NJR Structure & Governance

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. 

Income and expenditure 

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 approved by the NJR Board and is subject to a Memorandum of Understanding between NHSE, Welsh Government, Health and Social Care Board Northern Ireland, the Isle of Man, Guernsey, and Jersey, as well as by the Independent Healthcare Providers Network.

During 2025/26 subscriptions totalling £3,903,342 (2024/25 £3,545,502) were collected from NHS and independent sector providers. Other income of £1,291,855 (2024/25 £897,555) included supplier contributions, cost recovery charges for research dataset provision, investment income and other ad hoc income streams.

Expenditure on the management and development of the National Joint Registry was £4,637,156 (2024/25 £3,948,961). This included governance costs of £292,104 (2024/25 £329,518).

Full 2025/2026 accounts

The NJR’s financial accounts are included in the full audited accounts 2025/2026 of HQIP as ‘host’ of the NJR. The full audited accounts are available on the HQIP website from December each year and can also be accessed on websites for the Charity Commission and Companies House.

We are driven to achieve our goals, objectives and work priorities, as determined by our strategic planning process and we ensure these continually support the improvement of joint replacement surgery and enhance patient safety. We review and consult with a wide range of stakeholders to develop our Strategic Plan, to ensure that it is supporting the priority areas for joint replacement surgery.

We recently developed our Strategic Plan for the next five years, 2026-2030 with an in-depth consultation exercise involving our key stakeholders, including patient representation. The new plan looks ahead to the NJR’s place in a changing world with the pending developments in demographic and societal environments, alongside those in the wider health system. We identify the opportunities and challenges ahead in many related aspects, such as the growing use of digital and AI technology and the likely innovations in implants and surgical techniques, in our aspirations for the ‘registry of the future’. 

Our new plan identifies a number of strategic pillars and supporting themes, alongside our wide range of work programmes and activity that enable the delivery of the NJR’s objectives and goals, based upon those themes.

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

Our Strategic Plan is supported by our annual planning, which each year identifies the work programme required to deliver the strategy, based on priorities set by our Board. Following review and approval by the Board, our annual planning documents and processes are used to monitor the progress and performance of key activities, on a quarterly basis.

For further details about the NJR Board see Work of the NJR Committees.

Our NJR Strategic Plan for 2026-2030 is available on our general NJR Centre website here.
 

NJR Board 
The NJR Board (NJRB) is designated as an Independent Expert Advisory Committee. It leads and manages activities related to joint replacement surgery and provides independent advice on joint replacement to NHSE and other stakeholders.

Oversight of the NJR’s funding arrangements sits within the Healthcare Quality Improvement Partnership’s (HQIP) governance framework. HQIP hosts the NJR and is responsible for its legal identity, data controllership and governance arrangements, with engagement from relevant stakeholders, such as NHS England, as appropriate. 

Legal governance of the NJR is the responsibility of the HQIP Trustee Board, to ensure all administrative, legal and financial activities align with HQIP’s charitable objectives and meet high standards. 

Clinical leadership of the NJR is the responsibility of the NJRB who have autonomy for a) operational activity within the bounds of the strategic plan and budget approved by the HQIP Trustee Board, b) developing and implementing of projects and initiatives, c) reporting on progress e.g. to the HQIP Trustee Board, and d) making recommendations on improvements and innovations within the scope of NJR activities.

A Scheme of Delegation between the HQIP Board of Trustees and the NJRB provides a framework for defining the relationship between both organisations and facilitating the effective separation of legal governance and clinical leadership.

As a senior stakeholder the NHSE National Medical Director acts as the primary link between NJR and NHSE. The NJR Chair meets with the NHSE National Medical Director for strategic level discussions at least twice yearly. Also, meetings between the NJR and NHSE Outcomes and Registry Programme (ORP) are held on a periodic basis to discuss issues of alignment and partnership between both parties, related to development of the national Medical Devices Outcomes Registry (MDOR) platform and associated data-sharing. The NJR Chair, Medical Director and Director of Operations represent the NJR. 

The NJRB membership is formally recruited and the Board meets quarterly. The current list of members and their declarations are listed in the report online appendices (available in the Document Download section on this website).

NJR committees
Eight committees support the work of the Board:
• Executive Committee - Chair, Professor Sir Paul Curran
• Medical Advisory Committee - Chair, Mr Tim Wilton
• Editorial Committee - Chair, Mr Andrew Porteous
• Implant Scrutiny Committee - Chair, Mr  Colin Esler
• Surgical Performance Committee - Chair, Professor Mike Reed
• 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, led by Chris Boulton - NJR Director of Operations, supports the work of our Board and its committees. The team is responsible for the overall operational, contract and performance management of the NJR and for the associated communication 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. 

The NJR contracts for service delivery 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 and reporting software infrastructure. 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 teams across all 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 the Channel Islands.

We have collected data in England and Wales:
• for hip and knee surgery since April 2003.
• for ankle surgery since April 2010.
• for 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 us in November 2019, and Jersey in 2025.

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 over 4.6 million procedure records submitted, as at 31 March 2026.

NJR Mission

We record, monitor, analyse and report on outcomes of joint replacement surgery to continuously enhance patient safety, support surgeons, and assure value and improved patient outcomes.

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