Introduction

From April 2014 the funding of the NJR was changed from a levy on the sales of implants to a subscription-based model, with the subscription charge being based on the number of procedures submitted to the NJR.

Trusts, Local Health Boards and independent sector healthcare providers are now invoiced directly by the Healthcare Quality Improvement Partnership (HQIP) which hosts the registry's accounts. A report from the NJRSC Chairman can be found here. 

Income and expenditure 2018/19

The NJR is self-financing and from 1 April 2014 has been funded by a subscription paid by Trusts, Health Boards and independent sector healthcare providers.  Moving to this model, from the previous model based on a levy charged on the sale of hip, knee, ankle, elbow, and shoulder implants, has reduced the cost of the NJR to the NHS. 

The rate of the subscription is recommended by the NJR Steering Committee for approval by NHS England, and is subject to a Memorandum of Understanding between NHS England, Welsh Government, Health and Social Care Board Northern Ireland, and the Independent Healthcare Advisory Services.

During 2018/19, subscriptions totalling £3,376,379 were collected from NHS and independent sector providers (2017/18: £2,904,090). Other income of £687,320 (2017/18: £586,466) included supplier contributions and income from the NJR’s price benchmarking service.      
                                         
Expenditure on the management and development of the National Joint Registry was £3,676,664 (2017/18: £3,719,441). This included governance costs of £186,570 (2017/18: £157,298).
 
Full 2018/19 accounts

The NJR’s financial results are included in the audited accounts of HQIP who host the registry. The full audited accounts are available on HQIP’s website from November 2019, and also from the Charity Commission and Companies House.

NJR - NJR Steering Committee and NJR Management Team

The NJR is hosted by the Healthcare Quality Improvement Partnership (HQIP) and overseen by a Steering Committee (NJRSC), which is designated as an NHS England (NHS E) ‘Expert Committee'.

The NJRSC Chairman reports directly to the NHS England Medical Director. The NJR Management Team is hosted at HQIP's offices. The team is responsible for overall operational and contract management of the NJR and for supporting the work of the NJRSC and its sub-committees, as well as having overall responsibility for governance, communications and stakeholder engagement.

The NJR Steering Committee, which meets quarterly, is responsible for overseeing the strategic direction and running of the NJR and has the status of an NHS England Committee of Experts.

The current list of members and their declarations are listed in the online appendices and in the NJR Steering Committee report. The Steering Committee has a lay Chairman, Mrs Laurel Powers-Freeling.

The current list of members can be found on the NJR's main website here.

NJR Sub-committees

Nine sub-committees supported the work of the NJR Steering Committee in 2018/19:

• Executive Committee ~ Chairman, Mrs Laurel Powers-Freeling
• Medical Advisory Committee ~ Chairman,  Mr Martyn Porter until 31 December 2018, Mr Timothy Wilton from 1 January 2019
• Editorial Board ~ Chairman, Mr Martyn Porter until 31 December 2018, Professor Mike Reed from 1 January 2019
• Implant Scrutiny Committee ~ Chairman, Mr Peter Howard
• Surgeon Performance Committee ~ Chairman, Mr Peter Howard
• Research Committee ~ Chairman, Professor Mark Wilkinson
• Data Quality Committee ~ Chairman, Mr Matthew Porteous
• Regional Clinical Coordinator Committee ~ Chairman, Mr Matthew Porteous

NJR Management Team (NJRMT)

The NJR Management team is led by the NJR Director of Operations for all NJR operational activity and contracts including NJR Communications and Stakeholder Engagement which is overseen by an associate director within the NJR Management Team, to support the delivery and communication of the strategic plan. As well as working closely with the Editorial Board, the communication function also works with the Regional Clinical Coordinator Sub-committee and the NJR Patient Network.

NJR Service Delivery

The NJR services are delivered under two separate contracts which are overseen, managed and monitored by the NJR Management Team:

- NJR Service Centre

• This is contracted to a team within Northgate Public Services (UK) Ltd. Northgate has contracted responsibility for the management and development of the IT infrastructure, software applications, data management and reporting services for NJR. NPS is also contracted to facilitate the ‘NJR Service Desk’, a team who provide day-to-day information and support to NJR stakeholders, and the NJR Regional Coordinators (RC), a six-person strong team providing on-site support to orthopaedic units in hospitals, between them covering all of NJR’s geographical regions.

- NJR statistical support, analysis and research
 
• This work is contracted to a team at the Universities of Bristol and Oxford. The team is responsible for the delivery of statistical analyses of NJR data and data from other sources, and for developing the statistical methodologies for the identification of potential outlier performance. Their role also includes ad hoc data analyses, in addition to those included in the NJR Annual Report, that are central to the work of the Implant Scrutiny and the Surgeon Performance Committees.

About the NJR

The National Joint Registry (NJR) for England, Wales, Northern Ireland and the Isle of Man has collected joint replacement data on:

• hip and knee surgery since April 2003
• ankle surgery since April 2010 and
• elbow and shoulder surgery since April 2012

Northern Ireland started to submit data in February 2013 and the Isle of Man from July 2015.

The NJR still continues to be the largest register of its kind in the world, with over 2.86 million procedure records submitted to it as at 31 March 2019. The NJR’s purpose is set out in its strategic plan and is summarised below:

Mission statement

‘The purpose of the National Joint Registry for England, Wales, and Northern Ireland is to collect high quality and relevant data about joint replacement surgery in order to provide an early warning of issues relating to patient safety.  In a continuous drive to improve the quality of outcomes and ensure the quality and cost effectiveness of joint replacement surgery, the NJR will monitor and report on outcomes, and support and enable related research.’

Strategic goals

• Monitor in real time the outcomes achieved by brand of prosthesis, hospital and surgeon, and highlight where these fall below an expected performance in order to allow prompt investigation and to support follow-up action

• Inform patients, clinicians, providers and commissioners of healthcare, regulators and implant suppliers of the outcomes achieved in joint replacement surgery

• Evidence variations in outcome achieved across surgical practice in order to inform best practice

• Enhance patient awareness of joint replacement outcomes to better inform patient choice and patients’ quality of experience through engagement with patients and patient organisations

• Support evidence-based purchasing of joint replacement implants for healthcare providers to support quality and cost effectiveness

• Support suppliers in the routine post-market surveillance of implants and provide information to clinicians, patients, hospital management and the regulatory authorities.