Following the successful completion of a quality improvement pilot in orthopaedic surgery entitled Getting It Right First Time (GIRFT), the Department of Health and NHS Improvement (NHSI) have commissioned an expansion of the GIRFT programme that will cover an additional 35 clinical areas over four years from April 2017 to support providers in delivering clinical productivity and efficiency improvements. This programme is aligned closely to the Carter work streams in NHSI and the programme is part of the Operational Productivity Directorate of NHSI.

The ambition of the programme is to identify areas of unwarranted variation in clinical practice and/or divergence from the best evidence. Each work stream will culminate in a report and set of national recommendations aimed at improving quality of care and also reducing expenditure on complications, litigation, procurement and unproven treatment. This work will also support the development of the Model Hospital, which will provide NHS hospital trusts with a set of numbers to compare all areas of efficiency and productivity alongside their quality indicators and standards. It will allow acute Trusts, using a number of indicators and benchmarks, to assess clinical outcomes for their patients and measures of productivity by specialty and compare these with other Trusts.

The Neurology Getting It Right First Time is now being launched. This is being led by Dr Geraint Fuller, Consultant Neurologist at Gloucestershire Hospitals NHS Foundation Trust, and Professor Adrian Williams,
Professor of Neurology at University Hospitals Birmingham NHS Foundation Trust.

GIRFT will undertake an analysis of nationally collected neurological data by provider and population including:

  • inpatient and outpatient activities,
  • drug use,
  • measures of radiology and neurophysiology and
  • clinical outcomes.

This will be analysed and put together in a data pack for each Trust. These data packs with Trust-specific data will be issued to every Trust that provides neurological services. The GIRFT team will visit every Trust to present to clinicians, managers and Trust executives the data for their own Trust, allowing Neurology teams to understand what they are doing well and what they are not doing well.

To make sense of this data it needs to be set in the context of what services are available and how they are organised. To help us understand this the GIRFT team in collaboration with the ABN we will be undertaking a National Neurological Census to determine what services are available in every hospital site in the UK. This will build on the ABN Acute Neurology Survey.

The GIRFT programme for surgical specialties has found very significant variation in patient outcomes. Those units achieving the best results have sometimes been surprising and have often provided particularly useful insights in how best to deliver services. There seems little doubt this will be replicated in neurology. By providing meaningful national data about patient activity and outcomes along with an understanding of the relevant neurological services available, the GIRFT process will make units aware of their weaknesses and their strengths and help with national understanding of what works best. This will allow the sharing of best practice. The GIRFT process will also help with the implementation of any proposals developed through the visits. The clinical leads say they are optimistic that this process will allow them to understand and improve neurological services across the country.

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