Getting It Right First Time (GIRFT) is a national programme designed to improve medical care within the NHS by reducing unwarranted variations. By tackling variations in the way services are delivered across the NHS, and by sharing best practice between trusts, GIRFT identifies changes that will help improve care and patient outcomes, as well as delivering efficiencies, such as the reduction of unnecessary procedures, and cost savings.
The programme was first conceived and developed by Professor Tim Briggs to review elective orthopaedic surgery to address a range of observed and undesirable variations in orthopaedics. In the 12 months after the pilot programme, it delivered an estimated £30m-£50m savings in orthopaedic care – predominantly through changes that reduced average length of stay and improved procurement.
The same model has been applied across 40 surgical and medical specialties and other cross-cutting themes (see Workstream section). It consists of five key strands:
- a broad data gathering and analysis exercise, performed by health data analysts, which generates a detailed picture of current national practice, outcomes and other related factors;
- direct clinical engagement via visits or virtual meetings between clinical specialists and individual hospital trusts, which are based on the data – providing an unprecedented opportunity to examine individual trust behaviour and performance in the relevant area of practice, in the context of the national picture. This then enables the trust to understand where it is performing well and what it could do better – drawing on the input of senior clinicians;
- a national report, that draws on both the data analysis and the discussions with the hospital trusts to identify opportunities for improvement across the relevant services;
- an implementation phase where the GIRFT team supports trusts, commissioners, and integrated care systems to deliver the improvements recommended; and
- best practice guidance and support for standardised/integrated patient pathways and elective recovery work in ‘high volume/ low complexity’ specialties.
The value of the programme to patients and the NHS
GIRFT collaborates and works in genuine partnership with NHS trusts, specialist clinical professional bodies (Royal Colleges and societies), and its partner NHS organisations in collating, scrutinising and sharing data, highlighting both underperformance and excellence. This evidence has had a major impact in identifying variation in clinical outcomes and has provided the focus for hospital teams, departments and clinical networks to tackle unwarranted variation, where it exists, through benchmarking and adopting best practice.
The NHS benefits through improved productivity, efficiency and capacity, which in turn benefits patients, who can receive treatments quicker, have more equity of access to high quality care, and have better outcomes.
GIRFT’s specialty reviews and implementing recommendations
GIRFT’s drive to identify and reduce unwarranted variation and learn from top-performing trusts continues through the publication of national specialty reports and clinical guidelines, and regular engagement with trusts to help gain insight and a true understanding of care delivery across England (see GIRFT Methodology).
GIRFT’s metadata production identifies and enhances specialty-specific clinical metrics and develops real-time clinical data for the Model Hospital and Model Health System portals. This provides a continually-updated evidence base to allow procedure-specific benchmarking across local health system footprints. This approach supports the programme’s national and local implementation work, serving to embed best practice.
GIRFT tracks the implementation of specialty report recommendations at trust, system and national level, ensuring our work is helping to drive change across the health landscape.
The GIRFT Academy and best practice
Working with the specialty associations, GIRFT is mapping out what ‘good’ looks like for standardised pathways of care. This supports the commitment to driving out variation and learning from the best.
GIRFT encourages trusts and local systems to consider and tailor the best practice pathways to their population needs and local priorities to ensure equity of access.
These and other best practice guides are sourced via the GIRFT Best Practice Library, which provides an online learning platform with the knowledge GIRFT has amassed. This resource centre – the GIRFT Best Practice Library – brings together tools and information to help trusts achieve top decile performance, and includes:
- Examples of established best practice gained through GIRFT deep-dive visits to hospitals.
- Sentinel metrics to allow for self-assessment against top decile performance.
- Webinar recordings, videos and best practice guidance to support further learning.
GIRFT works closely with professional organisations to provide a wealth of co-badged evidence, policy documents and operational insight to enable strong and informed clinical leadership in improvement.
Helping systems and regions with elective recovery through the High Volume Low Complexity (HVLC) programme
The GIRFT team is working with systems and regions to help the NHS with post-COVID-19 elective recovery, aiming to reduce the backlog of patients waiting for operations and improve outcomes and access to care.
This is a key element of NHS England and NHS Improvement’s Elective Recovery Programme and is aligned with Pathways for Better Health. GIRFT’s HVLC programme engages integrated care systems and regions to work at pace to agree standardised pathways and adopt best practice, as well as pooling capacity and resources, to achieve top decile performance in clinical outcomes and equity of access to care for their population. This, in turn, allows them to free up capacity to deal with other surgical priorities.
Additional projects: adding value using GIRFT’s methodology and expertise
The GIRFT methodology of using data to shine a light on variation allows the programme’s clinical leads – all experts in their field – to identify where supporting projects can be introduced to bring about further improvements, or where the programme can collaborate with other organisations to add value and insight to existing bodies of work.
The GIRFT programme has initiated cross-cutting workstreams to address generic issues and challenges requiring an NHS-wide approach. These projects (see cross-cutting themes in Workstream section) include:
- Annual surgical site infection (SSI) survey
- Thrombosis survey
- The Learning From Litigation programme
- Clinical coding project to support trusts in improving the accuracy of coding
GIRFT also offers synergies with other projects which make use of its methodology, infrastructure and extensive clinical network. These include:
- The National Consultant Information Programme (NCIP), an initiative to offer an online portal to provide NHS consultants with a single point of access to outcomes data, covering orthopaedics, ophthalmology, urology, ENT, general surgery, gynaecology, paediatric surgery and oral and maxillofacial surgery.
- The Medical Devices Safety Programme (MDSP), working to improve monitoring and evidence on the use and benefit of medical devices as a response to the 2020 Cumberlege Report.
- The Veterans Covenant Healthcare Alliance (VCHA) project, ensuring armed forces veterans are properly supported when accessing secondary care.
- Using GIRFT methodology to support quality improvement across independent sector acute care providers.
The GIRFT programme was made possible by £60m of funding from the Department of Health, announced by the then Health Secretary Jeremy Hunt, in November 2016. GIRFT is now part of an aligned set of programmes within NHS England and NHS Improvement. It is the delivery vehicle for one of several recommendations made by Lord Carter in his February 2016 review of operational efficiency in acute trusts across England.
It has been a privilege for me to see clinicians and managers across the NHS taking ownership of their data, questioning their outcomes and taking actions to improve – working shoulder to shoulder to deliver our ambition of top decile performance.
Professor Tim Briggs CBE,
GIRFT programme Chair and National Director of Clinical Improvement for the NHS