Work of the NJR Committees

NJR Data Quality Committee (DQC) 
Chair’s report 2024/25 - Mr Derek Pegg 

The committee membership comprises representatives from our specialist societies and from the British Orthopaedic Association, senior representation of the management team, and Lot 1 and Lot 2 contractor representatives. We have continued to focus on completing our annual data quality audit for the current audit year, alongside supporting hospitals to complete audits for any outstanding years. The benefits of the automated data quality audit process, introduced in 2019, is that hospitals can review their data more regularly and complete audits in a timelier manner. 

There remain a few hospitals where compliance is poor and their engagement with the annual audit cycle has been consistently deficient. There are often multiple issues within such hospitals. The NJR will continue to support them as much as possible, to achieve the data quality many of their peers consistently manage. We have reviewed our escalation process that is in place for poorly compliant hospitals, to help clinicians access appropriate support. Ten hospitals are currently in this escalation process due to their poor engagement with the data quality cycle.

During 2024/25, qualifying hospitals were again awarded data quality provider awards in line with the new three-tiered criteria issued last year. From a total of 418 hospitals, 314 (75%) qualified for an award with 251 hospital teams receiving gold (60%), 49 receiving silver (12%) and 14 (3%) receiving bronze. It was encouraging that this year, there was an increase in the number of hospitals qualifying for an award and within the highest category. Work is continuing to support those hospitals who did not qualify to ensure they meet the criteria for the current audit year.

The latest audit year review records the most complete data capture in the last 22 years. The overall compliance is now 97.73% for primary and revision procedures.

Over 64% hospitals have achieved 100% compliance and 79% over 98% compliance. However, a couple of hospitals have struggled to reach even 30% compliance.

To ensure that the NJR can audit procedures added to the registry as part of the updates to the data collection forms, including the new form for Reoperations other than revision (RO), additional codes have now been included within the annual data quality audit. These codes will enable the NJR to audit hip hemiarthroplasty procedures, DAIRs and DAIRs without modular exchange. Further work is ongoing to establish appropriate mechanisms to audit Manipulation Under Anaesthesia (MUA) procedures and fixations of periprosthetic fractures. 

In August 2023, the NJR commenced an audit to retrospectively check and improve the volume and quality of registry shoulder replacement data. The audit completed on 31 December 2024 with approximately 5000 new shoulder procedures added to the registry. Following completion of the audit, the NJR is now in a position to commence planning for mortality and revision outlier analysis.  We would like to thank Mr Jaime Candal-Couto, who is leading this work for the NJR, in collaboration with BESS and BOTA.

Future plans

During 2025/26 the following data quality activity is planned
•    Benchmarking of the NJR vs. HES data to identify hospitals who are not currently entering any hip hemiarthroplasty procedures onto the registry.
•    A comparative audit of NJR vs. HES for ankle procedures.
•    Continuation of work to identify mechanisms to audit periprosthetic fractures and MUA procedures collected as part of the RO form introduced as part of MDSv8.
 

NJR Regional Clinical Coordinators Committee (RCC)
Chair’s report 2024/25 - Mr Derek Pegg

Over the past year, I’ve had the privilege of working alongside my Regional Clinical Coordinator (RCC) colleagues, who continue to play a vital role as the link between the National Joint Registry (NJR) and the front line of orthopaedic care in hospitals across the UK. As well as the RCCs, the committee membership is made up of senior members of the NJR Management Team, as well as some representation of our Lot 1 contractors, including our NJR compliance officers. As ever, the NJR has pursued a wide range of strategic initiatives, delivering an ambitious and forward-looking programme of work.

The RCC network has been instrumental in shaping and supporting many of these initiatives. One of our key focus areas has been driving improvements in data quality. This year saw the launch of a new escalation framework aimed at identifying and supporting hospitals that have not yet achieved specific data quality targets. The framework provides a clear pathway for improvement, combining support, accountability, and a shared understanding of the challenges. RCCs have been an integral part of this process, and we are encouraged by the positive improvements already being seen across the board.

The NJR continues to be deeply embedded within the fabric of the orthopaedic sector, with its scope evolving in step with a health environment that is growing in both complexity and demand. This calls for even closer collaboration between hospitals and the NJR. RCCs have played a key role in reinvigorating the Clinical Liaison Lead (CLL) role within hospitals. Working closely with newly nominated CLLs - who serve as the main points of contact for NJR-related matters - RCCs are helping to ensure that NJR processes run smoothly, and that coordination with our NJR compliance officers is effective and consistent.

RCCs remain central to fostering strong partnerships, open communication, and meaningful collaboration between hospital orthopaedic departments and the NJR. This year, the network has supported two national audits, including those for Shoulder and Manipulation Under Anaesthesia (MUA), and continued to serve as a valuable sounding board for NJR proposals. Notably, RCCs provided key feedback on the proposal to promote greater transparency of performance through public disclosure of data quality Issues. Hospitals undergoing the escalation process, would be identified while also showcasing the actions being taken to address any issues.

Most future meetings are likely to continue using online video conferencing facilities. 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.

Over the last twelve months, the RCC committee has seen two members complete their terms of appointment, and one step down. We thank Mr Sebastian Dawson-Bowling and also Mr Timothy Petheram, for their service and wish them well. We are very pleased to have four new members recently join the committee this year: Mr Amit Kotecha, Mr Peter Cnudde and Mr Andy Phillipson as RCCs representing West Midlands, Wales and North West respectively with Mr Sameer Jain, representing the British Hip Society.  This enables further coverage across the NJR’s wide geographic regions. We are also looking forward to seeing some of the RCCs serve on other committees, across the broad remit of the work of NJR, in the future.

We continue to recruit to vacant positions and trust that we will fill these with enthusiastic and experienced surgeons who will also be a great support to the hospital staff in their respective regions. 

As we close out the year, we look ahead with renewed focus. With ongoing changes in the healthcare landscape, the RCC role is more important than ever, serving as the crucial interface between hospitals and the registry. In the year ahead, we will continue to explore how best to leverage the RCC network to enhance our collective impact and further our shared commitment to improving patient safety. 

Finally, I would like to add that I am extremely grateful to all the RCCs, for their valuable input and their continued commitment to the NJR.

NJR Editorial Committee (EdCom)
Chair’s report 2024/25 - Mr Andrew Porteous

The NJR Editorial Committee brings together a range of contributors to plan and develop our Annual Report content. The committee membership is made up of expert clinicians from the orthopaedic specialist societies for each joint, representatives of other key NJR committees (e.g. Research), representatives from our experienced data collection and statistical analysis reporting teams and senior members of the NJR management team. Patient and industry representatives complete the report team and enable the considered development and subsequent publication of the report each year. The Annual Report is the main focus of the work of the committee, but members are also responsible for the planning and delivery of the NJR plenary session at the annual British Orthopaedic Association (BOA) Congress, where the Annual Report is usually launched together with a programme of presentations showcasing the wide range and impact of our work. 

The main work of the committee can only start once the relevant component dataset has been defined and analysed by the teams from NEC and the University of Bristol. During the past year a number of changes were made to the implant component database which resulted in delays to the availability of data and the normal timings of analysis. This led to the delay in the availability of all the necessary reports such that the full 2023 NJR Annual Report was not available in time for the BOA Congress, but all of the joint sections were available on the website by the end of the calendar year. This delay was unavoidable and the changes to the implant database will have a positive impact going forward by allowing greater granularity of detail and analysis, while also reducing the number of implants that we cannot analyse due to unvalidated construct data. The benefits of the changes to the implant database will be highlighted and discussed at the NJR plenary session at the BOA meeting in September 2025. 

It is expected that minimal changes to the dataset will occur for the 22nd Annual Report, which makes it likely that the report will be available on time. One of the changes imposed by the previous data delays, was the move to producing different sections of the report as they became available. This has added to the flexibility in the timings of the report outputs and this modification is being maintained this year, which enables us to produce sections of the annual report as they become available, rather than all reports being delayed until the final combined report is complete. The Annual Report is now only available in electronic format and the website will allow searching or downloading of individual section reports as well as the combined full report. Notifications will be issued as each new section report is added to the website. Specific joint section reports and the complete AR21 can all be found on our dedicated website here.

The Editorial Committee has always supported the NJR’s research study programme and is delighted to see the expansion of research using NJR data and collaborative research being shaped by NJR Research Committee Chair, Professor Mark Wilkinson. The Editorial Committee supported the publication of abstracts of key research projects in the 21st Annual Report and will be continuing this for the 22nd Annual Report, as well as including podium presentation of four key research papers in the NJR plenary session at the BOA Congress in Liverpool in September 2025. Poster presentations of further NJR research will be shown on the NJR information stand. Summaries of recent NJR-supported research papers are also available on the report website and we encourage you to explore further here.

Each year we aim to make progress in reporting on our rich data resource to make it easier for clinicians to access meaningful information and enable them to make wise implant choices with the aim of improving patient outcomes. The analysis now contains detailed information on implant performance and survivorship up to a maximum of 21.75 years. Details of implant and unit-level activity and performance can be found in more detail in the specific document in the Downloads area. The electronic reports with more flexible search and analysis options have been well-received by visitors to the NJR Reports website. There is ongoing work to strengthen this report website further, as we work on the enhancement of the report in an HTML format.

Key to the work of the committee is the hard work of all the committee members. We have seen changes to the committee personnel this year with Prof. Mike Reed completing his term as Chair and Sebastian Dawson-Bowling ending his term as RCC representative. The Committee wish to thank them both for the huge amount of time and effort they contributed to the Editorial Committee and also thank Prof. Reed for the valuable leadership he provided over the years. Andrew Porteous has taken over as Chair of the committee and Prof. Leela Biant has moved into the position he vacated as BASK Representative. Mr Jaime Candal-Couto has joined as BESS shoulder representative.

The 22nd NJR Annual Report will be formally launched at the BOA Annual Congress in Liverpool in September 2025, with sections available online as they become available. The NJR plenary session at the BOA will be held on Wednesday 17th September 08.30 - 10.00 and we hope that as many people as possible will join us for an informative and interactive session and to celebrate the launch.
 

Research Committee (RC)
Chair’s report 2024/25 - 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 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. After more than ten years’ providing data support to the committee, we thank Claire Newell for her steadfast service and wish her well for her retirement. The committee welcomes Tim Chisnall, who replaces Claire in this role. We also welcome Peter Sivey from the University of York as member with health economics expertise, and Steve Gwilym as shoulder and elbow surgeon representative. 

Our business-as-usual activities continue throughout the year, including research application review, the data access portal, and publications 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 address some of this year’s particular highlights and developments below.

Broadening data linkages

In 2022 the NJR was awarded £60,000 by Health Data Research UK to map our dataset to the Observational Medical Outcomes Partnership Common Data Model as part of the European Health Data Evidence Network. We are pleased to report that this mapping exercise is now complete and allows the NJR dataset to be linked with over 180 data partners across 29 countries that are mapping their data to this common model.

Research fellowship scheme

We are pleased to welcome Ben Tyas in his appointment as Research Fellow to the joint NJR/Orthopaedic Research UK/Royal College of Surgeons of England research fellowship programme. Ben is investigating clinical outcomes in revision knee arthroplasty for aseptic loosening.

In January 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 have seen only a fraction of its current level of development over the decades. The award is aimed at non-clinicians who wish to study towards a PhD on any topic within the field of joint replacement, providing the project has use of the NJR dataset at its core to address the question of interest. Professor Claire Brockett at the University of Sheffield has been awarded this year’s funding to host a PhD studentship entitled “Evaluating interventions for end-stage ankle osteoarthritis”.

NJR annual research programme

Building on many high-quality publications over the years, we continue to develop our annual research programme. Current projects are: Performance of all-poly tibias; Surgeon volumes and ankle replacement surgery; Outcomes of cemented devices using different cements; and Inequalities in joint replacement provision and outcomes. As projects complete, new topics are brought on stream. All projects are delivered in a collaboration between the NJR Research Committee and our statistical analysis partners.

Artificial Intelligence (AI) research

The NJR recognises the strengths, and limitations, that artificial intelligence brings to our field of study. We continue to support a machine learning PhD studentship to address the limitations of current models in predicting implant and patient survival and in the development of transfer learning and federated learning models to better predict the outcomes of surgery. 

Submitting a research application

The Research Committee takes formal responsibility for the approval for the release of NJR data for research, 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 question justifies access to the data and offers potential benefits to patients. Research proposals should align to our priority framework and be feasible, ethical, relevant, and methodologically-sound.

The committee provides a framework for applicants to request data for research of public benefit. We aim to support applicants through the process of developing a robust research application that addresses the question posed. All requests must also be approved by the Healthcare Quality Improvement Partnership (HQIP) Data Access Request Group for final authorisation of data release. Subsequent to approval, data is made available for analysis through the NJR Data Access Portal. 

Further information

In order to get a feel for the previous and current fields of research being studied using NJR data, please visit the NJR Research Project Portfolio. If you would like to submit a research application, you can submit an expression of interest for consideration via research@njr.org.uk. Invited full applications are 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 NJR data is included in Appendix 4.

NJR Surgical Performance Committee 
Chair’s report 2024/25 – Professor Mike Reed

The Surgical Performance Committee (SPC) comprises its Chair, Vice Chair, NJR Medical Director, RCC Chair, surgeon representatives from the RCC committee, representatives of the Care Quality Commission (CQC), a patient representative, representation from the NJR Management Team and representatives of both Lot 1 and 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 hospitals and surgeons performing hip and knee joint replacement. 

NJR Annual Clinical Report and Consultant Level Report

Further changes and updates were made once again this year to the Annual Clinical Report (ACR) which was 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 NJR Connect - Data Services.

In addition, as part of NJR Connect reporting services, hospitals are now able to access a wider range of information around hospital performance, via Management Feedback. 

NJR Clinician Feedback now contains a tab for the Implant Library which was expanded during 2024/25 to show the KM survival graphically against the expected for the class of implant, and to include hip stem/cup combinations.

Implant mismatch, “never events”

We are continuing to alert surgeons and hospitals to the continuing, but relatively rarely occurring, mismatches. This alert process is well embedded and is monitored regularly by both the SPC and NJR Data Quality Committee. This currently covers side mismatch for knees, articulating size mismatch for hips, and mixing of hip head and stems from different manufacturers. 

During 2024/25, the NJR introduced shoulder manufacture ‘mix and match’ for primary procedures as part of this process. 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 that use of this tool will help to reduce the overall numbers of “never events”. 

Future plans

Further work will be undertaken to roll out procedure outcomes at both trust and geographical level, to help improve hospital performance. 

The NJR plans to expand our Accountability and Transparency model to include elbow, shoulder and ankle performance metrics for all hospitals and surgeons. Following the completion of the NJR shoulder audit in December 2024, it is anticipated that this will commence with shoulder outlier analysis. 

During 2025/26, the NJR will be funding and providing support to the University of Bristol for a mixed methods project to support outlier surgeons and hospitals.

NJR Implant Scrutiny Committee (ISC)
Chair’s report 2024/25 - Mr Peter Howard

The ISC comprises its Chair, Vice Chair, the NJR Medical Director, surgeon members from the RCCs committee, a patient representative, 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 from 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 and report on these where necessary.

To date, the Patient Time Incidence Rate (PTIR) method has been used by the NJR 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, and in some cases missing out on relatively early poor performance. Over the past few years, a new statistical methodology had been developed using Kaplan-Meier estimates alongside the existing method. The aim is for the NJR to move to this methodology entirely by the end of 2025/26 financial year. An updated NJR Accountability and Transparency model for implant outlier monitoring will be published to reflect these changes, and associated engagement on this will take place with industry and key stakeholders.

A review of implant branding across the NJR continues, to ensure consistency across manufacturers and to also 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’s 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 on adopting 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 2024 report, there has been five notifications to the MHRA for hip implants (CLS Spotorno Cementless Stem, X3 Rimfit Cemented Cup, Delta Revision TT, Delta Multihole TT, and the Birmingham Head Resection Stem used with the BHR Resurfacing Cup) and two for knee implants (Legion Revision Oxinium PS and Maxim Unconstrained). Details can be found here.
 

NJR Medical Advisory Committee (MAC)
Chair’s report 2024/25 - Mr Tim Wilton

The Medical Advisory Committee (MAC) comprises its Chair, the presidents of the orthopaedic specialist societies, national directors, senior members of the NJR Management Team, as well as surgeon and patient representatives. It convenes three times a year, through a combination of virtual and face-to-face meetings.

The MAC serves as a vital conduit for the exchange of information and opinions on all aspects of the NJR’s work - highlighting areas of success and identifying opportunities for improvement.

I extend my sincere thanks to the presidents of the British Orthopaedic Association (BOA) and the specialist society associations, and our patient representatives for their valuable contributions and time spent attending MAC meetings over the past year.

I would also like to welcome the presidents of the British Orthopaedic Directors Society (BODS) and Computer Assisted Orthopaedic Surgery UK (CAOS UK), who have recently joined the committee. Their inclusion further strengthens the breadth of expertise within the membership.

The MAC has had another productive and impactful year, continuing to provide a vital forum for discussing key issues affecting surgeon members of the specialist societies. As always, the committee’s focus has been on collaborative problem-solving, informed debate, and ensuring that the interests and concerns of the surgical community are addressed with both sensitivity and rigour. 

Advocacy and engagement on data transparency

The MAC’s ongoing role as an advocate for fair, accurate, and transparent data usage was highlighted during the year. Following concerns raised about the accuracy and reliability of externally-published data-reporting on various health service platforms, MAC members continue to escalate and engage on the matter to explore possible next steps and seek resolution. Both the MAC Chair and the BOA President have engaged in discussions with one such organisation (PHIN) directly to bring some issues to their attention to enable their swift resolution.

Evaluating the Elective Care Review (ECR) process

MAC members continued to serve as a valued sounding-board on matters of clinical governance and review processes. This year, the committee had a provisional presentation on the Elective Care Review (ECR) process, previously established by the BOA to support hospital units identified as persistent outliers by the NJR. Since 2018, 16 units have been notified, with 14 reviews completed. While members broadly supported the initiative, concerns were raised about the long timeline to observe outcome changes and the associated costs, which they felt could act as a deterrent for effective participation. This feedback has been passed to the BOA to inform ongoing refinements of the ECR model, and a more detailed examination of the results of the process over the last seven years is due to be undertaken.

Contributing to methodological best practice

The MAC has also played a key role in reviewing analytical approaches to ensure methodological integrity across NJR reporting. Notably, the analysis of multicompartmental knee replacements prompted important discussion. The consensus of members was that these should continue to be compared with total knee replacements, the current gold standard for patients with multi-compartmental disease. However, a wider discussion with BASK was also proposed in order that the differences between the effects of these decisions on surgeons, as opposed to those on implants can be fully reflected.

The committee also welcomed suggestions to connect with academic centres conducting relevant research to further enhance the analysis.

Shaping the future of the collection of Patient Reported Outcome Measures 

Ongoing challenges with NHS England's provision of hip and knee Patient Reported Outcome Measures (PROMs) data were reviewed, including delays and a decline in data quality. In light of this, members supported a shift in focus by the NJR PROMs Working Group toward identifying local trust-level PROMs collection efforts. The proposal involves surveying hospitals to identify existing data-sharing agreements and leveraging these arrangements to offer tailored analysis and feedback reports in return. 

MAC agreed this was a promising direction and recommended that society presidents gather input from their members to support the initiative's rollout. The committee is absolutely in support of PROMs collection and analysis, as an adjunct to the assessment of revision rates and other outcome measures. This is a key point of the Cumberlege report and if the supply of PROMs data from NHSE continues to be unreliable then it was proposed that any and all other possible sources of such data should be approached in order to fill the gap.

Supporting surgical performance and wellbeing

Finally, the MAC continued to address the professional and pastoral support needs of its members. There was meaningful discussion around how best to advise clinical directors and departments when individual surgeons are flagged as outliers. While the NJR provides support via correspondence from the Chair of the NJR Surgical Performance Committee and guidance on improvement planning, the Committee recognised the need for a more structured and compassionate approach. Encouragingly, the NJR Executive has reviewed a proposal for a mixed-methods study aimed at identifying barriers and enablers to performance improvement. This initiative reflects a commitment to fostering a supportive, rather than punitive, response to performance concerns.

Liaison with industry and regulators on matters of interest to the orthopaedic community

The Committee continues to play an active role in fostering constructive dialogue between the orthopaedic community, industry, and regulatory bodies. A recent example of this ongoing engagement arose following the publication of an article on jnjmedtech.com by DePuy Synthes, which appeared to reference information shared jointly by BASK and the NJR at the BOA conference in September 2023. Concerns were raised that the article implied endorsement of a commercial product by both organisations. In response, the BASK President contacted DePuy Synthes to clarify the neutral stance of both BASK and the NJR and to request the article’s removal. The matter is ongoing however, both BASK and the NJR remain committed to upholding the integrity and impartiality of their contributions and continue to pursue a resolution to the matter.

In summary, the MAC remains a cornerstone of clinical leadership within the NJR ecosystem - providing oversight, insight, and guidance on key issues that influence surgical practice, data integrity, and patient safety. Although it is not always possible for the NJR to act on every request from members of MAC, and certainly there will sometimes be delays (for example where items need to be added to the Minimum Data Set data collection forms), the advice and the input to debate is crucial in determining the direction of travel for the organisation. 

As we look ahead to 2025-26, we will continue to harness the collective expertise of our members to navigate the evolving healthcare landscape and advocate for excellence in orthopaedic care.

NJR Executive Committee (NJREC) 
Chair’s report 2024/25 - Professor Sir Paul Curran 

The NJR Executive Committee (NJREC) meets quarterly to provide additional operational and financial capability to the NJR Board’s broader strategic and governance roles. As such it facilitates faster decision-making across the large and complex range of NJR business activity. The committee is led by NJR Chair, Professor Sir Paul Curran and in 2024/25 four meetings were held.

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

Importantly, the NJREC has delegated authority from the NJR Board 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 NJR Board.

NJR Board
Chair’s report 2024/25 - Professor Sir Paul Curran

This section provides a brief outline of the work undertaken by the NJR Board (NJRB) and our committees during 2024/25. 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 NJRB and committee members to ensure the work of the NJR meets the needs of our patient, clinical, regulatory and industry stakeholders.

NJR Board structure, governance and operating model

The NJRB is designated as an NHS England (NHSE) ‘Expert Advisory Committee’ and is responsible for overseeing the strategic direction and management of the NJR. Oversight of the NJR and its funding arrangements, rests with the NHSE Medical Directorate who provide 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, data controllership and governance arrangements. HQIP also acts as service provider to the NJR, providing operational services including finance, human resources and procurement. 

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

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 regularly to discuss issues of alignment and partnership between both parties, related to development of the national Medical Device and Outcome Registry platform and associated data sharing. The NJR Chair, Medical Director and Director of Operations represent the NJR.

The NJRB meets quarterly through a combination of virtual and face-to-face meetings and is responsible for setting our strategic direction and for overseeing the successful delivery of our work and closely managing the associated budget. The Board also oversees a supporting structure of our eight committees, each responsible for a dedicated area of NJR work and ensuring the delivery of work plans and development of activities against agreed objectives. All committees are accountable to the NJRB.

Key responsibilities of the NJRB 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 NJR committee structure is fit for purpose and all 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 they 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, and Beyond Compliance) 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.
•    The 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.