Work of the NJR Committees

2019/20 Data Quality Committee Chairman’s report - Mr Matthew Porteous

Data quality lies at the very heart of the NJR, as without confidence in the entered data, the output cannot be relied upon. Data quality comprises two main elements, case ascertainment and data entry accuracy.

This year the committee has continued to oversee the annual audit of case ascertainment of hips and knees with audits for years 2016/17 and 2017/18 now both completed. This gives us close to 100% data completeness (only cases not identified by both the hospital administration systems and the NJR are likely to be missing) since these audits started in 2014.

Automated data quality audits

The NJR has also started the pilot of the planned automated data quality programme which will be used to capture all procedures carried out since April 2018 onwards.

The automated system significantly reduces the administrative burden on both hospital data managers and the NJR team and will enable units to audit their data quality as often as they wish, within a month of data entry rather than some years later, which has obvious advantages. A total of 35 units (23 NHS and 12 independent) have now piloted the system and, once set up, users report back that they find it easy to use. The majority of the pilot sites are now fully up-to-date in auditing their data, having completed the audits for 2018/19 and 2019/20. The intention was for the system to be rolled out to all units, with all hospitals using it by April 2021, but this has been delayed due to the COVID-19 pandemic.

The NJR has been conscious of focusing on quality in the capture of hip and knee data as they comprise the overwhelming majority of entries into the Registry, however there are now also plans to audit case ascertainment of shoulders, elbows and ankles. A manual pilot of shoulder data has been completed in the North East and North West regions and using the feedback from this, the data automation software is being modified with the aim of including shoulder replacement. The committee is now working to undertake small pilot manual audits in elbow and ankle replacement with a view to including them in automation.

Data accuracy

The committee has not neglected the issue of data accuracy, although checking this is more difficult. The tightening of the rules around data entry and the regular identification of anomalies within the records (e.g. second primary on the same side, surgery after date of death, revision before primary operation etc.) help with this. Until the longer term goal of real-time data entry using scanned information is realised, it is acknowledged that inaccuracies will inevitably creep into the dataset.

The audit is also identifying approximately 2,000 potential “Never Events” each year which are investigated as soon as the data is entered. These include incorrectly-sided knee implants and in hip replacement, size mismatched femoral heads and acetabular cups. Whilst the vast majority of cases are shown to be clerical errors, the audit identifies approximately 20 cases a year which are genuine. To help improve the checks made in the operating theatre, the NJR is developing an app that can be used to scan implant box labels with a phone or tablet. This will identify potential mismatches and alert the user. This is intended to supplement and not replace a number of safety checks that are already carried out. The app will not require any patient identifiable data to be entered. The NJR’s longer-term goal is for real-time data entry into the Registry at the point of surgery in the operating theatre, with barcode scanning of the implants, to replace this interim solution.

I would like to thank all the members of the committee who have worked exceptionally hard with what has been a full agenda over the past year, and Carol Harrison and her team at Northgate Public Services who have implemented it on behalf of the NJR.

2019/20 Regional Clinical Coordinators (RCC) Committee Chairman’s report - Mr Matthew Porteous

The Regional Clinical Coordinators Committee acts as a two-way interface between the NJR and the orthopaedic community, with members providing useful feedback from the grass roots and acting as a ‘sounding board’ for new ideas and policy. The RCC members have provided excellent advice on communication with hospitals, both for feedback to units and where practice and performance has been of concern. They have also raised a number of topics which the NJR has then been able to clarify and address, and also assisted with individual surgeons and units in their regions who have become outliers.

Some RCC members have also been recruited to serve on other NJR sub-committees where they have again been doing sterling work, and have helped to share some of the administrative burden of NJR committee work. It is necessary and helpful that they already have a clear idea of the NJR and how the Registry works through their participation in the RCC Committee before they increase their involvement and commitment.

An RCC for each region will always attend each meeting, although there may be two RCCs appointed to share the role. Members of each specialist society are also represented across those roles and this has broadened the range of committee expertise, particularly in ankle and elbow replacement. These members have also been able to provide sound advice on extending the data quality audit to shoulder, elbow and ankle replacement.

My thanks go to all members of the Regional Clinical Coordinators Committee for their efforts and hard work in the past year which all makes it possible to continually improve hospital compliance and engagement with the NJR.

2019/20 Editorial Board Chairman’s report – Professor Mike Reed

The role of the Editorial Board is to facilitate the communication and dissemination of the key findings of the NJR Annual Report. The other main reporting outputs of the Board are the Patient Guides and the ‘NJR Reports’ website. The Editorial Board is accountable to, and reports to, the NJR Steering Committee and brings together experts in data collection and statistical analysis reporting, as well as generous input from patients, representative clinicians from orthopaedic specialist societies and representatives of the NJR management team.

Annual Report 2020

This year the board has published the NJR’s Annual Report in a solely digital format, making all sections of the report available either as pages on the ‘NJR Reports’ website or as downloadable files. The full report, which has been previously also published in print format, can be found here.

The formal accounts of the processes and activities of the NJR and its various sub-committees within the last financial year can be found online by navigating the NJR Reports website.

Descriptive analysis of the NJR’s demographic data and activity trends can also be found wholly online. The data is filterable to enable user-driven enquiries.

This year, analysis by the talented and committed team at the University of Bristol can be found in the full report in the Downloads area. This contains detailed information on implant performance and survivorship up to a maximum of 16.75 years. The Editorial Board has always supported an in-depth research study programme and is delighted to see the developments in the NJR’s approach to research with the strategic direction being shaped by NJR Research Committee Chairman, Professor Mark Wilkinson. Precis of just some of the most recently published research papers are published in section 3.7 of the full report. In addition we would particularly encourage you to explore the research published since the last annual report in Appendix 4.

Finally, details of implant and unit-level activity and performance can be found both in the full report and in more detail in the specific document in the Downloads area.

The Editorial Board develops the strategy and style of the report and all members take responsibility for producing a report that is rigorously edited and reviewed, taking almost a full year to prepare the content, design the layout, write each section and review. Each year the Editorial Board aims to make new progress in reporting on our rich data resource, making data easily accessible to improve patient outcomes.

Specific additions to this year’s report have been:
• Dual mobility hip replacement
• Knee replacement and resurfacing of the patella by brand
• Survival of unicompartmental knee replacement
• Separation of cemented and uncemented prostheses at brand level
• Multicompartmental knee replacement
• Construct based knee analysis

Enhancing the digital format

With the continued development of the NJR Reports website, members of the Editorial Board provided invaluable contributions towards the interactive filter options offered in the presentation of clinical activity data for all joint types. The intuitive, flexible options help readers to engage with the data and have been well received by users of the NJR Reports website and the board aims to strengthen this further in the coming years.

The Editorial Board has been particularly pleased to see the continued development of the NJR’s Patient Guides. This year will see a major overhaul of all editions with leadership and guidance on this provided by NJR’s patient representatives supported by some board members. The five guides cover the range of joint replacements for which data is collected by the NJR. These reference guides provide information from recent annual reports that is useful and easy to digest for patients who are considering a joint replacement. Analysis of the visitor page views of the online PDF versions of the Patient Guides show that they are a popular resource. This year, alongside the NJR Annual Report itself, the guides will be available for online viewing and download rather than being printed and distributed, once they have been completed by our patient and Editorial Board working group.

Promoting the 17th Annual Report findings

The 17th Annual Report will be formally launched online, at the BOA Online Congress in September 2020.

2019/20 Research Committee Chairman’s report - Professor J Mark Wilkinson

NJR Research Committee

The Research Committee is responsible for delivering the research agenda of the NJR. The committee’s aim is to enhance the understanding of the science of arthroplasty, improve clinical practice and benefit public health.

Research provides the route to improved treatments and keeping patients at the centre of what we do is a guiding principle for all NJR research activity. During 2019/20 the committee has had oversight of several major projects. Below are details of a small selection of these projects amongst a varied programme of work currently underway. These projects represent key achievements for the NJR in meeting its aim to maximise the value of the NJR dataset to patients and the wider healthcare community. My thanks go to all members of the Research Committee for their efforts in the past year and whose hard work makes it possible to facilitate data access and to support these high quality research outputs.

Having restructured the representation of NJR’s data analysis contractors (University of Bristol and University of Oxford) on the Research Committee, we are pleased to welcome Professor Andy Judge and Mr Mike Whitehouse onto the committee and would like to thank both Professor Yoav Ben-Shlomo and Dr Celia Gregson for their service to the group over a number of years.

NJR ePREMs Pilot

Collection of patient-reported metrics remains a major strategic priority for the NJR and the NJR PROMs Working Group was established to collaboratively draft an operational plan for how the NJR develops its patient reported outcome measures (PROMs).

This multidisciplinary group – consisting of clinicians, academics, information management specialists and patient representatives – has undertaken a review of ongoing PROMs activity in the area of arthroplasty surgery across the UK, engaging with multiple key stakeholders who are involved with the delivery of orthopaedic PROMs – including NHS Digital, NHS Wales and the National Orthopaedic Alliance.

A new innovation which has been developed during 2019/20 is a national pilot of collecting electronic Patient Reported Experience Measures (ePREMs) from all patients at six weeks following their surgery. This has involved updating the NJR consent form to ensure that a patient’s email address and mobile phone number could be captured as part of the NJR dataset. A set of experience questions have been agreed by the PROMs working group and during the pilot, these will be sent to patients for completion. At the end of the pilot, data will be analysed to determine if patient reported metrics are likely to be feasible at scale. Aggregate PREMs results will also be shared with hospitals to allow these to feed into local improvement discussions.

Patient Decision Support Tool

In 2019, the NJR launched the NJR Patient Decision Support Tool. This is a web-enabled personalised patient decision-making tool for those considering hip or knee replacement. This simple tool, the development of which was supported by the charity Versus Arthritis, will help patients who are considering having a joint replacement to make evidence-based choices about their treatment and share decision-making with their clinicians, when considering the benefits and risks of undergoing joint replacement. To date, there have been over 35,000 visits to the website from over 100 countries, with very positive feedback received.

Having now launched this tool (available at: https://www.njrcentre.org.uk/njrcentre/Patients/Patient-Decision-Support-Tool). The NJR is continuing to collaborate with the University of Sheffield to further develop the prediction algorithm methodology underpinning the tool, which will result in algorithms that will allow the most up-to-date NJR data to be used to calculate the projected risks and benefits of joint replacement surgery, thus increasing the versatility of the prediction tool.

NJR Health Economics

The NJR continues to fund health economics work at the University of Bristol and this year this programme has focused on examining the lifetime cost-effectiveness of implants for patients of different age and gender profiles in hip replacement surgery. For more detail on this project see the In-depth studies section of this year’s NJR Annual Report (available at https://reports.njrcentre.org.uk).

NJR Data Access Portal

The NJR Data Access Portal represents a secure data access platform that houses Registry data in a secure area that researchers can access, reducing the administrative burden of legal permissions that would be required if data were to be released to them directly. This portal has now been used by several groups to securely access NJR data and from 2020/21 the portal will be the standard mechanism by which NJR data is made available to researchers. The committee has also made progress with entering into a sub-licensing agreement with NHS Digital that would allow applications for linked NJR, HES, PROMs and mortality data to be managed under a single application. Details of how to apply for secure access to NJR data for research purposes can be found at https://www.njrcentre.org.uk/njrcentre/Research/Research-requests.

NJR Annual Research Programme

Building on many high-quality publications over the years, the NJR continues to develop its annual research programme. Current projects include: inequalities in provision and outcomes; surgical approach; development of an arthroplasty morbidity index; and examining factors associated with revision and its outcomes. As projects complete, new topics are brought on-stream.

The NJR is also looking forward to starting a programme of work this year examining the utility of data from the national PROMs programme for understanding the performance of implants in the Registry. This work will examine national PROMs data from NHS Digital in England, and consider if the data scope and quality is sufficiently robust to adopt PROMs as an outcome measure across the NJR.

Use of NJR data this year

The Research Committee encourages external use of the NJR dataset to answer questions of clinical relevance and this year the NJR dataset has provided opportunities for several external researchers to develop innovative projects.

The NJR dataset has been used as the key resource in 12 research papers published during this same time-period, of which four were conducted or led by external, independent researchers.

Please see the NJR Research Project Portfolio here which catalogues all sanctioned research projects, progress reports and NJR updates in relation to research, using the NJR dataset, together with links to all publications related to NJR data.

Research Fellowship Scheme

Due to the COVID-19 pandemic the committee has been unable to appoint to the NJR Research Fellowship this year. We are expecting to open the 10th round of this programme in 2021. This is part of the NJR’s Joint Clinical Research Fellowship scheme run in partnership with the Royal College of Surgeons of England, helping the NJR to support high quality research in orthopaedics. Prospective fellows are encouraged to apply to the rolling programme. The NJR encourages applications from a diverse pool of applicants, including those from the allied health professions and non-clinical backgrounds. Look out for current opportunities on the NJR website.

Toby Jennison, the ninth appointed Research Fellow, continues to investigate five-year survival of total ankle replacements, as well as supporting the NJR in its classification and reporting of ankle arthroplasty across the Registry.

Rob Middleton, outgoing Research Fellow, completed a study looking at the association between frailty and outcome in joint replacement surgery. This has involved the validation of the electronic Frailty Index as a measure of frailty when applied to HES data. A second phase of this work (outside of the NJR/ RCS Research Fellowship programme) will investigate the associations between patient frailty and the primary and secondary outcomes of joint replacement (change in quality of life, change in Oxford Knee Score, complication events, mortality and revision rate).

Submitting a research application

The Research Committee takes formal responsibility for the approval for the release of NJR data for research through an impartial and objective process and has oversight of the use and reporting of this data by research groups. Its priority is to ensure that any research question justifies access to the data and offers potential benefits to patients. Research proposals should align to the NJR’s priority framework and be feasible, ethical, relevant and methodologically sound.

The NJR has a commitment to uphold the standard and consistency of work that is carried out using NJR data, in line with national and international legislation. Therefore, all requests must also be approved by the Healthcare Quality Improvement Partnership (HQIP) Data Access Review Group for final authorisation of data release.

Further information

If you would like to submit a research application, the first step in this process is to submit an expression of interest for consideration. Invited applications are reviewed by the committee quarterly. Full details of the NJR’s research application pathway, together with detailed guidance notes for applicants, can be found here.

Please see the NJR Research Project Portfolio. A full list of publications related to NJR data is included in Appendix 4.

2019/20 Surgical Performance Committee Chairman’s report – Mr Peter Howard

The SPC is comprised of its Chairman, Deputy Chairman (Mr Matthew Porteous), NJR Medical Director, patient representative, and representation from the NJR Management Team and both Lot 1 & 2 contractors. Matthew left the NJR at the end of March, my thanks go to him for his highly valuable contribution to this committee and its work over the last five years.

The NJR has continued with the schedule of two data refreshes each year, assessing performance over the previous five and ten years for both units and surgeons. There are no planned changes to the management process for surgeons and units that first present at alarm level (potential outlier), however there will be further contact if this status persists beyond the time that corrective action should have brought about improvement.

Annual Clinical Report

The Annual Clinical Report (ACR) issued to trusts, health boards, independent organisations and units, and to surgeons has been further refined this year. Some of the planned changes have since been put on hold as a consequence of the COVID-19 pandemic, but will be implemented next year.

Implant mismatch

The process for alerting surgeons and units to mismatches in size and side is now firmly embedded and continues to reveal instances where an implant of the wrong size or side has been implanted. A further area has been identified as requiring an alert, namely the use of a metal-on-polyethylene bearing in revisions following ceramic fracture. This is known to have the potential to cause excessive wear of the metal head and potentially toxic levels of cobalt in particular. The NJR is in the process of contacting surgeons who have apparently used this combination in the past, and in the future on a rolling basis.

2019/20 Implant Scrutiny Committee Chairman’s report – Mr Peter Howard

The implant scrutiny committee meets formally four times a year. The committee is comprised of surgeons, the NJR Medical Director (Deputy Chairman), and representatives from NJR core contractors: University of Bristol (Lot 2 providers), Northgate (Lot 1 providers), MHRA, representative NJR Management team members and ODEP/Beyond Compliance. In addition to this there are occasional informal meetings to discuss data analysis methodology.

Examining the data

The NJR data is refreshed and analysed every six months. The committee assesses potential outlier implant performance and notifies the MHRA when there are concerns. This process is constantly refined and, as a result of recent reviews, it is likely that more comprehensive reports will be developed for the future.

The PTIR method continues to be used to identify performance, in line with all registries internationally. It has, however, become clear that this method alone is not sensitive enough to identify failure in sub-groups, nor in the longer term where early performance has been acceptable. Future development will most likely include Kaplan-Meier estimates for the longer term.

Notification from surgeons of poor implant performance

The committee continues to encourage surgeons who have concerns about any implant brand or a particular range within a brand to contact the NJR directly. This enables the committee to focus on a specific area that might otherwise be camouflaged by the overall brand if the remainder are performing well.

Data from the other major joint replacement registries are always monitored and used to provide areas of focus for NJR’s analyses.

Future development

Knee replacements are now being analysed with and without primary resurfacing of the patella and it is clear from data presented in the 2020 report that this makes a significant difference to some implant performance, but not to others. It has resulted in some implants appearing as outliers as a consequence.

Implants and combinations identified as outliers

Details of implants and combinations identified as outliers are again included in this year’s report. Since the 2019 report there have been several new notifications to the MHRA in knee and hip replacement. Metal-on-metal continues to provide new outliers, although of little relevance to current practice. In the future, these implants will be left out of the calculations of the expected revision rates.

2019/20 NJR Medical Advisory Committee (MAC) Chairman’s report - Mr Timothy Wilton

The MAC is chaired by the NJR Medical Director, and is the channel for exchange of professional views and advice between the NJR and the specialist associations whose members deal with the procedures of interest to the NJR. The association’s Presidents are invited to attend the MAC and in addition, the committee gains valuable input from members of the GIRFT team, senior NJR clinicians and members of NJR’s Core Contractors who provide data management and data analysis. I am most grateful to all of the members for their hard work and input over the last 12 months.

The committee meets three times a year and there have been some important developments achieved in the last year.

Elective Care Reviews

It had become apparent following the first few BOA Elective Care Reviews (ECRs) that the details of the NJR Consultant Level Reports (CLRs) and the NJR Annual Clinical Reports (ACRs) about trusts were sometimes not fully understood by the clinicians or managers at trust level. BOA team members had been sometimes left uncertain of the detailed interpretation of some aspects of the data, and questions posed by clinicians at trust level could not always be answered promptly and with confidence at the time of the review. In order to speed up the process and make it more immediately responsive it has been agreed between the BOA and the NJR that the NJR Medical Director (or another senior NJR Clinician) will always be a member of the review team, at least for the initial session where the NJR data interpretation is most relevant. Two further reviews have now been undertaken with this new arrangement which appears to work very satisfactorily and I am grateful to the MAC for endorsing this new way of working.

Mechanism for feedback to trusts about excessive revision variance

The MAC members have discussed extensively the issue of how best to feed information back to trusts regarding surgeons whose outcomes are giving cause for concern. This has resulted in an agreement that the Annual Clinical Report will contain surgeon identifiers for surgeons who are no longer active in the unit but whose revision results gave some cause for concern. This is already shown for all active surgeons, but previously did not include inactive surgeon’s ID numbers. A list of surgeons with their ID numbers will also be made available confidentially to Medical Directors (or Responsible Officers if more appropriate to that hospital/organisation) on request, where the surgeon’s and/or unit’s results have been highlighted to be of concern, in order to facilitate discussions.

PROMs and other alternative metrics

Following the decision last year, Consultant Level PROMs results were made available to consultants through their CLRs this year. These form a further mechanism for the interpretation of the individual surgeon’s outcomes. The hope of the committee is that as these become more complete the data will help distinguish between issues such as: ‘Is a surgeon’s low revision rate due to excellent procedures and surgery?’, or ‘might the low revision rates be due to patients with poor outcomes being unable to access revision surgery for some reason?’

Similarly, implant companies are now provided with their own implant-specific PROMs results. The committee accepts that both for individual implants and for individual surgeons the percentage return of PROMs is variable and sometimes low. Furthermore, these PROMs returns are not within the control of either the surgeon or the implant company. We need to improve the level of returns if the results are to be of optimal value and it is fully accepted by the MAC members that such results are currently of use mainly as an additional indicator and not as a concrete outcome measure.

The committee is also discussing what other measurements might be made available to consultants and units from our routinely collected data and how the data can be rendered more robust.

MSK Registry

Last year members of the MAC gave generously of their time to pursue the concept of amalgamating existing musculo-skeletal related registries and bringing them together under one umbrella body. This project was successful in attracting attention and support from several parts of NHSE but unfortunately was stalled by the general election and the financial difficulties within the health service.

This issue has moved on in the meantime due to the impending publication of the Cumberlege report on 8 July 2020, which is expected to provide a strong impetus for a UK-wide ‘Implantable Device Registry’ across all specialities.

The NJR, along with the other aspects of orthopaedic device surveillance, such as ODEP ratings and Beyond Compliance, has been involved in early development and talks about how such a system could best be set up across the whole implantable devices field and we will be drawing heavily on members of the MAC to give advice to that process in the coming year.

Data Completeness

Data completeness remains an issue in many areas and in particular the areas concerning joints that have more recently been entered into the NJR. Shoulder PROMs are of particular relevance and we are working with the British Elbow and Shoulder Society (BESS) Executive diligently to ensure that we improve the completeness of PROMs collection, especially as the PROMs results may form a pivotal part of assessment for benchmarking prosthesis used in shoulders. While data quality is dealt with in the NJR Data Quality Committee it is of such vital importance that we need the full engagement of the MAC and the relevant specialist societies in order to make an impact on this critical area.

2019/20 NJR Executive Committee Chairman's report - Laurel Powers-Freeling

The NJR Executive Committee (NJREC) meets every 4-6 weeks to provide additional operational and financial capability to the NJR Steering Committee’s broader strategic and governance roles. It is chaired by Laurel Powers-Freeling, NJRSC Chairman.

The committee is made up of a ‘core group’ which meets less regularly and when required, with membership comprising the NJRSC Chairman, NJR Medical Director and NJR Director of Operations; and an ‘extended group’, with additional representatives comprising of the NJRSC Sub-committee Chairmen, senior representatives of the NJR Management team and NJR Core Contractors as required. It is essential that the committee’s structure is flexible and responsive as the Registry grows and stakeholder requirements change. Please see the online appendices for a record of members.

Importantly, the Executive Committee has delegated authority from the NJRSC for operational decisions that are under a financial threshold of £50,000 and for review and approval of proposed projects that constitute a change in the strategic direction of individual work streams and previously agreed project plans.

Given the expansion of the NJR’s work in recent years, as set out in the NJR Strategic Plan for 2018/21, the committee has already provided invaluable support.

Management of impact of COVID-19 Crisis

This year, with delegated authority from the NJRSC, the NJREC undertook a radical review of the proposed 2020/21 annual work plan and budget to reflect the impact of the COVID-19 crisis and recognition that NHS funds and administrative capacity needed to be directed elsewhere. Consideration was given to how resources could be conserved until the NJR could re-engage in collecting, processing and analysing data and re-instating income collection via Trust subscription payments. As a result, the NJR development plans and expenditure programme for 2020/21 have been significantly reduced.

2019/20 NJR Steering Committee Chairman's report - Laurel Powers-Freeling

This section provides brief outlines of the work undertaken by the NJR Steering Committee (NJRSC) and its sub-committees during 2019/20. Although brief, these sections are written with the intent of illustrating the ever-increasing scope of the work of the Registry and the valuable commitment made by all committee members to meet the needs of patient, orthopaedic, and regulatory stakeholders.

NJRSC Structure, Governance and Operating Model:

The NJRSC is designated as a NHS England ‘Committee of Experts’ and Chairman Laurel Powers-Freeling reports directly to the NHS E Medical Director. The NJRSC is responsible for setting the strategic direction of the NJR and overseeing its work. It also oversees a supporting structure of nine standing sub-committees, ensuring delivery of objectives and work plans from each. Key responsibilities of the NJRSC are to ensure that:
• Appropriate advice is provided to the Healthcare Quality Improvement Partnership, the legal entity which hosts the NJR on behalf of NHS England, on NJR operational and financial matters;
• The NJR budget is effectively managed and monitored;
• The NJR sub-committee structure is fit for purpose and all sub-committees have clear terms of reference, agreed composition and defined purpose and responsibilities;
• Outcomes achieved by brand of prostheses, hospital and surgeon are monitored and where these fall below expected performance, are highlighted to enable prompt investigation and follow-up by relevant implant suppliers, regulators, commissioners and providers of orthopaedic care;
• Appropriate stakeholders (patients, clinicians, providers and commissioners of healthcare, regulators, professional societies and implant suppliers) are involved in and consulted on the work of the NJR as appropriate and informed of outcomes achieved in joint replacement surgery;
• Patient awareness of joint replacement outcomes is enhanced to better inform patient choice and quality of experience, through engagement with patients, patient organisations and providers of care;
• Evidence-based purchasing (quality and cost effectiveness) of joint replacement implants by healthcare providers is supported;
• Post-market surveillance of implants by key stakeholders (implant suppliers, the Regulator, Beyond Compliance and ODEP) is supported;
• Codes of conduct applied to NJR Contractor(s) in their relationship with key stakeholders are monitored;
• Delivery and quality of work of NJR Contractors is effectively contract managed;
• Accurate, relevant and timely data collected by the NJR is made available to relevant regulators, commissioners and providers/suppliers of orthopaedic care, in an appropriate format, in order to support clinical governance;
• An annual report on the work of the NJR is published and made available in both the English and Welsh languages (and languages appropriate to any future countries that may be incorporated into the NJR) and in patient-friendly language;
• Appropriate governance and monitoring arrangements are in place to facilitate the use of NJR data to support and enable related research;
• NHS England (and devolved administrations as appropriate) is provided with advice on the NJR’s strategic direction, annual operational plan and work programme and financial position (including annual review of subscription charges and any proposed change);
• NHS England is updated on the performance of prostheses and good surgical practice, international collaboration work with other national orthopaedic joint registries, and any financial and/or intellectual property implications associated with licensing of the ‘NJR brand’.

Membership 2019/20

During this reporting period, the following changes to the membership of the NJRSC can be reported:

NHS Trust management member Rob Hurd left the NJRSC following his appointment to a new role within the NHS. His successor will be appointed in 2020/21.

Co-opted member Mr Matthew Porteous retired from the NJR, also stepping down from his roles as Chairman of the NJR Regional Clinical Coordinators and Data Quality sub-committees and Vice Chairman of the Surgeon Performance sub-committee. A successor will be appointed during 2020/21. In the interim, Mr Tim Wilton, NJR Medical Director, will chair the sub-committees on a temporary basis.

Dr Khalid Razak, MHRA representative, also completed his co-opted NJRSC membership and was succeeded by MHRA colleague Sharon Knight.

Mr Don McBride completed his annual co-opted membership as BOA President in September 2019 and was succeeded by incoming BOA President Mr Bob Handley.

The NJR is thankful to all of its members, past and present, for their considerable contribution to the Registry. Details of the membership of the NJRSC and each of its sub-committees for 2019/20 can be found in online appendices. Further information on changes this year, with the Chairman’s expressed thanks, can also be found in the Chairman’s Foreword.