Elective care improvement

How is GIRFT supporting elective recovery?

GIRFT is running a number of priority programmes to support NHS trusts to deliver routine care and planned operations as quickly as possible and reduce patient waiting lists.

Up to 60% of people on waiting lists need high-volume, routine surgery, such as cataract removal, hernia repairs or joint replacement operations. GIRFT is working with local systems to help reduce the backlog of patients waiting for such operations and improve outcomes and access to care.

Work has focused on driving improvement in six high-volume, low complexity (HVLC) specialties – ophthalmology, general surgery, trauma and orthopaedics (including spinal surgery), gynaecology, ENT and urology.  But GIRFT is helping to deliver improvements in elective care across all surgical and medical specialties through:

  • agreeing standardised pathways;
  • pooling capacity and resources;
  • improving theatre utilisation and day case rates, to help free up beds and reduce length of stay; and
  • supporting outpatient transformation.


A key focus is to cut the number of patients waiting over 52-weeks, and specifically in outpatients which makes up 80% of the overall waiting list. Ensuring only the right patients are referred, and the effective management of referrals, DNAs, clinic capacity, follow up appointments (including Patient Initiated Follow-Up – PIFU) and discharge can have a huge impact on reducing the burden in this area.

In line with population needs, local systems are encouraged to identify their priority clinical pathways for improvement and to work with GIRFT to benchmark and review their performance against relevant metrics using ‘gateway frameworks’.

GIRFT works with clinicians and specialty associations to identify relevant specialty-specific clinical metrics, and from this develops real-time clinical data for the Model Health System (MHS) portal.  The GIRFT data enables hospitals to benchmark against expected standards of service and efficiency across a range of specialties and allows procedure-specific benchmarking across local health system footprints. 

The aim is to work at pace with national and regional partners and providers to implement a data-driven approach against four key improvements:

  • Adopting best practice – delivering excellent clinical outcomes.
  • Agreeing standardised pathways – reducing variation and learning from the best.
  • Ensuring equity of access– to support an ageing national population.
  • Sharing and pooling capacity and resources– to facilitate mutual aid when/where it’s needed.

Focused support for trusts

GIRFT is supporting a number of NHS trusts with focused improvement work to support their particular challenges around trauma and orthopaedic services, theatre utilisation etc.

 Multi-specialty work with ICBs aims to drive system-level working to improve patient flow and reduce elective backlogs.

GIRFT is providing clinical lead input for specialty specific escalations, and additional support is being delivered via mutual aid between providers. This improves access to care by pooling resources and moving patient care to where there is capacity across an ICS, or wider region.

Mutual aid is a short-term solution to take pressure away from the most challenged organisations/systems, to reduce the volume of long waiting patients. The GIRFT model is developed with the voice of the patient, enabled by the support of the Patient Association. Resources to support trusts include guidance on patient scheduling, telephone communication, transport arrangements and a patient video to explain the process.

Mutual Aid Guidance >

This programme has established clinical transformation groups across cohorts of trusts with the aim of reducing waiting times and specifically long waiting times of more than 52-weeks.

The work has brought together clinicians and operational teams with the challenge of collectively going ‘further and faster’ to transform patient pathways and reduce unnecessary appointments and improve access and waiting times for patients.

The focus is on sharing good practice, supporting trusts to follow the same methodology of networking and utilising case studies, innovations and best practice identified to help reduce 52-week waits.  The GIRFT Academy has produced speciality handbooks to promote the best practice and encourage adoption.

Find more information on ‘Further Faster’ here>

GIRFT is supporting systems to ring-fence elective capacity and create elective ‘hub’ facilities to carry out low and medium complexity procedures at scale within defined standards. These ‘hub’ sites will help increase elective activity with patient flows into the hubs from a number of different trusts or trust sites within a system.

Find more information on surgical hubs here >

GIRFT is working to agree system-wide operating theatre principles (e.g. accepting day surgery as the default), and theatre efficiencies (e.g. the number of cases per theatre list).  There is significant variation across England on how well operating theatres are utilised.  Part of the programme’s work is to improve data quality and data collection to help trusts to understand what is driving reduced theatre productivity and how to increase theatre throughput.

Find more information on theatre productivity here >

GIRFT has developed a number of guides for Trusts and ICSs to achieve top decile performance by 2024 and establish elective surgical hubs.

Click above to view the pdf

“By adopting best clinical and operational practice, we know we will achieve improved productivity and at the same time support our workforce to embed new ways of working and maximise the benefits of working together across systems.”
Professor Tim Briggs
GIRFT Chair, and National Director of Clinical Improvement for NHSE

Elective Care Improvement Resources