GIRFT — What It Is and What It Found

Part of The Joint Replacement Guide — Phase 6: The Bigger Picture · Article 37 of 42 · Hip & Knee

Key Points

• GIRFT (Getting It Right First Time) is a national NHS programme that reviews clinical practice and variation across specialties, including orthopaedics.
• Its orthopaedic review identified significant, sometimes surprising, variation in practice and outcomes between different hospitals and units.
• Findings from GIRFT have directly influenced national guidance referenced throughout this guide, including around fixation choice and pre-operative optimisation.
• It represents a broader, system-level example of the same evidence-based improvement culture discussed at the individual surgeon level in the previous article.

What GIRFT Is

Getting It Right First Time (GIRFT) is a national NHS programme designed to improve the quality of clinical care by reducing unwarranted variation in practice across hospitals. Orthopaedics, including hip and knee replacement, was among the specialties first reviewed under the programme, led by clinicians reviewing detailed data alongside visits to individual hospital trusts, comparing practice, outcomes, and costs across the country.

What It Found

The GIRFT orthopaedic review identified considerable variation between different hospitals and units in areas including implant choice and fixation method, infection and complication rates, length of hospital stay, and how consistently evidence-based practices — such as pre-operative optimisation and enhanced recovery protocols, both discussed earlier in this guide — were being applied. This variation wasn’t necessarily about any individual surgeon’s skill, but often reflected differences in local systems, protocols, and resource allocation between different hospitals.

What Changed as a Result

GIRFT’s findings have directly informed a number of the practices and recommendations discussed throughout this guide — including national guidance around fixation choice by age group (covered in the article on cemented and uncemented fixation), wider adoption of enhanced recovery principles, and a stronger national push towards standardised pre-operative optimisation. It has also influenced how some services are organised, including efforts to separate elective (planned) orthopaedic surgery from emergency and trauma work where possible, reducing the risk of planned operations being cancelled due to emergency demand on the same wards and theatres.

Why This Matters to You as a Patient

Much of the good practice referenced throughout this guide — from pre-operative optimisation to same-day mobilisation — exists in its current, more standardised, evidence-based form partly because of programmes like GIRFT identifying where practice was falling short and driving improvement. It’s a useful reminder that the individual care you receive sits within a much larger system that is, genuinely, continuously trying to identify and close gaps in quality across the whole country.

In More Depth

GIRFT’s methodology — combining detailed national data analysis with peer-led hospital visits and direct clinician engagement — has been influential enough to be extended well beyond orthopaedics into numerous other surgical and medical specialties across the NHS. Its orthopaedic-specific reports remain publicly available and are worth reading for anyone interested in understanding the broader system-level context behind the individual clinical decisions and guidance covered throughout this guide.

This article is general information and does not replace individual clinical advice.

Sources

• GIRFT (Getting It Right First Time) — National Report on Orthopaedics
• NHS England — GIRFT programme overview

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