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Written on 30th March 2021 by Susan Brown

GIRFT or ‘Getting It Right First Time’ has published its report following its pilot independent sector review of orthopaedic and spinal healthcare providers. The pilot was the first time the GIRFT healthcare improvement programme has reviewed independent healthcare organisations, looking for ways to share best practice, save unnecessary costs and improve standards of care.

Welcomed and supported by the Independent Healthcare Providers Network (IHPN), GIRFT’s pilot review identified examples of good practice and opportunities for improvement to raise care standards and patient outcomes in private hospitals providing NHS care.

Why is GIRFT reviewing independent sector healthcare?

Since Professor Tim Briggs launched GIRFT with his first pilot review of NHS orthopaedic services in 2015, GIRFT’s national improvement programme has worked with trusts across the NHS to improve patient care by reducing unnecessary variations in clinical practice. GIRFT has already made a real difference across a range of clinical services. It does this by identifying the best and worst examples of practice and patient outcomes within an NHS clinical specialism, such as diabetes or vascular surgery, highlighting changes that can be made by the NHS and individual NHS trusts to improve patient care, save costs and increase efficiency.

The key to GIRFT’s success is in the way that it carries out its reviews. GIRFT’s specialists analyse the data relating each trust’s performance and outcomes in the type of care being reviewed. The data review is followed by a ‘deep-dive’ visit to the trust in which senior, respected, frontline clinicians with significant experience in their specialty meet with clinicians and management at the trust. These ‘shoulder-to-shoulder’ professional meetings are meaningful and allow the trust and their senior staff to understand how their standards compare to those of other NHS trusts and, where necessary, give them a plan to improve the efficiency of their services and quality of care.

Although we may think of NHS and private healthcare as separate pathways for treatment, GIRFT’s pilot review reminds us that independent healthcare providers deliver care to millions of NHS and private patients every year. For example, in response to the coronavirus pandemic the independent hospital sector made its entire services available to the NHS on a non-profit basis. This included 8,000 hospital beds, nearly 1,200 ventilators, 700 doctors, 10,000 nurses, and over 8,000 other clinical staff. Since March 2020 over 2 million NHS operations, chemotherapy sessions, tests and consultations have been delivered in independent hospitals.

As GIRFT points out, with independent healthcare playing such an important role in NHS care, it is important that its services meet the same standards.

GIRFT’s independent healthcare sector pilot review

The independent healthcare sector pilot review was led by GIRFT and supported by the Independent Healthcare Providers Network (IHPN). Its aim was to test whether an adapted version of GIRFT’s unique methodology could work to bring about improvement in the independent healthcare sector, as it has in some areas of the NHS.

The pilot review of orthopaedic and spinal services involved 63 independent hospitals which also provide NHS care, across a number of independent healthcare providers. The GIRFT clinical teams were led by GIRFT founder and orthopaedic specialist, Professor Tim Briggs, and GIRFT spinal care clinical lead, Mike Hutton. After analysing the data, deep dive meetings took place at the hospitals with the aim of improving patient care, outcomes and safety in ‘orthopaedics and spines’, by highlighting good practice, unwarranted variations, untoward incidents and poor practice.

The report does not set out the pilot review’s findings in detail, as this was not the primary aim of the review, but it confirms that, within the independent hospitals reviewed, the GIRFT teams were able to identify areas of excellence, areas for improvement and unwarranted variation. 
Examples of good practice areas in some hospitals included:

  • a named infection control nurse who liaised with NHS trusts to monitor patients who were re-admitted with infections;
  • length of stay; 
  • operating theatre productivity;
  • high numbers of surgical first assistants trained and working in operating theatres;
  • low mortality (death) rates; 
  • excellent relationships seen between physiotherapists and ward staff;
  • 7-day physiotherapy services; 
  • CQC ratings of good to outstanding. 

Examples of variations and areas for improvement included:

  • variation in revision rates for hip and knee replacements;
  • variation in non-specialist and specialist surgery procedures;
  • variation in elective (not urgent) primary hip replacement, and NHS Patients and private patients’ length of stay;
  • variation in numbers of orthopaedics and spinal procedures;
  • variation in the performance and quality monitoring by CCGs and NHS trusts who have contracted with the independent sector.

The pilot was welcomed by private sector healthcare providers, all of whom requested that GIRFT incorporate their private practice data into the review, at their own cost, even though the official scope of the review was limited to independent provision of NHS care. This, together with the success of the pilot review in identifying areas in which GIRFT can make a difference, indicates that in future GIRFT will be able to help the independent healthcare sector, as well as the NHS, deliver consistent higher standards of care.

What happens now?

Following their deep dive visits, each of the reviewed hospitals receive a report on the GIRFT team findings and an action plan for improvements. The report sets out individual recommendations to reduce complications, increase the standard of care and reduce the risk of litigation (compensation claims). The hospital is responsible for ensuring that the recommendations are implemented.

The individual hospital reports are not published, but those hospitals that have been reviewed are now learning from their involvement in the GIRFT pilot. GIRFT and the independent sector are hopeful that the programme can be rolled out to make a difference in all areas of patient care.

At Boyes Turner, we understand the suffering experienced by patients and their families when injury occurs as a result of poor standards of care. We are committed to securing the highest levels of compensation for those who are injured by medical negligence, and we welcome GIRFT’s efforts to reduce patient harm and improve standards of NHS and independent healthcare.

If you have been injured as a result of medical negligence, and would like to find out more about making a claim, contact us by email at