The GIRFT Litigation workstream, led by John Machin, shares data on litigation costs with NHS trusts with the aim of working with clinicians and managers to determine how clinical practice could improve, reducing the potential for future litigation. Data on the surgical specialties has already been shared with trusts.

The GIRFT litigation data packs for surgical specialties encourage trusts to triangulate the learning from claims, incidents, complaints and inquests.  In particular, since implementing the review of claims through the GIRFT orthopaedic visits and the litigation data packs, there has been a year-on-year fall in orthopaedic claims volume.

The litigation workstream is being expanded to cover medical and clinical service workstreams, which will help drive the reduction of litigation across the NHS.

Best practice for hip and knee arthroplasty surgery

As part of ongoing work both to improve patient outcomes and to reduce litigation costs, GIRFT has produced professional standards guidance for hip and knee arthroplasty in association with the British Hip Society, British Association for Surgery of the Knee, the British Orthopaedic Association and NHS Resolution.

Clinical Lead: John Machin

Specialist Registrar in Trauma & Orthopaedic Surgery at Nottingham University Hospital, Previous National Medical Director’s Clinical Fellow

John is the litigation lead for GIRFT, working with NHS Resolution and NHS England and NHS Improvement to ensure patient care is improved from reviewing clinical negligence claims. Responsible for publishing a range of scientific papers spanning clinical research, quality improvement and medical negligence, John has also co-authored and contributed to a number of national reports, including The Chavasse Report on improving armed forces and veteran care, and Getting It Right First Time – National Review of Elective Orthopaedics.

John is a previous National Medical Director’s Clinical Fellow at NHS England where he worked as the joint programme lead for 7-Day Services in the five Urgent Network Services as part of the Urgent and Emergency Care Review under the supervision of Professor Sir Bruce Keogh and Professor Keith Willett.

John holds an honours degree in Medical Sciences from Magdalen College, Oxford, and completed his clinical training at UCL. He was awarded a distinction in a Postgraduate Certificate in Musculoskeletal Science, is a member of the Royal College of Surgeons of England, and a higher surgical trainee in Trauma and Orthopaedic Surgery.

John is involved in many of the current workstreams.

Clinical Fellow: Annakan Navaratnam

NHS England and NHS Improvement National Medical Director’s Clinical Fellow


Lisa Paget ( is the project manager for the litigation workstream.