NJR Structure & Governance

Finance

A subscription charge is made to every hospital carrying out joint replacement surgery. The charge each year is calculated on the number of procedures each hospital has submitted into the registry in the previous financial year.

Income and expenditure 2021/22

The NJR is self-financing and we review the subscription rate in accordance with the cost of the work we will need to perform each year in order to meet our strategic aims.

Once reviewed and re-assessed, the new rate of the subscription charge is then recommended by the NJRSC for approval by NHSEI and is subject to a Memorandum of Understanding between NHSEI, the Welsh Government, Health and Social Care Board Northern Ireland, Guernsey and the Independent Healthcare Providers Network.

During 2021/22 subscriptions totalling £3,246,110 (2020/21 £3,423,026) were collected from NHS and independent sector providers. Other income of £782,863 (2020/21 £773,045) included supplier contributions, cost recovery charges for research dataset provision and other ad hoc income streams.
    
Expenditure on the management and development of the National Joint Registry was £3,329,365 (2020/21 was £3,414,078). This included governance costs of £169,493 (2020/21 £150,250).                
             
Full 2021/2022 accounts

The NJR’s financial results are included in the audited accounts of HQIP as ‘host’ of the NJR. The full audited accounts are available on HQIP’s website from December 2022 and can be accessed on websites for the Charity Commission and Companies House.

NJR Strategic Plan

We review and consult with a wide range of stakeholders to develop our three-year strategic plan to ensure that it is supporting the priority improvement areas for joint replacement surgery.  

The plan identifies a number of strategic themes, along with the work programmes necessary to support those themes. 

The broad areas covered in the plan are:

•    Patient safety
•    Improving patient outcomes
•    The value of joint replacement surgery
•    Enabling and supporting research
•    Data quality improvement
•    Patient and public involvement
•    Stakeholder engagement and communication
•    Enabling access to data and information
•    Key partnerships and international collaboration
•    Robust operating model and governance

The strategic plan is supported by our annual planning which each year identify the work required to deliver the strategy, based on priorities set by our NJRSC. Following review and approval by the NJRSC, the annual planning is used to monitor the progress and performance of key activities on a quarterly basis.

For further details on the NJRSC see Work of the NJR Committees.

The current NJR Strategic Plan for 2022-2025 is available on our general NJR website here.

NJR Steering Committee (NJRSC)

The NJRSC is designated as an NHS England/Improvement (NHSEI) ‘Expert Committee’ and is responsible for overseeing the strategic direction and management of the NJR. The NJRSC meets quarterly and membership is formally recruited. The current list of members and their declarations are listed in the report online appendices (available in the Downloads section).

The NJR formal links into NHSEI have been delegated to the NHSEI Medical Directorate, who have ownership of the NJR and oversight of funding arrangements. As the NJR is not a legal entity as established, NHSEI provides delegated authority to the Healthcare Quality Improvement Partnership (HQIP) to ‘host’ the NJR on their behalf and provide the necessary data controllership and governance arrangements. Joint NHSEI/NJR/HQIP accountability meetings are held quarterly, with representatives of each organisation in attendance. The NJR Chair, Medical Director and Director of Operations represent the NJR. Meetings are also held between the NJR Chair and NHSEI National Medical Director as needed, to discuss areas of NJR strategy and policy

NJR Sub-committees

Eight sub-committees support the work of the NJR Steering Committee.
• Executive Committee - Chair, Professor Sir Paul Curran
• Medical Advisory Committee - Chair, Mr Timothy Wilton
• Editorial Committee - Chair, Professor Mike Reed
• Implant Scrutiny Committee - Chair, Mr Peter Howard
• Surgeon Performance Committee - Chair, Mr Peter Howard
• Research Committee - Chair, Professor Mark Wilkinson
• Data Quality Committee - Chair, Mr Derek Pegg
• Regional Clinical Coordinators Committee - Chair, Mr Derek Pegg

NJR Management Team (NJRMT)
The NJR Management Team is led by the NJR Director of Operations and supports the work of the NJRSC and its sub-committees. The team is responsible for the overall operational, contract and performance management of the NJR and for the associated communications to support NJR business activity and stakeholder engagement. The NJR’s services are delivered under two separate contracts, which are overseen, managed and monitored by the NJR Management Team. 

These are:

Contract Lot 1: Data Management, Data Solutions and Associated Services
The NJR’s data management and data solutions work is contracted to a team within NEC Software Solutions (NEC). NEC has responsibility for the management and development of the data collection, software infrastructure, and data management and for reporting services for the NJR. NEC is also contracted to facilitate the front-face of the ‘NJR Service Desk’, a team who provide day-to-day information and support to the NJR’s stakeholders.  A team of four NJR Compliance Officers and a Data Quality Officer also supports orthopaedic units across NHS and independent sector hospitals.

Contract Lot 2: Statistical Analysis, Solutions and Associated Services
The NJR’s statistical analysis work is contracted to a combined team from the Universities of Bristol and Oxford. The team is responsible for the delivery of analyses of the NJR’s data and data from other sources, and for developing and implementing the statistical methodologies for the identification of potential outlier performance. Their role also includes planned and ad hoc data analyses, in addition to those included in the NJR Annual Report or that are central to the work of our Implant Scrutiny Committee and our Surgical Performance Committee.

The National Joint Registry (NJR) collects joint replacement data in England, Wales, Northern Ireland, the Isle of Man, and Guernsey.

We have collected data in England and Wales for:
• hip and knee surgery since April 2003
• ankle surgery since April 2010
• elbow and shoulder surgery since April 2012

Northern Ireland started to submit data to the registry in February 2013 and the Isle of Man in July 2015. Guernsey joined in November 2019.

Described as a global exemplar of an implantable medical device registry, the NJR continues to be the largest orthopaedic registry in the world, with an international reputation and now with around 3.5 million procedure records submitted, as at 31 March 2022.

NJR Mission

The mission of the National Joint Registry is to collect and analyse high quality and relevant data about joint replacement surgery in order to provide timely warnings of issues relating to patient safety. In a continuous drive to improve patient outcomes and to ensure the quality and value of joint replacement surgery, we will monitor and report on outcomes, and enable and support related orthopaedic research.

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