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Email: info@gettingitrightfirsttime.co.uk
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About the GIRFT programme

The Getting It Right First Time (GIRFT) programme is a national NHS England programme designed to improve treatment and care by reviewing health services in England. It undertakes clinically-led reviews of specialties, combining wide-ranging data analysis with the input and professional knowledge of senior clinicians to examine how things are currently being done and how they could be improved.

By tackling variations in the way services are delivered across the NHS, and by sharing best practice between trusts, GIRFT identifies changes that will help improve care and patient outcomes, as well as delivering efficiencies, such as the reduction of unnecessary procedures, and cost savings.

The GIRFT methodology has been applied across more than 50 different areas of clinical practice in surgical and medical specialties and cross-cutting themes including diagnostics, day case surgery, outpatient services and clinical coding.

The programme takes a detailed look at individual specialties’ performance based on a number of metrics including mortality rates, length of stay, post-surgical infection rates and hospital re-admission rates.

Providing benchmarking data and sharing best practice has helped trusts to review their practices and reduce unwarranted variation which in turn delivers efficiencies and unlocks savings.

The model consists of five key strands:

  • Data gathering – a broad data gathering and analysis exercise, generating a detailed picture of current national practice, outcomes and other related factors.
  • Peer reviews – direct clinical engagement via visits or virtual meetings between clinical leads and trust teams; an opportunity to examine trust behaviour in the context of the national picture, enabling teams to understand where they are performing well and what they can do better,    drawing on the input of GIRFT clinical leads.
  • A national specialty report and Academy resources – production of national reports that draw on data analysis and discussions with provider teams to identify opportunities for improvement, locally, regionally and nationally, alongside clinical resources such as best practice pathways and guides. 
  • Support to deliver – the implementation phase where the GIRFT team supports trusts, commissioners and integrated care systems to deliver recommended improvements via the Further Faster programme and other focused support mechanisms.
  • Studies and Research – GIRFT fellowships support resident doctors, nurses and allied health professionals to develop their research and clinical improvement skills, delivering research projects and GIRFT identified improvements in their host provider, system or region.

GIRFT Projects Directorate at the Royal National Orthopaedic Hospital NHS Trust

The GIRFT methodology was first conceived and developed by Professor Tim Briggs to review elective orthopaedic surgery to address a range of observed and undesirable variations in orthopaedics.  As a consultant orthopaedic surgeon at the Royal National Orthopaedic Hospital NHS Trust (RNOH), Professor Briggs undertook a pilot which highlighted opportunities to deliver an estimated £30-£50m cost efficiencies in orthopaedic care – predominantly through changes to reduce average length of stay and improved procurement of medical devices.

Following the successful pilot, Professor Briggs was appointed to lead the NHS England GIRFT programme.  However, the RNOH Trust continues to offer healthcare service reviews using GIRFT methodology via its GIRFT Projects Directorate, under Professor Briggs’ chairmanship.

The RNOH GIRFT Projects team supports other organisations and principally the devolved nations of Northern Ireland, Scotland and Wales.

For more information visit GIRFT Projects Directorate webpage here>

Specialty reviews and implementing recommendations

GIRFT’s drive to identify and reduce unwarranted variation and learn from top-performing trusts continues through the  publication of national specialty reports and clinical guidelines, and regular engagement with trusts to help gain insight and a true understanding of care delivery across England (see GIRFT Methodology).

GIRFT tracks the implementation of specialty report recommendations at trust, system and national level, ensuring our work is helping to drive change across the health landscape.

Support to deliver service improvements

Working to the principle that a patient should expect to receive timely and effective investigations, treatment, and outcomes wherever care is delivered, irrespective of who delivers that care, GIRFT aims to identify approaches from across the NHS that improve outcomes and patient experience. The GIRFT team works with trusts, systems and regions to deliver improvements in three key areas:

  • Elective care – the GIRFT Elective Team is supporting improvements in referral to treatment times (RTT) and long wait targets to reduce the backlog of patients waiting for operations and improve outcomes and access to care.
  • Urgent and emergency care – the GIRFT UEC Team is working to improve category 2 ambulance response times, and the 4-hour and 12-hour standards.
  • Mental health – the GIRFT Mental Health Team is focused on enhancing urgent access and inpatient pathways.

 

GIRFT engages with trusts, integrated care systems and regions to work at pace to agree standardised pathways and adopt best practice, as well as pooling capacity and resources, to achieve top decile performance in clinical outcomes and equity of access to care for their population. This, in turn, allows clinical teams to free up capacity and improve patient access and waiting times.

The Academy and best practice resources

Working with the specialty associations, GIRFT is mapping out what ‘good’ looks like for standardised pathways of care. This supports the commitment to driving out variation and learning from the best.

GIRFT encourages trusts and local systems to consider and tailor the best practice pathways to their population needs and local priorities to ensure equity of access.

These best practice pathways and other clinical guides are sourced via the resource centre on this website which brings together clinically-led guidance and information to help trusts achieve top decile performance, and includes:

  • Examples of established best practice gained through GIRFT deep-dive visits to hospitals.
  • Clinical pathways guidance for individual specialties.
  • Webinar recordings, videos and best practice guidance to support further learning.


GIRFT works closely with professional organisations to provide a wealth of co-badged evidence, policy documents and operational insight to enable strong and informed clinical leadership in improvement.

How GIRFT shares data

GIRFT has a significant and growing presence on the Model Health System (Model Hospital) portal, with its data-rich approach providing the evidence for hospitals to benchmark against expected standards of service and efficiency.

GIRFT’s metadata production identifies and enhances specialty-specific clinical metrics and develops real-time clinical data for the Model Health System portal. This provides a continually-updated evidence base to allow procedure-specific benchmarking across local health system footprints. This approach supports the programme’s national and local implementation work, serving to embed best practice.

The value of the programme to patients and the NHS

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

The NHS benefits 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.

To read more about the GIRFT Patient Voice Principles, click here

Additional projects: adding value using GIRFT’s methodology and expertise

The GIRFT methodology of using data to shine a light on variation allows the programme’s clinical leads – all experts in their field – to identify where supporting projects can be introduced to bring about further improvements, or where the programme can collaborate with other organisations to add value and insight to existing bodies of work.

The GIRFT programme has a number of cross-cutting workstreams to address generic issues and challenges requiring an NHS-wide approach. These projects (see cross-cutting themes in Workstream section) include:

 

GIRFT also offers synergies with other projects which make use of its methodology, infrastructure and extensive clinical network. These include:

  • The National Consultant Information Programme (NCIP) –  an online portal to provide NHS consultant surgeons with a single point of access to outcomes data across 12 surgical specialties.
  • The Medical Devices Safety Programme (MDSP), working to improve monitoring and evidence on the use and benefit of medical devices as a response to the 2020 Cumberlege Report.
  • The Veterans Covenant Healthcare Alliance (VCHA) project, ensuring armed forces veterans are properly supported when accessing secondary care.
  • Using GIRFT methodology to support quality improvement across independent sector acute care.

A short video introduction to what GIRFT does (click here to view full screen)