Chairman's Foreword

Chairman's Foreword

Laurel Powers-Freeling Chairman,
National Joint Registry Steering Committee (NJRSC)

The NJRSC oversees the strategic and operational work programme of the registry and I am delighted to have performed the role of Chairman of the Committee over the past ten years, which means, following good governance standards, it is time for me to make way for a new person in the NJR chair.

In each of the past ten years, I have had exciting news to share regarding the evolution of the NJR. While this year has been very challenging in the wake of the pandemic - the NJR nonetheless delivered a number of important developments. This NJR Annual Report provides the opportunity to reflect back on our work over the last year and look to the year ahead. Highlights are summarised here in this 18th edition of our Annual Report.

Our Work and Developments

Managing the impact of the COVID-19 crisis: In 2020/21 the NJR undertook a radical review of our proposed annual work plan and budget to reflect the impact of the COVID-19 crisis. We considered how resources could be conserved until we could re-engage in collecting, processing and analysing data for our work and reinstating income collection via trust subscription payments. As a result, our development plans and expenditure programme last year were significantly reduced. We will continue to monitor our activity and finance in 2021/22, to ensure the impact of reduced elective surgery and its effect on trust subscription income continues to be managed.

NJR/BOA plans for implementation of a Musculoskeletal [MSK] Registry: This year we have continued to pursue the proposal to develop a national MSK registry, bringing the seven registries forming the BOA Trauma and Orthopaedic Registries Unifying Structure (TORUS) together with the NJR, under a single governance body. This proposal has gained support in principle from NHS leadership following publication of the Cumberlege report, which identified the need for more comprehensive implant device registries and cited the NJR as a ‘global exemplar’ of such a registry. This provided the opportunity for us to propose the MSK registry be considered as a useful pilot for plans to develop appropriate options for implementation of larger integrated data sets for implantable devices. We will pursue this objective in the coming year and ensure that we continue to align with national plans to deliver appropriate options for implementation of a centralised registries database.

Automating our Data Quality Audit: Data quality has continued to be a key priority for the NJR and our Data Quality Audit programme has been a unique initiative with considerable success in assessing the completeness and quality of the data submitted to the registry. However, the process of comparing local hospital records to those submitted to the NJR has been labour intensive for both hospital and NJR staff, so we began a national roll out of an enhanced, automated process. This has greatly reduced the burden involved in undertaking this work and enables units to check their data quality on a more frequent basis. Full roll out of this enhanced process in all joint types was completed in 2020/2021. In addition, data quality exercises involving dual mobility hip replacements, reverse shoulder replacements and multi-compartmental knee replacements are now being developed in consultation with the relevant specialist societies.

PROMs and ePREMs: An important element of work continues to be the collection, analysis and reporting, of patient reported metrics and this year we have focused on a number of key areas. We have been examining the quality and representativeness of national PROMs for patients who have hip and knee replacement surgery, which will ensure that clinicians, hospital managers and regulators can have confidence in using patient reported metrics to assure quality. We have also been routinely including reporting of PROMs metrics in implant reports made available to manufacturers via the NJR Supplier Feedback service and developing a system that will make a library of these implant reports available to clinical teams via a new digital platform that will be launched in 2021/22. In conjunction with both BESS and GIRFT, we have been working to improve patient engagement with pre-operative PROMs submissions and in the coming year we will commence an electronic Patient Reported Experience Measures (ePREMs) pilot, halted this year due to the COVID crisis, where we hope that patients will share their experiences of joint surgery to help improve healthcare for patients.

Modernising our IT Platform - Launch of ‘NJR CONNECT’: Last year we commissioned the development of a cloud-ready, platform-based application framework for provision of future NJR services. The rationale for this included a focus on the need to develop an environment with the ability to move to a cloud-based infrastructure and have the capacity to extend to any additional registry alignment. This year the first phase of development launched and transferred the NJR Clinician Feedback services into the new environment, along with a more interactive reporting service, including the Consultant and Surgeon Level Report, Annual Clinical Report, Clinical Outcomes Publication Preview, Clinician Profile Edit, interactive outcomes and clinical practice reports and a contacts database. Further development will continue during 2021/22 and include the NJR component database and supplier and management feedback systems, interactive reporting, availability of an implant data library, a new semantic layer to aid researcher secure access to NJR data, data entry and data quality tools, and the Data Access Portal.

Unique/innovative solutions to support patient safety: Following the NHS Healthcare Safety Investigation Branch requirement to reduce the number of ‘never events’ associated with joint replacement surgery, the NJR has been working to deliver validation rules that apply in data entry to an external environment, for use in support of intra-operative checks. The data entry system has been updated to enable it to detect potential ‘never events’ and warn the data entry user, also alerting the NJR team so that this can be investigated. We have also developed an Application Programming Interface, to allow hospital theatre systems to interface with NJR’s checking rules and enable immediate identification of implant incompatibilities as ‘never events’ in real time, so these are identified before the implant is put in the patient. A smartphone version of this application is also being developed so clinical teams can undertake validation checks even if their hospital does not have a compatible front-end system. This work also supports the importance of the emphasis on patient safety as highlighted in the Cumberlege report.

Research and the NJR Data Access Portal (DAP): Research has been a huge part of the NJR’s success and the output of peer-reviewed papers by the University of Bristol and by others using NJR data, has been truly extraordinary and ensures that NJR data can be best used to inform and improve practice. It has led to a large number of important and impactful publications, delivering valuable evidence about how joint replacement surgery works and with the key aim of being used to improve patient safety and outcomes. This year the NJR DAP has been developed to streamline research applications by providing a secure working environment, including analysis tools for researchers and users of NJR data, whilst enabling the NJR to manage and control our data more effectively. Providing access to the data without the need for datasets to be sent to third parties will significantly reduce the governance burden that research teams face.

The NJR Patient Decision Support Tool: A major initiative has been the launch of the NJR Patient Decision Support Tool, a web-enabled personalised decision-making tool for patients considering hip or knee replacement. This tool, whose development was in collaboration with the University of Sheffield and supported by the charity Versus Arthritis, will help patients considering joint replacement make evidence-based choices about their treatment and share decision-making with their clinicians when considering the benefits and risks of undergoing joint replacement. We are continuing a collaboration with the University of Sheffield to enhance the tool to allow the most up-to-date NJR data to be used to calculate the projected risks and benefits of joint replacement surgery. This NJR initiative will continue to benefit healthcare economies through improved clinical outcomes and better resource utilisation.

Redevelopment of the NJR Website: Work has been ongoing to design and build the architecture for our new website. As our public-facing information portal, the aim of the upgrade is to develop increased functionality to make the website more engaging and enable us to develop new visual material to inform our stakeholders more imaginatively about the work we do and to clearly demonstrate how the NJR benefits the orthopaedic sector. The website is scheduled to launch during 2021/22.

NJR Component Database and International Benefits: Following work with the German Arthroplasty Registry (EPRD) to develop a common classification system for defining the attributes of hip and knee arthroplasty components, the classification has been adopted by both our registries, each of us managing our own local databases populated by industry implant suppliers. Use of this classification data for NJR reporting will commence in 2021/22. In addition, we have agreed to license the component classification system to the International Society of Arthroplasty Registers for their International Prosthesis Library platform, meaning the hip and knee components can be classified in the same way in registries across much of the world. This will provide the valuable international benefits of improving the comparability of data for identifying poor outcomes and of decreasing the burden on industry colleagues in data upload. In addition, the University of Oxford have proposed a new component classification for shoulder arthroplasty devices, which is planned to be published on open access and will be free to license and will further form the basis of a new shoulder component database, to be developed by the NJR in the coming year.

The people who make the NJR a success

This year has seen a number of changes to the NJRSC membership. I am delighted to welcome Derek Pegg as a co-opted member of the NJRSC, in his new role as Chairman of the NJR Regional Clinical Coordinators (RCC) and Data Quality Committees, succeeding Matthew Porteous. Derek has supported the NJR for many years as Vice Chairman of the RCC Committee and through membership of a number of NJR sub-committees. I thank him for his continued support and wish him well in his new roles. I am also very pleased to confirm the re-appointment for a further term of office, of both Peter Howard, NJRSC surgeon member and Robin Brittain, NJRSC patient representative member and to thank them for their continued hard work. My appreciation also goes to Bob Handley for his contribution as BOA President to the NJRSC this year, which has been important in continuing our valued relationship with the orthopaedic profession. We look forward to welcoming his successor John Skinner, who takes up post from September 2021.

As ever, my grateful thanks go to the NJR Regional Clinical Coordinators who underpin and champion the work and success of the NJR at a local level. Also to our contract partners Northgate Public Services (UK) Ltd (who will be known as NEC Software Solutions UK Ltd from July 2021) and the University of Bristol, for their excellent work throughout the year in supporting the NJR to deliver its work agenda and objectives. I would like to end by thanking all members of the NJRSC and sub-committees for their valuable contribution. In particular, my thanks to Tim Wilton, NJR Vice Chairman and Medical Director, for his clinical expertise and leadership and for his interim chairmanship of the RCC and Data Quality committees, pending the appointment of Derek Pegg. My sincere thanks also to the Chairmen of each of our sub-committees - Peter Howard, Mark Wilkinson, Mike Reed and Derek Pegg - for their hard work, vision and effort. Without their dedication, the NJR would not be the world-leading arthroplasty register and global exemplar of an implantable device registry that it is. I would encourage you to read the reports from each committee Chairman at where they provide strategic oversight into key work areas.

Finally, my thanks as ever to the NJR Management Team who in the past year have had to cope with an environment of uncertainty in how and where to work, with shifting priorities and compressed budgets. They have continued to support the NJR cheerfully and tirelessly, against a challenging background. I particularly want to thank Elaine Young, my partner in all things NJR for the past decade, whose dedication to what the NJR delivers has always been extraordinary.

I leave the NJR with mixed feelings: I am immensely proud to have been associated with so many talented, dedicated professionals and to have been a part of a truly extraordinary organisation. But I am also concerned about how the NJR we have all worked so hard to build will fare in the headwinds of a challenging NHS environment. Having said that, I know I leave our organisation in the capable and protective hands of my extraordinary Steering Committee colleagues…but I will be watching!