Dr Christopher Moulton and Dr Clifford Mann to head up work stream

Dr Christopher Moulton, the Vice President of the Royal College of Emergency Medicine, and Dr Clifford Mann*, the Royal College’s Immediate Past President, have been appointed as joint medical leads for the Emergency Medicine work stream, the latest review to be carried out by the Getting It Right First Time (GIRFT) programme.

Dr Moulton is a Consultant in Emergency Medicine at the Royal Bolton Hospital, whilst Dr Mann, in addition to being a Consultant in Emergency Medicine at the Taunton and Somerset Hospital, is also a National Clinical Adviser on A&E to NHS England.

The pair will lead a deep dive review of Emergency Medicine in England using the GIRFT methodology, which is designed to identify and address unwarranted variations to help improve clinical quality and efficiency. Using reports based on trusts’ own data, Dr Moulton and Dr Mann will visit emergency departments across England to discuss the research with clinicians and trust managers. As with all GIRFT work streams the review will culminate in a national report that will highlight existing good practice and include recommendations for improving the service. GIRFT will then support providers to deliver those recommendations throughout an implementation phase that follows publication of the national report.

Announcing the new appointments, Professor Tim Briggs, Chair of GIRFT and National Director of Clinical Quality and Efficiency at NHS Improvement, said: “Emergency Medicine is at the frontline of the NHS and is currently experiencing unprecedented volumes and pressures, so I am delighted that two consultants with the experience and calibre of Christopher and Clifford have agreed to take the reins of this GIRFT review.”

Jeremy Marlow, NHS Improvement’s Executive Director of Operational Productivity, added: “The GIRFT methodology has already proven invaluable in helping to improve efficiency and patient outcomes in orthopaedic surgery, and I am certain the same evidence-based approach will enable us to address the challenges we face in emergency medicine.”

Explaining why he wanted to take on the GIRFT role, Dr Moulton said: “There are enormous variations between emergency departments, but that’s no surprise because they are now dealing with city size workloads using an old district hospital model. I believe the GIRFT programme will give us an opportunity to actually address the problems we face.”

Dr Mann agreed, stating that having the correct data would help the GIRFT team understand problems and develop solutions. He continued: “On the face of it there is a lot of disparity between trusts, but GIRFT looks at the resources and the outcomes to provide a much fairer picture of where we should be learning from, so we have a level playing field.

“GIRFT will illuminate many of the key issues A&E departments face, but it will be fair to staff and patients in understanding the challenges, the resources available and the outcomes. This will help trusts and the NHS make more informed choices about investment and spending.”

Recruitment for the Emergency Medicine clinical leads was undertaken by GIRFT working with the Royal College of Emergency Medicine, which has welcomed the announcement of the leads and the review itself. Dr Tajek B Hassan, President of the Royal College of Emergency Medicine, said: “The College is very aware of the variation in staffing, facilities and practices between emergency departments. These differences – often linked to chronic under-resourcing – can be for a number of reasons, some of which are poorly understood.

“The GIRFT programme has been set up to firstly better clarify and then to address this variation so that we can ensure safe and sustainable emergency care in all areas. Our College will be working closely with the two GIRFT clinical leads for Emergency Medicine in order to bring about improvements that will deliver long-term benefits for both patients and staff.” Dr Moulton and Dr Mann will start work on the review this month, helping to shape the research phase, before beginning the deep dive visits to NHS trusts later in the summer. The programme will be completed and the national report published next year.

The Emergency Medicine clinical leads are the first to be announced since the GIRFT programme was expanded to over 30 specialties late last year.

GIRFT is a partnership between the Royal National Orthopaedic Hospital Trust (RNOH), which first hosted the pilot programme within orthopaedic surgery, and the Operational Productivity Directorate of NHS Improvement (NHSI). Each work stream is led by a clinician from that specialty, using trusts’ own data and engaging directly with medics and trust managers to understand the challenges they face and share best practice with others.

* Dr Mann sadly died in February 2021. You can read tributes to him here.