Professor Briggs launches report - “Getting it Right First Time”

Improving the Quality of Orthopaedic Care within the NHS

In a new report launched today, Tuesday 4 September, at the House of Commons, a leading surgeon warns that the provision of orthopaedic care in England could soon suffer from falling quality and rising waiting lists unless fundamental changes are made to the way the service is delivered.

The new report, which looks into the issues facing orthopaedic care in England, has been launched in the House of Commons by Professor Timothy Briggs and Rt Hon Stephen Dorrell MP, Chair of the Health Select Committee.

The report, which has the support of every professional and patient body including the Patients’ Association and the British Orthopaedic Association and Royal College of Surgeons of England, proposes a series of reforms for a joined up approach across the NHS to improve orthopaedic treatment. It also comes with a warning to the Government that they could be in the ‘last chance saloon’ in terms of preventing increased waiting times and widespread rationing.

Briggs report launchL-R: Professor Norman Williams, President of The Royal College of Surgeons, Professor Tim Briggs, Consultant Orthopaedic Surgeon at the RNOH, Rt Hon Stephen Dorrell MP and Andrew Selous MP.

Professor Briggs explained, “The NHS is faced with having to make savings of up to £20bn over the next 5 years, the annual budget for dealing with orthopaedic patients, is £10bn a year – put that in the context of an ageing population, people living longer, and a rise in obesity then we are heading into real problems in terms of inconsistent quality, rising waiting times and rationing. 

“I am proposing the formation of networks of hospitals and treatment centres to provide specialist orthopaedic units that will be quality assured and provide specialist services for patients close to their homes.  These would focus on providing complex procedures, such as revision hip and knee replacements, to make sure that appropriate expertise is applied first time, every time, to improve the survival rate of implants, reduce complications and infection, and consequently reduce litigation costs.” 

Professor Briggs’ recommendations include improved clinical pathways to streamline referrals as well as nationally developed guidelines, which by working with Primary Care will ensure the treatment of musculoskeletal disease should be seamless from presentation to treatment.

Professor Briggs also suggests that there should be a musculoskeletal lead GP in each practice, who would ensure referrals are targeted, so that patients receive the right care locally and when necessary are referred to the appropriate specialist without delay.  This is particularly relevant as patient demand is growing and currently orthopaedic complaints account for 30% of a GP’s workload, while often a GP may only get five weeks specialist orthopaedic teaching during their training.

According to Professor Briggs patients currently face a ‘postcode lottery’ as to the quality and accessibility of care and the introduction of a network of accredited units working within networks to deliver nationally agreed pathways of care would raise standards for patients while also saving the NHS significant sums of money.  Money currently sometimes wasted on misdirected referrals, inappropriate treatments, re-admissions, treating infections and litigation.

As the recent scandal of the problems associated with a number of replacement hip joints demonstrates, the introduction and use of new implants within the NHS needs further regulation.  Specialist Units, with a proven track record of translational research, should be taking a leading role in their evaluation.  Indeed, Professor Briggs proposes that the ‘accredited’ specialist units should also be central to the development and introduction of new orthopaedic technologies and procedures within the NHS.  

Professor Briggs added, “The issues we have are enormous but not insurmountable. This report doesn’t only define the problems it offers very real solutions, solutions which can be readily implemented and which come with the endorsement of the professional bodies that would be impacted by these changes.  If the Government doesn’t address these fundamental problems with the quality of orthopaedic provision and continues to focus predominantly on the model of commissioning care, then cracks will soon begin to appear in the service.  There is no time to wait for the new models of commissioning to drive up quality, action must be taken now and taken in collaboration with the orthopaedic clinicians.

“It is absolutely crucial that the recommendations I set out in this report form the basis of future orthopaedic services to ensure patients can access high-quality care in a timely fashion as we move into a financially unsure future.”

View the report by visiting: Getting It Right First Time

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