Work of the NJR Committees

NJR Data Quality Committee (DQC)

Chairman’s report 2020/21 - Mr Tim Wilton

Our previous Chair, Matthew Porteous, retired from practice and from the NJR, at the end of March 2020 and relinquished his role as Data Quality Committee Chairman [and also RCC Committee Chairman]. We are greatly indebted to him for all his excellent hard work to bring NJR data quality and the data quality audit process, to the greatly improved current position. In view of the fact that by the time of his retirement the pandemic had begun in earnest, the position of DQC Chair was not then advertised and I took on the responsibility for the DQC, pending the financial and pandemic situation being clarified later in the year.

The year 2020/21 has proven a somewhat challenging in many respects for monitoring and improving data quality for national audits of all kinds. With the advent of the COVID-19 pandemic there was an immediate and massive impact on arthroplasty throughput, but this was followed rapidly by interventions from NHS England designed to allow hospitals to focus maximum attention on managing the pandemic. These interventions included instructions initially to all NHS trusts to cease entering data into the audits to release staff for other purposes. Happily this did not have as marked an effect as might have been the case for the NJR data, as the case numbers initially fell so dramatically that those cases which were in fact done were largely still entered by the data entry staff as usual.

The NJR data quality audit was continued, after an initial pause during spring 2020, and the automation of the audit process was rolled out to include independent hospitals. Towards the end of 2020 the automation process was also rolled out to include the other joints: shoulders, elbows and ankles, in addition to hips and knees.

Early in 2020 the NJR data quality strategy was reviewed, and minor adjustments made, and it is anticipated that the strategy will be formally reviewed in its entirety next year once the new DQC Chair is fully ensconced.

Particular issues with data quality have been identified with certain segments of the database including reverse shoulders, elbows, and dual-mobility hips. The reverse shoulder issue has been addressed by the new shoulder implant classification developed in collaboration with BESS and this should hopefully now enable a comprehensive reconciliation of the reverse shoulders in the database.

A pilot elbow replacement audit was completed with the assistance of Adam Watts and Wrightington Hospital, and this proved successful in correcting the data where there were inaccuracies. That process will now be extended to the rest of the NJR regions. With additional HES data for comparison it should now be possible to reconcile the whole elbow database which will then become the largest and most useful database of elbow replacements in the world. Difficulties with coding multi-compartmental partial knees has been rectified within the data-entry system but there have been few registered, due perhaps to a combination of COVID-19 and changes to some surgeons’ practice. This is to be the subject of debate at BASK during 2021 in order to resolve any remaining issues.

Due to the difficulties with the data entry suspension in-year, some units have struggled to meet the deadline for our NJR data quality award, and this deadline was therefore extended so that units who meet the required data standard for an extension have still been able to achieve the data quality levels necessary to receive their data quality award.

I am delighted to announce that from 1 April 2021 Derek Pegg was formally appointed to Chair the DQC and we look forward to his energy and enthusiasm taking data quality in the NJR to even greater heights.

NJR Regional Clinical Coordinators (RCC) Committee

Chairman’s report 2020/21 - Mr Derek Pegg

On 6 January 2020, Matthew Porteous chaired his last RCC meeting before retiring from the NJR and orthopaedic practice in March that year. We are all extremely grateful for all the great work and enthusiasm he brought to the role over the years and wish him a happy retirement.

At that January meeting, little did we know what was about to happen to global health care! Due to the COVID-19 pandemic the May 2020 meeting was cancelled, and subsequent meetings have been held through online meeting arrangements. After serving as a deputy, I was appointed to the role of Chair during March 2021 and took up post formally on the 1st April 2021.

The RCC Committee acts as a collaborative interface between the NJR and the orthopaedic community. Members provide useful observations and suggestions from the community and act as a ‘sounding board’ for new ideas and NJR policy direction.

The RCC members provide excellent advice on communication with hospitals, both for feedback to units and where practice and performance has been of concern. They have also raised several topics that we have then been able to clarify and address; as well as assisting individual surgeons and units in their regions who have faced challenges.

It is always extremely helpful to have a degree of local knowledge where issues may arise. For example, helping ‘nudge’ units to engage with the ongoing automated data quality audits.

There are currently ongoing discussions on the overall composition of the RCC committee as regards numbers and regional/proportional representation; and to what extent RCCs can support colleagues within their region who find themselves highlighted as having a significantly higher revision rate than their peers.

Most future meetings are likely to continue to be conducted online. However, it was agreed at the February 2021 meeting, that it would be highly desirable to have at least one face-to-face meeting a year, to enable an opportunity to meet for more usefully engaging interaction.

Editorial Board

Chairman’s report 2020/21 – 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 information guides and the ‘NJR Reports’ website.

The Editorial Board is accountable to, and reports to, the NJR Steering Committee and brings together specialist 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 2021

Moving away from expensive lithographic printing techniques and harnessing modern technology this year the board has published the NJR’s 18th Annual Report in a digital print format, and again digitally online making all sections of the report available either as navigable pages on the ‘NJR Reports’ website or as downloadable files, which 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, descriptive analysis of the NJR’s demographic data and activity trends can also be found by using the above link to the site. 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 17.75 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. We also publish a document reporting usage of prostheses in the most recent full calendar year.

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 all of the numerous report sections and review across the team. 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.

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 continue to strengthen this further in the coming years.

The Editorial Board has been particularly pleased to see the root and branch review 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 to move this useful information onto the new NJR website to make it even more imaginatively presented and to enhance public and patient accessibility.

The five current guides cover the NJR range of joint replacements for which data is collected. These reference guides provide information understood from NJR annual report analysis that is useful and easy to digest for patients who are considering a joint replacement.

Promoting the 18th NJR Annual Report findings

The 18th NJR Annual Report will be formally launched at the BOA Annual Congress in September 2021.

NJR Research Committee (RC)

Chairman’s report 2020/21 - Professor J Mark Wilkinson

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 of our research activity. During 2020/21 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 our aim to maximise the value of the registry dataset to patients and the wider healthcare community. My thanks go to all members of the committee for their efforts in the past year and for their hard work which makes it possible to facilitate data access and to support these high quality research outputs.

We are pleased to welcome Derek Pegg, NJR Regional Clinical Coordinators Committee and Data Quality Committee Chair onto the committee as a co-opted member. We also welcome Dave Townshend onto the committee as a specialist in foot and ankle research. I’d like to also express my thanks to Jitendra Mangwani for his contributions to the committee over recent years.

NJR ePREMs Pilot

Collection of patient-reported metrics remains a major strategic priority for us 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 and communication specialists as well as 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 orthopaedic PROMs – including NHS Digital, NHS England/Improvement, the Care Quality Commission and the Medicines and Healthcare products Regulatory Agency (MHRA).

Having developed and agreed tools for the pilot collection of electronic Patient Reported Experience Measures (ePREMs) from all patients at six weeks following their surgery, we had delayed starting this pilot due to reduced surgical volumes as a result of COVID-19. This pilot will take place during 2021/22 and will be delivered using patient contact details (email address and mobile number) either provided by the patient, or from patient data already held by hospitals. 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 enable these to usefully feed into any relevant local improvement discussions.

Patient Decision Support Tool

In 2019 we 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 their 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 launched this tool (available at: https://www.njrcentre.org.uk/patients/patient-decision-support-tool/), we are continuing to collaborate with academic partners to further develop the underpinning prediction algorithm methodology. This will result in more agile algorithms that will allow the most up-to-date registry 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

We continue to fund health economics work conducted at the University of Bristol and this year this programme has focused on examining the budget impact on the NHS of implant types used in primary total hip replacements.

NJR Data Access Portal

The NJR Data Access Portal represents a secure data access platform that houses registry data in a secure environment that researchers can access under strict data protection protocol, reducing the administrative burden of legal permissions that would be required if data were to be released to them directly. This portal has been used by several groups to access registry data and the portal will now be the standard mechanism by which data is made available to researchers. We have entered into a sub-licensing agreement with NHS Digital that allows 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/research/research-requests/.

NJR Annual Research Programme

Building on many high quality publications over the years, we continue to develop our annual research programme. Current projects include: inequalities in provision and outcomes; development of an arthroplasty morbidity index; examining factors associated with revision and its outcomes and an examination of the data quality of the national PROMs programme. As projects complete, new topics are brought on-stream. All projects are delivered in a collaboration between the NJR Research Committee and the University of Bristol.

Use of NJR data this year

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

Our dataset has been used as the key resource in 21 research papers published during this same time-period, of which five 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 was unable to appoint to the NJR Research Fellowship in 2020. The NJR’s Joint Clinical Research Fellowship scheme is 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. Look out for ongoing opportunities on the NJR website.

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 our priority framework and be feasible, ethical, relevant, and methodologically-sound.

We have a commitment to uphold the standard and consistency of work that is carried out using registry data, in line with both 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 check whether the same topic is currently being examined by another research team by visiting the NJR Research Project Portfolio, then submit an expression of interest for consideration. Invited full 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.

A full list of publications related to NJR data is included in Appendix 4.

NJR Surgical Performance Committee (SPC)

Chairman’s report 2020/21 - Mr Peter Howard

The SPC is comprised of its Chairman, and also the NJR Medical Director, RCC Chairman, surgeon representatives from the RCC committee, CQC representatives, a patient representative, representation from the NJR Management Team and representatives of both Lot 1 & 2 NJR contractors.

We have continued with the schedule of two data reviews each year, assessing performance over the previous five and ten years for both units and surgeons performing hip and knee joint replacement. The Accountability and Transparency Model, that we first introduced in 2017 is now well embedded and we work closely with the CQC and NHS Improvement to escalate issues where necessary. Work is ongoing to further develop the model to ensure we are enabling transparency across the whole sector.

Annual Clinical Report and Consultant Level Report

Further changes and updates have been made this year to the Annual Clinical Report (ACR) provided for all Trusts, health boards and independent hospitals and also to the Consultant Level Report (CLR) provided for consultant surgeons. These reports are accessible through the NJR Connect - Data Services portal. They include a number of changes that were previously put on hold due to the COVID-19 pandemic. A new section has been included in the CLR that enables surgeons to see how many procedures they have carried out jointly with another consultant (dual or tandem operating). The ACR also carries a new section identifying how many different implant brands a unit has used over the past five and ten years, the names and volume used of each brand can be seen through the Reports (Trust Level Implant Reports).

Implant mismatch

We are continuing to alert surgeons and units to the very rarely occurring mismatches in size, side and manufacturer. This alert process is well embedded and is monitored regularly by the both the SPC and NJR Data Quality Committee. We have developed a tool that enables a check in theatre for any incidence of mismatch and throughout the coming year, the recommendations from the Healthcare Service Investigations Bureau (HSIB) to action and enable this real time checking of implants in theatre will be piloted.

Future plans

A working group is developing a process and methodology to monitor surgeon and hospital performance for shoulder joint replacement. The expansion of the SPC committee to oversee and monitor shoulder replacement surgery will provide further reassurance to patients of the value on the registry for their safety.

NJR Implant Scrutiny Committee (ISC)

Chairman’s report 2020/21 - Mr Peter Howard

The ISC meets formally four times a year. The committee is comprised of surgeons, the NJR Medical Director (Deputy Chairman), and representatives from the NJR’s core contractors: University of Bristol (our Lot 2 providers), Northgate Public Services - known as NEC from July 2021 (our Lot 1 providers), MHRA, representative NJR Management Team members and ODEP/Beyond Compliance.

Examining the Data

The registry data is refreshed and analysed every six months. The committee assesses potential outlier implant performance and notifies the MHRA when there are concerns. In addition, the committee also responds to any queries and concerns raised by surgeons and regulators, undertaking additional analysis to investigate these where necessary.

We currently use a Patient Time Incidence Rate (PTIR) method to identify poor performance, in line with other registries. It has become apparent that this method alone is not sensitive to identify failure in sub-groups or in the longer term. A working group is currently developing a methodology to use Kaplan-Meier estimates alongside PTIR to improve the sensitivity of implant performance monitoring.

In addition, further stratification has also been introduced into the current analysis to separate out different sub-groups. For the coming year, primary knee replacements will be analysed by posterior stabilizing and cruciate retaining types, as it becomes clear this could make a difference to implant performance.

Future developments

A working group is currently developing the processes and methodology to enable us to monitor the performance of shoulder implants more closely, in line with the current processes for hip and knee implants. This key development will ensure that the NJR is committed to even greater levels of scrutiny of implant performance.

Implants and combinations identified as outliers

Details of implants and combinations identified as outliers are again included in this year’s report. We encourage all surgeons to review this carefully to help inform their clinical decisions. Since the 2020 report, there have been several new notifications to the MHRA in hip and knee replacement. During the coming year, surgeons will be able to access a greater level of information on implant performance via our new NJR Connect - Data Services portal. In the future, we will be informing any surgeon who may be using implants identified as outliers, as soon as this status comes to light, to enable them to consider their future usage.

NJR Medical Advisory Committee (MAC)

Chairman’s report 2020/21 - Mr Timothy Wilton

The MAC committee met three times during the year and the enforced ‘virtual’ nature of our meetings did not appear to have an adverse impact on the discussions, with extremely useful feedback to the NJR from the BOA and specialist societies on many issues. The committee also provides the NJR with the opportunity to share information with the specialist societies and ensure that they kept updated on developments, such as the new cloud-based data services portal ‘NJR Connect’, and the newly improved and automated NJR audit systems that are now actively in operation.

Representatives of the BOA and specialist societies have canvassed their opinion about a number of crucial issues including:

1) Patellar resurfacing and secondary resurfacing procedures;

2) Debridement Antibiotics and Implant Retention (DAIR) procedures for both hips and knees; and

3) Recent NICE guidance on arthroplasty, and the implications for the data collected and disseminated by the NJR.

These matters have been taken back to other NJR committees to formulate processes and policies, which will hopefully enable the issues of concern to be addressed more appropriately in the future. These ongoing issues are to be the subject of debate at the forthcoming specialist society meetings, which I, and Peter Howard, will attend to help inform those discussions.

Several important revisions to both the Annual Clinical Reports (to trusts, Health Boards and independent sector providers) and the Consultant Level Reports, have been introduced in the last year and feedback to the MAC was that these had been well received by the orthopaedic community. In particular, the inclusion in the new ACR appendices of information regarding the breakdown of revisions in the hospital unit by indication for revision, was found very helpful. Similarly, the breakdown of expected versus observed revisions by consultant for each individual unit’s primary activity, was found to be a very useful adjunct to the information about the consultant’s whole practice, which has previously been, and remains, available.

Following the Cumberlege report there has been considerable activity from NHSE/I in relation to the development of better more comprehensive registries and systems, to support patient safety in relation to implantable medical devices. The NJR is regarded as a ‘global exemplar’ for this sort of work and extensive discussions occurred in MAC regarding the advice that could be offered to these organisations, about setting up registries and the mechanisms for furnishing that advice. As the NJR Medical Director, I am actively involved in these developments and am keen to ensure that all necessary channels of advice from the BOA and specialist societies are as open and engaged as possible to facilitate this process.

The issue of the NJR/BOA/TORUS MSK Registry development remains at the forefront of our discussions with NHSE/I, but currently progress on this front has stalled due to the overlapping and more extensive discussions around the wider development of nationwide Medical Devices Information Systems. Professor Briggs, on behalf of GIRFT/NHSE/I, has continued to repeat his support for the MSK Registry proposal, as well as his conviction that the NJR produces invaluable data and analysis, which is of considerable importance to the overall patient safety and clinical improvement programmes. He repeated his assurance to the MAC, that development of these programmes, currently underway, will not be allowed to undermine the quality of data being collected by the NJR, or jeopardise our current ability to continue our assessment of the safety of arthroplasty.

NJR Executive Committee (NJREC)

Chairman’s report 2020/21 - Laurel Powers-Freeling

The NJR Executive Committee (NJREC) meets quarterly to provide additional operational and financial capability to the NJR Steering Committee’s broader strategic and governance roles. It plays a vital role in facilitating faster decision making across the large and complex range of NJR business. In 2020/2021 four meetings of NJREC were held. The committee is chaired by Laurel Powers-Freeling, NJRSC Chairman.

The committee is made up of a ‘core group’ which also meets separately and less frequently when required, with membership comprising the NJR 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 as required and representatives from NJR contractors.

Importantly, the NJREC has delegated authority from the NJRSC for operational decisions that are under a financial cost threshold of £50,000 and for review and approval of proposed projects and developments that constitute a change in the strategic direction of individual work streams and previously agreed project plans. Please see the online appendices for a record of members.

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

Management of Impact of the COVID-19 Crisis

This year, with delegated authority from the NJRSC, the NJREC held three additional extraordinary meetings to undertake a radical review of the proposed 2020/21 annual work plan and budget, to reflect the impact of the COVID-19 crisis and recognise that NHS funds and administrative and surgical capacity, needed to be directed to dealing with the emerging pandemic crisis. 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 were significantly reduced.

NJR Steering Committee (NJRSC)

Chairman's report 2020/21 - Laurel Powers-Freeling

This section provides brief outlines of the work undertaken by the NJR Steering Committee (NJRSC) and our sub-committees during 2020/21. Although brief, these sections are written with the intent of illustrating the ever-increasing scope and complexity of our work and the valuable commitment made by all committee members to ensure the work of the NJR meets the needs of our patient, clinical, regulatory and industry stakeholders.

NJRSC Structure, Governance and Operating Model:

The NJRSC is designated as a NHS England ‘Committee of Experts’ and our Chairman Laurel Powers-Freeling reports directly to the Medical Director for NHS England. The NJRSC is responsible for setting our strategic direction and for overseeing the successful delivery of our work and closely managing the associated budget. The committee also oversees a supporting structure of nine sub-committees, each responsible for a dedicated area of NJR work and ensuring the delivery of work plans and development activities against agreed objectives.

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 Medical Directorate), on operational and financial matters;
• The NJR budget is effectively managed and monitored;
• The NJR sub-committee structure is fit for purpose and that all sub-committees have clear terms of reference, agreed composition, and defined purpose and responsibilities and report outcomes to the NJRSC regularly;
• 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 Medicines and Healthcare products Regulatory Agency, Beyond Compliance and Orthopaedic Devices Evaluation Panel) 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 and patient safety;
• An annual report on the work of the NJR is published and made available in both the English and Welsh languages and in patient-friendly format;
• 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 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 the licensing of the ‘NJR brand’.

Membership 2020/21

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

NHS Trust Management member Rob Hurd stepped down from the NJRSC following his appointment to a new role within the NHS and Mr David Macdonald, Independent Sector representative, also left the committee. New representatives for both roles will be recruited during 2021/22. Robin Brittain, patient representative, was re-appointed as a member for a second term of office from 1/1/2021 to 31/12/24.

At the end of the last financial year, co-opted member Mr Matthew Porteous retired, also stepping down from his roles as Chairman of the NJR Regional Clinical Coordinators Committee [RCC] and Data Quality Committee, and Vice Chairman of the Surgical Performance Committee. He was succeeded by Mr Derek Pegg, who commenced as Chairman of the RCC committee in January 2021 and as Chairman of the Data Quality Committee in April 2021. Pending his appointment, Mr Tim Wilton, NJR Medical Director, undertook the role of acting Chairman of both committees. As Chairman of these two sub-committees, Mr Derek Pegg also joins the NJR Steering Committee as a co-opted member and the extended Executive Committee as a member.

Mr. Don McBride completed his annual co-opted membership as BOA President in September 2020 and was succeeded by incoming BOA President, Mr Bob Handley.

We are thankful to all NJR committee members, past and present, for their considerable contribution to the registry. Details of the membership of the NJRSC and each sub-committee for 2020/21 can be found online in appendices. Further information on changes this year, along with the NJR Chairman’s notes of thanks, can also be found within the Chairman’s Foreword.