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Getting It Right First Time for Ophthalmology

26 February 2017

The Getting It Right First Time (GIRFT) report into orthopaedic surgery, published by Professor Tim Briggs in 2012, suggested that changes could be made to improve pathways of care, patient experience and outcomes within the specialty, which would also deliver significant cost savings. As a result The Secretary of State for Health and NHS England funded the GIRFT orthopaedics as a pilot reviewing all orthopaedic trusts in England. The recommendations from the pilot were published on 16 March 2015.

The project featured targeted self-assessment and peer review at local level, reviewing data relating to the musculoskeletal services and their clinical outcomes (including complications and infection rates), processes, patient experience, patient pathways, network arrangements, financial impacts and waiting times. The subsequent implementation of the review’s findings led to improved quality and reduced unwarranted variation in clinical practice, changes in surgical practice and shortened average length of hospital stay. From an initial £200,000 investment, the pilot programme helped deliver cost savings and procurement improvements of £90 million. Litigation costs in orthopaedics dropped by 5% in 2014/15 and by a further 8% in 2015/16.

Following its success in orthopaedics, the GIRFT programme was initially expanded to include further ten surgical specialties and is now being rolled out to a total of over 30 medical specialties, including pathology and radiology services, acute and general medicine, and mental health, in a partnership between the Royal National Orthopaedic Hospital Trust, which hosted the pilot, and the Operational Productivity Directorate of NHS Improvement.

As with the initial pilot, the ambition of the programme is to identify areas of unwarranted variation in clinical practice or divergence from the best evidence and the sharing of best practice. Led by clinicians with a strong evidence basis, the work culminates in a report and a set of national recommendations for each specialty aimed at improving quality of care and reducing expenditure on complications, litigation, procurement and unproven treatments.


In ophthalmology the GIRFT team has completed four pilot visits. These have been used to finalise the data required for the full review of the specialty, with all ophthalmology departments in England due to be visited during 2017, beginning in late February.

So what happens at a GIRFT visit?

Before each visit, nationally available Hospital Episode Statistics (HES) data is collected and collated into an individual trust level report by the GIRFT team via Dr Foster. In addition, a questionnaire is sent to each unit, including questions relating to non-specialised and specialised services, focussing on key areas which may be possible to influence. It includes specific questions where it is thought that item costs may be improved. Although the questionnaire includes questions on clinical and financial data, which must be completed for the visit to go ahead, information on each unit is held confidentially and is used in a non-attributable summary in the final report. The questionnaire is combined with the HES data by the GIRFT team, with individual reports sent to each unit ahead of the ‘deep dive’ face to face visit.

At each visit the GIRFT team will review the HES data and information from the questionnaire with departmental staff. Further discussion will take place to clarify the findings and to understand the context of the data, particularly if it varies significantly from the average findings. For the visits to be productive it is important that as many staff as possible attend, with representation of all groups including clinical, coding teams and managerial. Executive representation is expected with the Medical Director and either the Chief Operating Officer or CEO in attendance.

After the visit

After the visit, notes of the meeting which include actions and key recommendations, will be sent to the unit. Once all GIRFT visits have been completed a national report will be prepared which will summarise the findings, highlight any trends and issues, and include general recommendations and an implementation plan.

In orthopaedics the GIRFT team is now revisiting all units to ensure the implementation plan has been actioned and assess its impact. This will be the case for all other specialties, including ophthalmology, after all the initial visits, reporting and implementation stages have been completed.

If you have any questions regarding the GIRFT project, please contact Neha Patel, GIRFT Ophthalmology project manager, on

Carrie MacEwen and Alison Davis, Co-Clinical Leads, and Lydia Chang, Clinical Advisor

Neha Patel, GIRFT Project Manager for Ophthalmology