Getting It Right First Time

The Getting it Right First Time (GIRFT) programme is a national programme designed to improve the quality of care within the NHS by reducing unnecessary variation in services. By sharing good practice and new approaches between trusts, GIRFT identifies changes that will help improve care and patient outcomes, as well as delivering efficiencies such as a reduction in unnecessary procedures and patient length of stay, and the consequent cost savings. 

GIRFT began as a pilot within orthopaedic surgery led by orthopaedic surgeon Professor Tim Briggs, during the time he was president of the BOA. The GIRFT methodology has since been applied across more than 40 surgical and medical specialties and cross-cutting themes including diagnostics, day case surgery, outpatient services and clinical coding.

Each workstream is led by one or more frontline clinicians who are experts in the specialty they are reviewing. Professor Briggs remains as the GIRFT clinical lead for adult elective orthopaedic surgery, as well as being the programme’s Chair and the National Director for Clinical Improvement and Elective Recovery for NHS England.

The full list of GIRFT clinical leaders:

• Adult elective orthopaedic surgery
  • Clinical lead: Professor Tim Briggs
  • Deputy workstream lead: Andrew Dunn
• Adult orthopaedic trauma
  • Clinical lead: Bob Handley
• Spinal services
  • Clinical lead: Mike Hutton
  • Clinical advisors: Vinay Jasani and Mike Grevitt
• Paediatric trauma and orthopaedic surgery
  • Clinical lead: James Hunter

GIRFT collaborates and works in partnership with NHS trusts, specialist clinical professional bodies (Royal Colleges and societies), and partner NHS organisations in collating, scrutinising and sharing data, highlighting both underperformance and excellence. This evidence has 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. 

GIRFT works closely with professional organisations to provide a wealth of co-badged pathways, guidance and operational insight to enable strong and informed leadership in improvement. Resources to support improvement in orthopaedic surgery can be found here:

• Adult elective orthopaedic surgery
• Adult orthopaedic trauma
• Spinal services
• Paediatric trauma and orthopaedic surgery

GIRFT’s work benefits the NHS 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. 

More information on GIRFT’s work and methodology can be found on the programme’s website. 

 GIRFT adult elective orthopaedic resources co-badged with the BOA

• Elective primary total hip replacement pathway
• Elective primary total and uni knee replacement pathway
• Trauma total elbow replacement pathway
• Elective total elbow replacement pathway
• Anterior Cruciate Ligament Reconstruction pathway
• Bunions pathway
• Therapeutic shoulder arthroscopy for rotator cuff repair OR subacromial decompression pathway
• Orthopaedic surgery outpatients guidance
• Surgical Antibiotic Prophylaxis – principles for primary arthroplasty 
• Best Practice Pathway for Hip and Knee Replacement Surgery – default to ambulatory surgery
• Best practice for hip arthroplasty surgery documentation
• Best practice for knee arthroplasty surgery documentation

GIRFT paediatric trauma and orthopaedic surgery resources co-badged with the BOA

• Paediatric forearm fracture manipulation in the ED

GIRFT adult orthopaedic trauma resources co-badged with the BOA

• Non-ambulatory fragility fracture pathway

GIRFT spinal services resources co-badged with the BOA

• National suspected Cauda Equina Syndrome pathway
• National suspected Cauda Equina Syndrome pathway guide
• National suspected Cauda Equina Syndrome interactive pathway

Other useful links

• GIRFT national review of adult elective orthopaedic services in England (2015): The 2015 GIRFT report reviewed practices and outcomes of NHS hospitals providing orthopaedic surgery in England.
• Getting It Right in Orthopaedics: A follow-up on the GIRFT national specialty report on orthopaedics (2020): Follow-up report demonstrating the progress since the original 2015 GIRFT national report
• BOA Professional Guidance to Implement Getting It Right First Time in England
• GIRFT Further Faster orthopaedics master handbook (2024)
• GIRFT national report for spinal services (2019)
• GIRFT national report for paediatric trauma and orthopaedic surgery (2022)
• GIRFT orthopaedic surgery case studies
• GIRFT spinal surgery case studies
• QR codes on plaster casts case study
• Paediatric super clinics case study
• Model Health System metrics
• The National Consultant Information Programme (NCIP) and how to access your data