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. Prior to 2020 this was based on volumes from the previous financial year, but for the last two years, volumes have been frozen at 2019/20 levels to account for COVID effects.
Income and expenditure 2022/23
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 2022/23 subscriptions totalling £3,385,630 (2021/22 £3,246,110) were collected from NHS and independent sector providers. Other income of £717,090 (2021/22 £782,863) 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 £3,753,045 (2021/22 £3,329,365). This included governance costs of £187,649 (2021/22 £169,493).
Full 2022/2023 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 2023 and can be accessed on websites for the Charity Commission and Companies House.
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 identifies 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 NJR Steering Committee is designated as an NHSE ‘Advisory Committee.’ It leads and manages activities in relation to joint replacement surgery and provides independent advice on joint replacement to NHSE.
NHSE’s Medical Directorate has ultimate ownership of the NJR and oversight of its funding arrangements but 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 and necessary data controllership and governance arrangements. While HQIP acts as host and service provider to NJR, it is the NJRSC that leads and manages day-to-day activities of the NJR and internal NJR governance resides with the NJRSC.
NHSE’s strategic oversight of NJR is facilitated by the Medical Director for Transformation, National Medical and Transformation Directorates (currently, Dr Vin Diwakar) and at least twice-yearly meetings between the NJR Chair and National Medical Director (currently, Professor Sir Stephen Powis), are held to discuss areas of strategy and policy.
Joint NHSE/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 registry.
The NJRSC meets quarterly and the membership is formally recruited. The current list of members and their declarations are listed in the report online appendices (available in the Downloads section on this website).
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 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.
Contract Lot 1: Data Management, Data Solutions and Associated ServicesThe 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 hospital teams across all NHS and independent sector hospitals.
Contract Lot 2: Statistical Analysis, Solutions and Associated ServicesThe 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 3.7 million procedure records submitted, as at 31 March 2023.
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 related 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.
NJR 20th Annual Report 2023 and other downloads
NJR Surgeon and Hospital Profile
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