Laurel Powers-Freeling Chairman,
National Joint Registry Steering Committee (NJRSC)
The NJRSC oversees the strategic and operational work programme of the registry and I am delighted to have performed the role of Chairman of the Committee over the past eight years. In each of those years, I have had exciting news to share regarding the evolution of the NJR. While this year has been very challenging in the wake of the pandemic - NJR nonetheless delivered a number of important developments. This Annual Report provides the opportunity to reflect back on our work over the last year and look to the year ahead. Highlights are summarised here in this 17th edition of our Annual Report.
Our work and developments
Managing the impact of the COVID-19 crisis: This year the NJR undertook a radical review of our proposed 2020/21 annual work plan and budget to reflect the impact of the COVID-19 crisis and recognition that NHS funds and administrative capacity needed to be directed elsewhere. With delegated authority from the NJRSC, the Executive Committee considered how resources could be conserved until we could re-engage in collecting, processing and analysing data for our work and re-instating income collection via Trust subscription payments. As a result, our development plans and expenditure programme for 2020/21 have been significantly reduced. This will be reviewed for FY2021/22.
Supporting the Independent Medicines and Medical Devices Safety Review [IMMDSR]: The NJR was invited to provide evidence to the IMMDSR, chaired by Baroness Cumberlege, on how a high impact clinically-led registry can improve device safety through continuous monitoring. The recently published review report recommended setting up an implantable medical devices registry and cited the NJR as a global exemplar of such a registry. NHSX, which has been requested by the Secretary of State to deliver appropriate options for a wider device registry, has asked to work with the NJR to undertake an in-depth analysis of our operating model for potential adoption or re-use. We are pleased to share NJR best practice with NHSX on this national data strategy and this work will form a major area of focus for the NJR in the coming year. It will also provide an opportunity to continue to secure support for the NJR/BOA/TORUS proposal for a National Musculoskeletal Registry that aligns to this national data strategy of establishing larger integrated data sets.
Automating our Data Quality Audit: Data quality has continued to be a priority for the NJR. However, our audit process is labour intensive so the NJR has now begun a national roll out of a semi-automated process enabling units to check their data quality on a regular basis, while reducing the burden on resources and ensuring the audit activity becomes part of the normal workflow. Roll out is underway for hip and knee data and will be followed by shoulders, elbows and ankles, with full roll out across all joints by the end of FY2020/21.
Modernising our IT Platform: We have commissioned the development of a cloud-ready, platform-based application framework for provision of future NJR services that will focus on developing a modern, unified environment and ability to move to cloud-based infrastructure. This will amalgamate our currently separate reporting portals to a single NJR securely encrypted cloud-based platform, providing increased flexibility for all future change, enhance user and public interrogation of the data and have the capacity to extend to any additional registry alignment.
Articulating NJR benefits: Work commenced to better communicate the benefits of the NJR, realised over the past 17 years. Phase one provided a summary for hospital executives of the benefits to their services that become available by subscribing to the NJR https://njr-subscriber-benefits.webflow.io/. Phase two will take place during FY2020/21 and will take a broader view, including quantified impact metrics, of the improvements in arthroplasty practice and benefits to hospitals, surgeons, patients, regulators and policymakers associated with the NJR.
Identifying and preventing ‘Never Events’: Following the NHS Healthcare Safety Investigation Branch requirement to reduce the number of ‘Never Events’ associated with joint replacement surgery, the NJR has been working to deliver validation rules that apply in data entry to an external environment, for use in support of intra-operative checks. We have developed an Application Programming Interface (API) to allow hospital theatre systems to interface with NJR’s checking rules. A smartphone application is also being developed so clinical teams can undertake validation checks even if their hospital does not have a compatible front-end system.
Unveiling a Patient Decision Support Tool: We have launched the NJR Patient Decision Support Tool, a web-enabled personalised decision-making tool for patients considering hip or knee replacement. This tool, whose development was in collaboration with the Universities of Sheffield and Bristol and supported by the charity Versus Arthritis, will help patients considering joint replacement make evidence-based choices about their treatment and share decision-making with their clinicians when considering the benefits and risks of undergoing joint replacement. Work to enhance the tool will continue.
The people who make NJR a success
This year has seen a number of changes to the NJRSC membership. My sincere thanks to outgoing co-opted member Matthew Porteous, who as Chairman of the NJR Regional Clinical Coordinators and Data Quality sub-committees and Vice Chairman of the Surgeon Performance sub-committee, has made an outstanding contribution to the NJR over many years. In addition, my thanks go to NHS Trust management member, Rob Hurd, for his valuable advice and considerable contribution to the NJR.
My appreciation also to outgoing MHRA representative, Khalid Razak, for his significant contribution to the NJRSC and valuable support to the Implant Scrutiny sub-committee. I look forward to working with his successor, Sharon Knight, and continuing our close working relationship with the MHRA. Our final outgoing member is Don McBride, who I thank for his contribution this year as BOA President, which has been important in continuing our valued relationship with the orthopaedic profession. I look forward to welcoming his successor Bob Handley, who takes up post from September.
As ever, my grateful thanks go to the NJR Regional Clinical Coordinators who underpin and champion the work and success of the NJR at a local level. Also to our contract partners Northgate Public Services (UK) Ltd and the University of Bristol for their excellent work throughout the year in supporting the NJR to deliver its work agenda and objectives - particularly in the past few months with the challenges of different modes of working that result from the COVID-19 pandemic.
I would like to end by thanking all members of the NJRSC and sub-committees, for their valuable contribution. In particular, my thanks to Tim Wilton, NJR Vice Chairman and Medical Director, for his clinical expertise and leadership, and to the Chairs of each of our sub-committees - Peter Howard, Mark Wilkinson and Mike Reed - for their hard work and insight. Without their dedication, the NJR would not be the world leading arthroplasty register and global exemplar of an implantable device registry that it is. I would encourage you to read the reports from each committee Chairman at reports.njrcentre.org.uk where they provide strategic oversight into key work areas.
Finally, my thanks to the NJR Management team, especially to our Operations Director, Elaine Young, who provides constant and positive support for the NJR and ensures that we deliver what we promise…and more.