GIRFT review aims to put breast surgery patients first

As Breast Cancer Awareness Month gets under way, the Getting It Right First Time (GIRFT) programme is working with clinical teams to enhance the NHS experience and outcomes for the tens of thousands of breast surgery patients treated every year.

GIRFT’s ongoing national review of breast surgery – led by breast surgeons Fiona MacNeill, of the Royal Marsden NHS Foundation Trust, and Tracey Irvine, of the Royal Surrey County Hospital NHS Foundation Trust – has seen 101 visits to hospitals across England to date, presenting in-depth data to help identify good practice which can be shared with other trusts, as well as looking at where improvements can be made.

The two clinicians have been impressed by the level of care on offer to patients, and the willingness of hospital teams to review and refine their services.

Fiona said: “It has been fantastic to visit so many engaged teams, and see the enthusiasm and openness for reviewing their data and using the GIRFT process to improve care further. We have been consistently impressed with the dedication and high standards of care being provided by breast teams across the country.

“Many of the surgical and diagnostic teams we have visited are already working on improving patient care – we have seen innovation in so many areas. It has been especially encouraging to see the collaborative approach in some trusts, with multi-disciplinary teams working to put the patient at the centre of everything.

“In addition, the growing partnerships between breast and plastic surgery – the ‘oncoplastic team’ – is allowing better and more timely patient access to the range of oncoplastic surgery and breast reconstruction, as recommended by NICE in 2018.”

Running throughout October, Breast Cancer Awareness Month is a worldwide annual campaign involving thousands of organisations, highlighting the importance of breast awareness, education and research. Data compiled by GIRFT shows that breast and plastic surgeons in England conduct around 102,000 breast operations every year – 98% on women and 2% on men. 80% of these operations relate to breast cancer treatment or prevention.

Breast cancer is the most common female cancer, with one in eight women diagnosed in their lifetime, as well as a small number of men. Around 150 people every day in the UK are told they have breast cancer.

The Getting It Right First Time (GIRFT) programme aims to improve patient care by tackling variations in the way services are delivered across the NHS. As the GIRFT national report on breast surgery is drafted – with an expected release in early 2020 – the focus is on:

Improving the patient experience: “With modern breast surgery and anaesthetic techniques the majority of our breast surgery can be carried out as day case or short stay admissions,” said Tracey. “Most patients are keen to go home to recover and they should be encouraged and supported to do that, for their own comfort and convenience.”

The GIRFT review is supporting the individualisation of care, focusing on the needs of the patient, through:

  • Shorter length of stay, supporting British Association of Day Surgery (BADS) guidelines;
  • Open access follow-up, allowing patients to determine when and how they interact with breast teams;
  • Reducing unnecessary hospital attendances, operations and tests.

Achieving excellence: Fiona said: “Many of the trusts we have visited already have well-embedded quality improvement ethos and programmes, with innovative, patient-focused treatment pathways and educational materials to allow patients more informed choices. GIRFT can support these initiatives and innovations by providing high-quality, trust level comparative data on activity and surgery outcomes to help deliver excellence of care across the NHS.

“The GIRFT review is the first to offer a unique insight into breast surgery, in particular the collaborative partnerships between breast and plastic surgery. There have been several audits in recent years, but only GIRFT has reviewed the totality of breast surgery activity and benchmarked quality outcomes.

“GIRFT will build on this review of breast surgery by linking with other NHS data organisations to provide contemporaneous high-quality data for the Model Hospital and the National Clinical Improvement Programme (NCIP), allowing clinicians to monitor performance, evaluate innovations and make further improvements.”

GIRFT is working with key stakeholders as it moves towards publication of its national report in 2020.

President of the Association of Breast Surgery (ABS), Dr Julie Doughty, said: “GIRFT is an exciting initiative and has been met with great enthusiasm by both breast surgeons and the wider MDT. It has highlighted the increasing collaboration with our plastic surgical colleagues to improve patient care.

“The Association of Breast Surgery would like to congratulate Fiona MacNeill and Tracey Irvine for the huge amount of work they have put into delivering this project. We now look forward to working with the GIRFT team to improve the patient journey, provide equity of care and prevent unwarranted variation in clinical practice throughout the country.

“We also want to capitalise on areas of excellence identified in the GIRFT visits through education of our members. We look forward to reading the full report in 2020.”

About our clinical leads

Fiona MacNeill is a consultant breast surgeon at the Royal Marsden NHS Foundation Trust, past president of the Association of Breast Surgery and examiner for the European Board of Breast Surgery.

Tracey Irvine is a consultant breast surgeon at the Royal Surrey County Hospital NHS Foundation Trust. She has been clinical director of the breast, skin and plastics unit in Surrey, where she had experience of delivering quality breast care in a financially challenging environment.

1 October 2019