The GIRFT Litigation workstream, led by John Machin, shares data on litigation costs with NHS trusts with the aim of working with clinicians and managers to determine how clinical practice could improve, reducing the potential for future litigation. Data on the surgical specialties has already been shared with trusts.

The GIRFT litigation data packs for surgical specialties encourage trusts to triangulate the learning from claims, incidents, complaints and inquests.  In particular, since implementing the review of claims through the GIRFT orthopaedic visits and the litigation data packs, there has been a year-on-year fall in orthopaedic claims volume.

The litigation workstream is being expanded to cover medical and clinical service workstreams, which will help drive the reduction of litigation across the NHS.

Best practice for hip and knee arthroplasty surgery

As part of ongoing work both to improve patient outcomes and to reduce litigation costs, GIRFT has produced professional standards guidance for hip and knee arthroplasty in association with the British Hip Society, British Association for Surgery of the Knee, the British Orthopaedic Association and NHS Resolution.

Hip guidance

Click here to view the GIRFT, BHS and BOA Best practice hip arthroplasty documentation guidance >

Or click here for a one page summary version >

Knee guidance

Click here to view GIRFT, BASK and BOA Best practice knee arthroplasty documentation guidance >

Or click here for a one page summary version > 

Clinical Lead: John Machin

Specialist Registrar in Trauma & Orthopaedic Surgery at Nottingham University Hospital, Previous National Medical Director’s Clinical Fellow

John is the Clinical Lead for Litigation at GIRFT, working with the NHS Resolution and NHS England & Improvement to ensure patient care is improved from reviewing clinical negligence claims. Responsible for publishing a range of scientific papers spanning clinical research, quality improvement and clinical negligence, John has also co-authored and contributed to a number of national reports, including The Chavasse Report on improving armed forces and veteran care, “Getting It Right First Time – National Review of Elective Orthopaedics” and “Getting It Right in Orthopaedics – follow-up report.”

John holds an honours degree in Medical Sciences from Magdalen College, Oxford and completed his clinical training at UCL. He is a fellow of the Royal College of Surgeons of England having completed his higher surgical training in Nottingham before being awarded a post-CCT fellowship in Joint Reconstruction & Oncology at the University of British Columbia, Vancouver. John is a previous National Medical Director’s Clinical Fellow at NHS England.

John is involved in many of the current GIRFT work streams.

Clinical Fellow: Annakan Navaratnam

NHS England and NHS Improvement National Medical Director’s Clinical Fellow



Lisa Paget ([email protected]) is the project manager for the litigation workstream.