GIRFT — What It Is and What It Found

Part of The Joint Replacement Guide — Phase 6: The Bigger Picture · Article 39 of 44 · Hip & Knee

Key Points

  • GIRFT (Getting It Right First Time) is an NHS England programme that uses clinical data and professional peer review to help services improve care and reduce unwarranted variation.
  • Its original national orthopaedic review found substantial differences between hospitals in areas such as implant selection, fixation methods, complications, length of stay and the cost of care.
  • Variation is not automatically a sign of poor practice: differences may be appropriate when they reflect individual patient needs. GIRFT focuses on variation that cannot readily be explained by clinical need or good evidence.
  • GIRFT has supported more consistent practice, service improvement and the sharing of successful approaches across the NHS.

What GIRFT Is

Getting It Right First Time (GIRFT) is a clinically led NHS England improvement programme. It combines analysis of routinely collected healthcare data with the experience of senior clinicians to examine how services are delivered, identify variation and help clinical teams improve their pathways.[1]

Orthopaedics was the programme’s original pilot specialty. The first national review involved visits to more than 140 providers across over 200 hospital sites and led to the publication of a national report on adult elective orthopaedic services in 2015.[2,3] The GIRFT approach has since been extended across numerous surgical and medical specialties.

Understanding “Unwarranted Variation”

Hospitals do not need to provide identical treatment to every patient. Some variation is appropriate because patients differ in their health, anatomy, preferences and clinical needs.

GIRFT is primarily concerned with unwarranted variation: differences in care, outcomes or use of resources that do not appear to be adequately explained by those legitimate clinical factors. Its purpose is to help teams understand why differences exist, learn from services achieving good outcomes and decide whether local practice should change.

GIRFT data should therefore be viewed as a starting point for professional review and improvement, rather than as proof that an individual hospital or surgeon has provided poor care.

What the Orthopaedic Review Found

The original orthopaedic review identified considerable variation between hospitals in areas including:

  • the types and costs of implants being used;
  • cemented and uncemented hip fixation;
  • infection, complication and revision rates;
  • length of hospital stay;
  • procurement arrangements; and
  • the organisation of elective orthopaedic services.[2]

Some differences reflected reasonable clinical judgement or differences between patient populations. Others suggested opportunities to follow stronger evidence, improve local pathways, purchase implants more consistently or learn from units producing good outcomes.

A subsequent GIRFT orthopaedic follow-up reported improvements in several measures, including reductions in average length of stay, infection and hip revision rates.[3] These are encouraging national trends, although observational programme data cannot prove that GIRFT alone caused every improvement.

What Changed as a Result

GIRFT’s findings and recommendations have contributed to national improvement work in orthopaedics. This has included encouraging closer consideration of registry evidence when choosing implants and fixation, reducing avoidable variation in clinical pathways, and sharing effective approaches between hospitals.

GIRFT has also supported the development of standardised pathways for common planned operations and the expansion of ring-fenced elective surgical hubs. These hubs separate planned surgery from at least some emergency pressures, helping reduce the risk of operations being cancelled when emergency beds and theatres are required.[4]

Enhanced recovery, pre-operative optimisation and early mobilisation were not created by GIRFT and each has its own independent evidence base. It is more accurate to say that GIRFT has helped promote and support their more consistent implementation where appropriate.

Why This Matters to You as a Patient

Much of GIRFT’s work takes place behind the scenes. You may experience its influence through more consistent surgical pathways, careful implant selection, structured preparation before surgery, shorter hospital stays and services designed to protect planned operations from emergency pressures.

However, GIRFT recommendations do not replace individual clinical judgement or shared decision-making. Your treatment should still be based on your particular condition, general health, preferences and the informed judgement of your clinical team.

GIRFT data is mainly designed to help healthcare services understand and improve their performance. It is not intended to provide a simple league table for patients or to rank individual hospitals without considering differences in the patients and procedures they manage.

In More Depth

The GIRFT method combines national data analysis, comparison with similar services, clinically led review and discussion with local teams. This matters because figures rarely explain themselves: a higher complication rate, longer hospital stay or different implant choice may have several possible explanations, including the complexity of the patients treated.

The value of the programme lies in using data to ask informed questions, identify successful practice and agree practical improvements—not in assuming that every numerical difference represents poor care. This complements the National Joint Registry discussed in the previous article: the NJR principally records joint-replacement procedures and outcomes, while GIRFT uses data from the NJR and other sources to examine how whole services and clinical pathways might be improved.

This article provides general information and does not replace individual clinical advice. Services and pathways vary between hospitals, and decisions about your treatment should be made with your own clinical team.

References

  1. NHS England. Connected NHS England programmes: Getting It Right First Time.
  2. Briggs T. A national review of adult elective orthopaedic services in England. Getting It Right First Time; 2015.
  3. Getting It Right First Time. Orthopaedic Surgery: national review and follow-up report.
  4. Getting It Right First Time. Surgical hubs.

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