NJR launches new Accountability and Transparency Model to improve safety, care for joint replacement patients

The orthopedic joint replacement registry for England, Wales, Northern Ireland and the Isle of Man has launched a new Accountability and Transparency Model for how it monitors implant, hospital and surgeon performance. The implementation of the model is the coming together of significant consultation during 2017 between the National Joint Registry (NJR), healthcare regulators, and the UK’s orthopedic professional bodies and surgical societies.

The model will see National Joint Registry data integrated across a robust regulatory and professional framework. Structured across five key processes, the model defines roles and strengthens responsibilities for monitoring orthopedic ‘never events’, implant, hospital and surgeon performance, and surgeons’ individual reflection of their practice.

It was hailed by National Joint Registry medical director, Mr Martyn Porter, as “a ground-breaking collaboration that will correct substandard practice earlier and reduce or eliminate poor outcomes for joint replacement patients.”

One of the newly developed processes outlined in the model, the NJR’s Surgeon Appraisal Enhancement Process, offers a formal mechanism to allow joint replacement surgeons the unique opportunity to formally record, via the NJR’s Clinician Feedback tool, that they have reviewed their NJR data as part of their appraisal and revalidation. Surgeons will be required to reflect upon the data. This is a new ground-breaking approach for the NHS and for patient safety and reassurance.  

The NJR was established in 2002, it monitors the performance of implants, the effectiveness of different types of joint replacement surgery and provides evidence to improve clinical standards — all with a focus on patient outcomes. The NJR reported earlier this year that more joint replacements than ever before were carried out in the financial year 2016/17, with just fewer than 243,000 cases submitted to the registry. This sees a significant increase of more than 20,000 joint replacement operations recorded in the registry on the previous period.

National Joint Registry medical director, Mr Martyn Porter, said:

It has never been more important to ensure that anyone who chooses to have a joint replacement procedure has the right to safe care. Now with close to 2.5 million records, the NJR’s role in monitoring implant, hospital and surgeon performance remains of vital importance. The strengthened partnerships developed through the NJR’s Accountability and Transparency Model will drive even greater patient safety and quality of care for joint replacement patients.

Since inception, the NJR’s scrutiny has unmistakably led to increased patient safety with poorly performing devices removed from the market and a spotlight turned on poor surgical practice. It is important for a registry the size of the NJR to routinely review its processes and ensure it is continuing to best serve patients.

At the surgeon-level, offering joint replacement surgeons the unique opportunity to demonstrate and record that they have reviewed their own performance data will inform the appraisal process in a constructive way. ‘Practitioner reflection’ will support surgeons by encouraging best practice behavior and help drive a positive professional culture with a sharp focus on patient safety.

At the hospital-level, formulating an agreed process to allow appropriate review of hospitals which fall below expected performance thresholds is an important development of the new model. The model will help encourage hospital management to place a stronger importance on engagement with audit data and this supports the data-driven change which is happening across the healthcare sector.

Fundamentally, this review of roles and relationships between the NJR, regulators and the profession, should offer the public even greater confidence in the NJR’s monitoring processes. This way of working will provide a robust holistic view of surgical performance which will guide even more informed patient choice.

Supported by NHS England National Medical Director, Professor Sir Bruce Keogh, the NJR’s Accountability and Transparency Model is an initiative designed in collaboration between the NJR, Medicines and Healthcare products Regulatory Agency (MHRA), Care Quality Commission (CQC), NHS Improvement (NHSI), Healthcare Inspectorate Wales (HIW), Healthcare Quality Improvement Partnership (HQIP), the British Orthopedic Association (BOA), specialist surgical orthopedic societies, and the NJR’s contractors, Northgate Public Services Ltd and the University of Bristol.