Work of the NJR Committees

NJR Data Quality Committee (DQC) 
Chair’s report 2022/23 - Mr Derek Pegg 

During 2022/23, we have continued to focus on completing the audits for the outstanding audit years 2018/19, 2019/20, and 2020/21, completion of which for many units were directly impacted as a result of the initial COVID wave. The 2020/21 audit is almost complete, and work is ongoing to complete the 2021/22 audit using data quality automation, further extending the audit to elbows, shoulders and ankles. As a result of this automation, units have been able to review their data more regularly and the NJR goal to conclude these essential audits in a timelier manner is already evident.
 
However, there remain a few units where consistently compliance and engagement with the annual audit cycle remains poor. There are often multiple issues within such units. The NJR will continue to support such units as much as possible to achieve the data quality of their peers. 

A total of 313 hospitals completed the 2021/22 audit by the target deadline and were eligible to receive their Data Quality Provider Awards. Work on expansion of the data quality audit to include additional codes for Debridement and Implant Retention (DAIR), hip hemiarthroplasty and focal knee resurfacing is well underway. Following the historical issues with data quality regarding certain segments of the registry data, work on the elbow and dual-mobility hips audits continued in 2021/22 to further address these concerns.

The NJR Elbow Audit (which commenced in October 2021) concluded in March 2023, resulting in a 37% increase of elbow procedures recorded on NJR since 2022. An additional 3,742 elbow records were captured and audited across England, resulting in an additional 2,887 elbow procedures being added to the registry. These additional procedures contributed to the analysis in this NJR Annual Report and greatly enhanced the elbow dataset. The audit was supported by British Orthopaedic Trainee Association (BOTA), the British Orthopaedic Association (BOA), the Royal College of Surgeons of England and British Elbow & Shoulder Society (BESS) and the NJR benefited from the engagement of orthopaedic trainees at a local level in assisting with the audit. I would like to extend my grateful thanks to Professor Adam Watts for leading on this work, Zaid Hamoodi, NJR clinical fellow, and to all the hospitals who completed the audit.

The dual-mobility hips audit, supported by NEC, continues to examine hospital records in order resolve data issues within the registry in relation to missing component data for these procedures. To date 18 hospitals have completed the audit, it is still in progress at 17 hospitals and nine hospitals still have to engage in this phase of the audit. Again, a big thank you to all the staff in the hospitals who have been involved in this work over the last two years.

Future plans

The NJR will continue to work to improve compliance further, through the introduction of our new three-tier Data Quality Provider Award Scheme. Work on this is almost complete, with the updated metrics now published on our website and we are looking forward to introducing this new framework to keep improving the quality of data within the NJR, across all joints. 

We will continue to build on the work of the dual mobility hip audit and to further enhance the dataset available for other joints. 

Improvements to the automated data quality audit platform will conclude shortly, resulting in an improved experience for users and streamlined identification and capture of missing cases.

Work on a comparative audit of HES and NJR shoulder procedures is going to commence this summer, with the aim to ensure data completeness for outlier analysis going forward.

NJR Regional Clinical Coordinators Committee (RCC)
Chair’s report 2022/23 - Mr Derek Pegg

The RCC Committee acts as a collaborative interface between the NJR and the orthopaedic community. Members provide useful observations and suggestions from their own regional community and act as a ‘sounding board’ for new ideas and NJR strategic policy direction. The new Minimum Data Set version 8 (MDSv8) launching in summer 2023 is a particular development activity where RCC input to enable hospitals to manage the system upgrade changes and to feed back to the NJR team on resolving local challenges will be invaluable. 

The RCC members provide excellent advice in their two-way communication with hospitals, both for feedback about what the NJR is engaged with and to facilitate remedial action where practice and performance may have been of concern. They have also raised several locally addressed topics that we have then been able to offer greater clarity on and address suggested solutions to any challenges through an exchange of ideas and best practice examples proposed by other members; as well as continually supporting individual surgeons and hospitals in their regions who have faced challenges.

It is always extremely helpful to have a degree of local knowledge and effective communication networks where issues may arise. For example, helping ‘nudge’ hospitals to engage with the ongoing automated data quality audits, in collaboration with our NJR Compliance Officers.

During this reporting time the RCC committee has seen Mr. Peter Cnudde complete his term of appointment for Wales. I am extremely grateful to Peter for his most valuable input in these continued challenging times, as the pandemic recovery for elective orthopaedic surgery has continued.

With the reorganisation of the regional structure of the NHS in England and the desire to have some degree of proportional representation across the regions, the RCC regions have been updated to reflect the new geographical regions. To reflect these changes, combined with naturally occurring vacancies, there has been a continued recruitment process. We welcome new members, Mr Devender Khurana and Mr Rohit Rambani who have joined for the East of England region and Mr Brian Mockford who also joined us during the year to represent Northern Ireland. We look forward to further new consultant orthopaedic surgeons being appointed to the committee as we move forward. 

Most future meetings are likely to continue to be conducted using online conferencing facilities that have proved so effective for collaborative discussion; especially useful for all those of us who incur time and financial costs for travel. However, as for other NJR committees it is highly desirable to have at least one face-to-face meeting a year, to enable the opportunity for us all to meet any new RCC members and for extended, usefully engaging interaction, and this will take place for our committee once at least in the next twelve months.

NJR Editorial Committee (EdCom)
Chair’s report 2022/23 - Professor Mike Reed

The NJR Editorial Committee brings together a range of contributors to collaboratively develop our report content. This includes expert clinicians from the orthopaedic specialist societies for each joint, representatives from our experienced data collection and statistical analysis reporting teams, as well as valued input from our patient and industry representatives, alongside input from senior members of the NJR Management Team, to enable the considered development and subsequent publication of the NJR Annual Report. We also plan the report launch in the autumn of each year at the British Orthopaedic Association (BOA) Congress event, within a plenary session that showcases a variety of presentations about our wide range of work. 

The Committee develops the report content development strategy and style with all members taking responsibility for producing a report that is rigorously edited and reviewed, taking almost a full year to consider and prepare the content, design the layout, write all the numerous report sections and review all final content across the team. 

The Editorial Committee has always supported the NJR’s 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 Chair, Professor Mark Wilkinson. Precis of just some of the most recent NJR-supported research papers that use NJR data are published in section 3.7 of the full report. In addition, we would particularly encourage you to explore research using NJR data that has been published since the last annual report which you can find here.

This year we have also included short reports on sustainability from the two fellows we are currently guiding in their valuable work spotlighting sustainability considerations and concerns in the orthopaedic sector.

Each year we aim to make new progress in reporting, using our rich data resource, making data easily accessible in our aim to help to improve patient outcomes. This year, analysis by the talented and committed team at the University of Bristol on each joint 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 19.75 years.

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. 

Enhancing the online digital format

With the continued progress of development of the NJR Reports website, alongside the demise of printed publications more generally, the NJR Executive and Editorial committees have made the ecological, cost-saving decision to only publish the Annual Report on our online website this year, so we will not have any print copies available. Sharing the report online makes all sections of the report more accessible as navigable pages on the report website or as downloadable files, which can all be found here.

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 and members of the Editorial Committee 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 visitors to the NJR Reports website - and we will review and strengthen this report website further each year.

The 20th NJR Annual Report will be formally launched at the BOA Annual Congress in Liverpool in September 2023, during the NJR Session.

NJR Research Committee (RC)
Chair’s report 2022/23 - 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 joint replacement, improve clinical practice and benefit public health. Research provides the route to improved treatments and therefore keeping patients at the centre of what we do is a guiding principle for all of our research activity. 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 Toby Jennison to the committee as a co-opted member representing foot and ankle surgery. Toby takes over from Dave Townshend and I would like to take this opportunity to express my thanks to Dave for his contribution to the committee in this role. 

Our business-as-usual activities continue throughout the year, including research application review, the data access portal, and associated publication outputs. Please download the NJR Research Project Portfolio here that catalogues research projects, progress reports and NJR research updates, together with links to all publications related to NJR data – I would like to take this opportunity to report below some of this year’s particular highlights and developments.

Broadening data linkages

In 2022 we made a grant application to Heath Data Research UK to participate in the European Health Data Evidence Network. I am pleased to report that the NJR was awarded £60,000 to map the NJR dataset to the Observational Medical Outcomes Partnership (OMOP) Common Data Model. This initiative will allow the NJR dataset to be linked with over 180 data partners across 29 countries that are also mapping their data to this common model. This initiative will enable the NJR to participate in federated data analysis initiatives across the globe. Closer to home, we are also working on agreements which would enable greater value to be gained out of the NJR dataset through other data-sharing partnerships.

Research fellowship scheme

We are pleased to welcome Zaid Hamoodi in his appointment as the eleventh Research Fellow to the joint NJR/Royal College of Surgeons of England research fellowship programme. Zaid is investigating predictors of failure in patients with total elbow joint replacement .

The NJR has been working closely this year with Orthopaedic Research UK, the UK’s leading surgically-focussed musculoskeletal research charity, and the Royal College of Surgeons of England to fund the first NJR/ORUK/RCSE Joint Surgical Research Fellowship. 

In January of 2023 the NJR Steering Committee also approved funding for the development of a non-clinical Researcher PhD Fellowship. This award recognises the wealth of expertise within our specialty that lies with non-clinical scientists, without whom orthopaedics would only have seen a fraction of its development over the decades. This award is aimed at non-clinical scientists who wish to study towards a PhD on any topic within the field of joint replacement, as long as the project has at its core use of the NJR dataset to address the research question of interest. The call for applications to this scheme will be launched at the 2023 BOA annual meeting.

Prospective fellows are encouraged to apply to the rolling programme and can look out for current funding opportunities on the NJR website.

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 a joint replacement 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 as a collaboration between the NJR Research Committee and our statistical analysis partners.

Artificial intelligence research

The NJR recognises the strengths, and limitations, that artificial intelligence (AI) brings to our field of study. Over the last four years the NJR has supported a PhD studentship in the field of machine-learning to address the limitations of current AI models in predicting implant and patient survival. We congratulate Fabio deMello, of the University of Sheffield, on his ground-breaking work in developing a new neural network-based framework for survival analysis that addresses these limitations, and also on the recent award of his PhD. The NJR continues supporting this programme of artificial intelligence research to include patient-reported outcomes prediction, and the fields of federated-learning and transfer-learning.

Submitting a research application

The Research Committee takes formal responsibility for the approval for the release of NJR data for research under strict conditions 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 proposal questions justify access to the data and offer 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 Request Group for final authorisation of data release.

Further information

For those who 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, if not, then submit an expression of interest for consideration via research@njr.org.uk. Invited full applications are then reviewed by the committee quarterly. Full details of the NJR’s research application pathway can be found here and please refer to the recording of our research webinar for full guidance. 

A full list of publications related to research that has used NJR data is included in Appendix 4.

NJR Surgical Performance Committee (SPC)
Chair’s report 2022/23 - Mr Peter Howard

The Surgical Performance Committee (SPC) comprises its Chair, and also the NJR Medical Director, RCC Chair, surgeon representatives from the RCC committee, Care Quality Commission (CQC) representatives, a patient representative, representation from the NJR Management Team and representatives of both Lot 1 and Lot 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, first introduced in 2017, was recently updated to reflect changes throughout the year, and we work closely with the CQC and NHS Improvement to escalate issues where necessary. This year for the first time, hospitals who were at ‘alert level’ over five or ten years of data were notified that they may wish to review their outcome data to address any potential issues as early as possible. 

NJR Annual Clinical Report and Consultant Level Report

Further changes and updates were made once again 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. In addition, as part of NJR Connect hospitals are now able to access a wider range of information around hospital performance via management feedback. 

Changes to knee surgeon performance outcome monitoring

Following discussions with the British Association for Surgery of the Knee (BASK) and British Orthopaedic Association (BOA), our alarm process has been amended to identify surgeons who appear as potential outliers for their total knee replacement (TKR) practice data and/or their unicondylar knee (UKR) practice and/or their patellofemoral joint replacement (PFJ) data alone rather than just based on their overall knee practice. Units are now notified for these sub-strata, but also for their overall knee replacement outcomes.

As overall knee practice data for a surgeon may still indicate an imminent outlier status in the subgroups, (UKR/TKR), surgeons whose overall five and/or ten year knee practice data demonstrates outlier status have their results individually assessed. If no concerns, the surgeon will be notified as an ‘alert’ but if a potential problem is identified, notification as a potential alarm outlier will take place, as per the old process. The performance in “all knees” continues to be monitored and will appear in surgeons’ Annual Clinical Reports, however reaching alarm level no longer automatically triggers a notification involving the hospital’s medical director.

The surgeon Consultant Level Report (CLR) now contains funnel plot information about TKR and UKR practice separately, as well as data about overall knee practice. 

For more information, see our website.

Persistent outlier status

If a surgeon or unit is identified as being a persistent outlier for either their 5-year or 10-year data and remained at this status for five years for 10-year data or three years for 5-year data, they and their medical director will be sent a further notification letter and asked to submit an update on progress against an action plan. This is then reviewed by the NJR Surgical Performance Committee and further recommendations given if necessary. Surgeons who have had up to two (consecutive or non-consecutive) periods of non-outlier performance during this five or three-year period are considered ‘persistent’. Hospitals that are not making progress to improve their status may be referred to the BOA for an Elective Care Review.

Usage of outlier implants

We currently write to surgeons to notify them if an implant/combination of implant used by them in the last twelve months has been identified by the NJR as having a higher‐than‐expected revision rate. The purpose of the alert is to ensure that surgeons are aware of the implant’s higher revision rate in primary procedures and to remind them to take this into account when making their implant choice. There may be legitimate reasons to use such an implant thereafter in certain complex cases, but alternatives should also be considered to avoid having an adverse impact on their patient(s). We will have already informed the MHRA about these implants.

Implant mismatch

We are continuing to alert surgeons and hospitals to the very rarely occurring mismatches in size, side and manufacturer. This alert process is well embedded and is monitored regularly by both the SPC and NJR Data Quality Committee. The implant scanning tool, available for hospitals to check implant compatibility in real time in theatre has been in use over the past year; as adoption by more hospitals increases, it is hoped this tool will help to reduce the numbers of “never events”. 

Future plans

During 2023/24, the NJR will be rolling out procedure outcomes at both trust and geographical level to help improve hospital performance. The NJR will also commence notifications to lead surgeons, in addition to those for consultant in charge. 

The NJR plans to expand our Accountability and Transparency model to include elbow, shoulder and ankle performance metrics for all hospitals and surgeons.

The NJR Connect - Data Services reporting platform will be further developed to include additional performance data for hospitals and surgeons to support quality improvement, which will include development of a new module to capture megaprosthesis devices used in tumour surgery.
 

NJR Implant Scrutiny Committee (ISC)
Chair’s report 2022/23 - Mr Peter Howard

The ISC meets formally four times a year. The committee comprises its Chair, surgeons, the NJR Medical Director (Deputy Chair), as well as representatives from the NJR’s core contractors: University of Bristol (our Lot 2 providers), NEC Software Solutions (our Lot 1 providers), representatives of the Medicines and Healthcare products Regulatory Agency (MHRA), representatives from the NJR Management Team and the Orthopaedic Data Evaluation Panel (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.

To date, the Patient Time Incidence Rate (PTIR) method has been used by the NJR in order to identify poor performance, (in line with other registries) however it became apparent that this method alone was not sensitive enough to identify failure in sub-groups or in the longer-term. Over the last year a new statistical methodology has been developed using Kaplan-Meier estimates; this will be tested on the second 2023 data cut, with the aim for the NJR to embrace the new methodology by the end of the year. An updated NJR Accountability and Transparency model for implant outlier monitoring will be published to reflect these changes, and engagement will take place with industry and key stakeholders.

A review of implant branding across the NJR commenced, in order to ensure consistency across manufacturers and enable a more consistent stratification of implants as part of outlier analysis.

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 the NJR’ commitment to deeper levels of scrutiny in relation to implant performance.
 
The committee will continue to work closely with EPRD (the German registry) and ISAR (International Society of Arthroplasty Registries) on the development of an international shoulder component classification, having now agreed a comprehensive classification for hips and knees.

Implants and combinations identified as outliers

Details of implants and combinations identified as Level 1 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 2022 report, there have been several new notifications to the MHRA in hip and knee replacement. These have been two hip stems, two hip acetabular components and two stem/acetabular component combinations. All of these implants have been off the market for several years. In knees there have been two new Level 1 outliers, one of these is still in use (Origin Knee). Further details can be found here.

Implant library

Surgeons are now able to access a greater level of information on implant performance via our new implant library within Clinician Feedback, which is part of our NJR Connect - Data Services portal. They also have access to supplier feedback information for all implants, regardless of their outlier status, as part of this new library.

NJR Medical Advisory Committee (MAC)
Chair’s report 2022/23 - Mr Tim Wilton

The Medical Advisory Committee (MAC) has met three times during the past year and has continued to provide invaluable advice and professional context to the functioning of the NJR. I thank all of the specialist society presidents and representatives, the BOA President and our core members for the contributions to these many discussions.

The change in outlier analysis method from using ‘All Knees combined’ as a metric to using ‘Total Knee Replacement’, ‘Unicondylar Knee Replacement’ and ‘Patello-femoral replacement’ as separate metrics has inevitably caused some further discussion in the orthopaedic community since, as expected, the change caused some surgeons and hospitals to reach ‘alarm’ status where previously they were not at that level. It is comforting that the change also enabled some surgeons and hospitals to no longer be considered to be at ‘alarm’ level. The MAC members have discussed this matter further retrospectively after the changes and are generally very satisfied with the overall outcome.

There have been some concerns expressed over the years that surgeons whose outcome data show them to have a relatively high revision rate could suffer consequent mental health issues and that this might be something which we might alleviate by modifying the outlier notification process. This matter was discussed amongst MAC members and some very helpful suggestions were made about modifying the language within letters sent to surgeons and Medical Directors, in order to be sure that such issues were being appropriately considered by the local personnel and processes. The possibility of changing the protocol so that Medical Directors were notified of the issues earlier in the process was discussed and rejected on the grounds that surgeons do need and appreciate the advanced warning they currently receive, as it allows proper collection of the relevant audit data. It was therefore felt that to remove that advance warning might actually increase the possibility of causing anxiety and distress for the surgeon.

This year MAC members have also discussed the introduction of the Minimum Data Set version 8 (MDSv8) for the collection of data and have contributed input for additional procedures to be collected, in particular relating to the data which might be necessary to support the developing regional revision network systems for hips and knees. It was agreed that adding this as data collected by the registry would be a far better solution rather than collecting much of the information again in a separate database, as this will limit duplication of effort and minimise the risk of undermining data input into the existing registry system.

Discussions that the NJR has about governance considerations, access to other datasets through NHSE and the many other matters involved in the regular NJR/NHSE/HQIP accountability meetings occurred regularly during the year in order to keep the BOA and specialist societies abreast of these conversations and where necessary seek their assistance in both communicating and effecting the requisite changes to practice. There remains a serious problem with the supply of PROMs data to the NJR from NHSD (now incorporated into NHSE) which is responsible for the collection and management of the national Hip and Knee PROMs programme. It is very clear that PROMs are an increasingly important outcome measure and essential to supplement the registry information on outcomes relating to mortality, revision surgery and re-operation. Discussion in MAC has left no room for doubt that, without the PROMs data to link to other outcomes in the NJR, the profession would feel the value of the data provided about both implants and surgeons would be seriously diminished. These feelings have been regularly represented to NHSE and GIRFT in a forthright fashion and we trust that NHSE will soon find a solution to reinstating PROMs.

I am particularly grateful to the presidents of the BOA and BASK for their help with the issue of communicating to knee surgeons the problems surrounding a knee implant that was identified as having a high revision rate. This problem produced, understandably, a great deal of concern and potential confusion about how to deal with existing recipients of the devices. Urgent meetings were held with BOA and BASK presidents at very short notice, and this enabled a suitably measured and considered response to be developed that was subsequently shared with the MHRA and the manufacturer. This experience has also been very useful in guiding how the process can be modified for the future to allow such issues with implant ‘recalls’ to be dealt with more swiftly and appropriately.

NJR Executive Committee (NJREC) 
Chair’s report 2022/23 - Professor Sir Paul Curran 

The NJR Executive Committee (NJREC) meets quarterly to provide additional operational and financial capability to the NJR Steering Committee’s (NJRSC) broader strategic and governance roles. As such, it facilitates faster decision-making across the large and complex range of NJR business. In 2022/23 four meetings of NJREC were held. The committee is led by Chair, Professor Sir Paul Curran.

The committee membership comprises the NJR Chair, NJR Medical Director and NJR Director of Operations, and additional representatives comprising the NJRSC sub-committee chairs, senior representatives of the NJR Management Team, as required, and representatives from NJR contractors. Please see the online appendices for a record of members.

Importantly, the NJREC 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 and developments that constitute a change in the strategic direction of individual workstreams and previously agreed project plans. 

Given the expansion of the NJR’s work in recent years, as set out in our NJR Strategic and Annual Plans, the committee has consistently provided invaluable support to the NJRSC.
 

NJR Steering Committee (NJRSC)
Chair’s report 2022/23 - Professor Sir Paul Curran

This section provides a brief outline of the work undertaken during 2022/23 by the NJR Steering Committee (NJRSC) and out sub-committees. 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 an NHS England (NHSE) ‘Advisory Committee’ and is responsible for overseeing the strategic direction and management of the NJR. The NHSE Medical Directorate has ultimate ‘ownership’ of the NJR and oversight of its funding and has delegated authority to the Healthcare Quality Improvement Partnership (HQIP) to host the NJR on their behalf and so provide the NJR with its legal identity. HQIP also acts as NJR’s service provider in its provision of a range of operational services including finance and human resources.

Joint NHSE/NJR/HQIP accountability meetings are held quarterly; the NJR Chair, Medical Director and Director of Operations represent the NJR and provide assurance, primarily on strategic matters relating to its advice. The NJR Chair also meets with the NHSE National Medical Director for strategic level discussions at least twice yearly. 

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 our eight 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:

•    Advice is provided to NHSE Medical Directorate and HQIP, as appropriate, on the NJR’s strategic direction, annual operational plan, work activity and financial position (including annual review of subscription charges and any proposed change); 
•    Appropriate advice is provided to NHSE Medical Directorate and HQIP on any financial and/or intellectual property implications associated with licensing of the ‘NJR’ brand, particularly related to international collaboration with other national orthopaedic joint registries;
•    Accurate, relevant and timely data collected by the NJR, is made available to relevant stakeholders (regulators, commissioners/providers of orthopaedic healthcare) in an appropriate format, in order to support clinical governance;
•    Appropriate stakeholders (regulators, professional societies and implant suppliers) are involved in and consulted on the work of the NJR as appropriate and informed of outcomes in joint replacement surgery;
•    The NJR budget is effectively managed and monitored;
•    The NJRSC 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 stakeholders (implant suppliers, regulators, commissioners/ providers of orthopaedic healthcare);
•    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 value) 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; 
•    Delivery and quality of work by NJR Contractors and the codes of conduct applied to NJR Contractors in their relationship with key stakeholders, are effectively managed and monitored by the NJR Management Team;
•    An annual report on the work of the NJR is published in English and Welsh (and languages appropriate to any future countries that may be incorporated into the NJR) using patient-friendly language;
•    Appropriate governance and monitoring arrangements are in place to facilitate the use of NJR data to support and enable related research.

Membership 2022/23

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

•    Professor Sir Paul Curran joined as NJR Chair in May 2022
•    Ms Sandra Lawrence completed her term as an ABHI, Orthopaedic Manufacturer Representative and was succeeded by Mr Joshua Bridgens in April 2022
•    Professor John Skinner completed his annual co-opted membership as British Orthopaedic Association (BOA) President in September 2022 and was succeeded by incoming BOA President, Professor Deborah Eastwood
•    Mr Jeff Stonadge stepped down as an ABHI, Orthopaedic Manufacturer Representative in September 2022 and was succeeded by Dr Hassan Achakri, who joined in October 2022
•    Mr Peter James joined in October 2022 as the Independent Healthcare Provider Network Representative 
•    Ms Rebecca Owen began her co-opted membership in January 2023 as the MHRA Representative

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 2022/23 can be found online in appendices. Further information on changes this year, along with the NJR Chair’s notes of thanks, can also be found within the Chair’s Foreword.