 31 March 2020.

Mission statement

'The purpose of the National Joint Registry, which covers England, Wales, Northern Ireland, the Isle of Man and the States of Guernsey, 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.'

Learn more about the NJR at www.njrcentre.org.uk