BOA Elective Care Reviews

About BOA Elective Care Reviews

As a key priority the BOA supports Orthopaedic units to improve the quality of their elective services. To complete our support to units, the BOA now provides Elective Care Reviews (ECRs). ECRs are site visits to Trusts by a review team consisting of BOA members and representatives from Specialist Societies the British Association for Surgery of the Knee (BASK) and/or the British Hip Society (BHS). The review considers aspects of the Trust’s hip/knee arthroplasty service to produce recommendations in order to improve it. The review can be triggered either when a Trust is flagged as a persistent outlier by the NJR, or by the Trust wanting a review based on some other concern or factor. ECRs always happen at the request of the Trust.

It is a significant undertaking to hold an in-depth review of this nature, both for the review team and the unit being reviewed. However, such reviews have an important role to play in helping units identify areas for improvement and ultimately for patients to benefit.

Trusts that are interested in a review must email their enquiry to [email protected]. The BOA Policy Team will then be in touch concerning the next steps. 

History of BOA Elective Care Reviews

The first BOA ECRs were piloted in 2018, and have continued frequently since. There have been a total of 9 ECR’s completed since 2018.

Objectives of a BOA Elective Care Review

There are two main parts to a BOA ECR:

•    The overall focus is a Review Visit, in which a team coordinated by the BOA visit the unit, with a pre-arranged programme in which they meet staff and see the facilities. The aim of the visit is to discuss and review issues occurring at that unit, based on agreed Scope of Work and objectives for the review. This visit will occur over one afternoon and the following morning, and will consist of various meetings with unit staff and tour of facilities.
•    In advance of the visit, there is a preparatory stage in which the unit will need to provide detailed information to us, such as relevant data and policies. This information will (1) assist us in planning the approach we take in relation to the visit and (2) provide background information to discuss further. We may also liaise with the NJR to help us understand any data provided.
The specific objectives of each review will vary depending on the scope of work and particular issues to be looked at. However, the following broad objectives will be common to all reviews:
•    To evaluate the relevant data from the unit.
•    To assess standards of care, as set down by current NICE guidelines, NICE quality standards, BOA elective care standards and the Best Practice Tariff against the delivered service from your unit. 
•    To recommend changes in the care pathway to aid an improvement in care.

There is an emphasis on creating an encompassing and supportive review aimed at helping units optimise care for patients. All reviewers will be expected to uphold this core value throughout their involvement with the review.


The reviews are paid for by the Trust and currently cost £15,000 exclusive of VAT. An invoice will be sent when the review is requested and to be paid before the review is organised. 

The Trust being reviewed will also be responsive for the expenses of the reviewers, including travel, accommodation and subsistence, as well as the cost of the time away from their employing trusts.

Sites that are interested in a review should e-mail their enquiry to [email protected].  The BOA Policy Team will then be in touch about the next steps.