Orthopaedic Surgery

GIRFT has published two reports on orthopaedic surgery. The first publication in 2015 was a landmark report for the orthopaedic specialty, highlighting areas of excellence and areas for focus and improvement. The initial orthopaedic surgery review established the GIRFT methodology and became the pilot for the current programme. Professor Tim Briggs and his team visited over 140 providers, covering more than 200 hospital sites. His original report coined the term ‘Getting It Right First Time’.

In February 2020 a follow-up document was shared, reflecting on success and reinforcing improvement.  It marked the progress made since the first report and the work that has continued in improving outcomes for patients, including reductions in complications, rates of hip revision surgery, length of stay and infection.

Headline findings included:


  • A reduction in revision rates every year since 2012, even while total activity and demand grew.
  • Average length of stay reduced by 20%, releasing more than 368,000 bed days.
Professor Tim Briggs CBE

Clinical Lead for Orthopaedic Surgery

Tim is a consultant orthopaedic surgeon and was appointed National Director for Clinical Improvement and Elective Recovery for NHS England in November 2022. He is Chair of the GIRFT programme and leads the roll out of GIRFT methodology across all surgical and medical specialties.

Tim was appointed to the Royal National Orthopaedic Hospital as a consultant in 1992. His specialist interests are in orthopaedic oncology as well as surgery to the hip and knee. He was medical director at the RNOH for 15 years, ensuring a re-build, and was president of the British Orthopaedic Association in 2014.

He is also chair and national lead of the Veterans Covenant Healthcare Alliance (VCHA) and Honorary Colonel of 202 (Midlands) Field Hospital RAMC.

He was made a Commander of the Most Excellent Order of the British Empire (CBE) in the 2018 New Year’s Honours List for services to the surgical profession.

Useful information

  • The original GIRFT orthopaedic surgery review
    The initial Orthopaedic Surgery review established the GIRFT methodology and became the pilot for the current programme. Professor Tim Briggs and his team visited over 140 providers, covering more than 200 hospital sites. His original report coined the term “Getting It Right First Time”.
  • The British Orthopaedic Association (BOA) and its annual conference
    BOA co-badged and endorsed the GIRFT national report on orthopaedics and the GIRFT programme is one of the key strands of the BOA’s Practice Strategy. Find out more about BOA and register for its  Annual Congress.
The report included a raft of recommendations, many of which have been adopted by orthopaedic trusts and delivered real benefits
  • The recommendation to adopt cemented hip replacements for patients aged over 65 has led to a 10% increase in the use of this method, saving an estimated £4.4m p.a.
  • Reduced length of stay for hip and knee operations has freed up 50,000 beds annually
  • Trusts have moved to more ring-fenced orthopaedic beds, reducing cross infection
  • An increase in localised consolidated working between trusts, sharing resources and maximising the number of procedures carried out
  • 75% of trusts have renegotiated the costs of implant stock and rationalised their use
  • Greater awareness of costs has led to reduced use of expensive “loan kit”
  • Litigation claims are down from 1,758 in 2013/14 to 1,505 in 2015/16
  • A GIRFT “Pricing Letter”, providing transparency of the prices different orthopaedic trusts pay for prosthesis, is now used by consultants selecting implants
  • In 2016 the British Orthopaedic Association used GIRFT principles in published guidance to ensure best practice amongst its members
In a survey carried out by the NHS more than 70 of the trusts visited during the orthopaedic review responded: they reported total savings of between £20m and £30m for 2014/15 as a result of adopting GIRFT’s recommendations. If extrapolated across the more than 140 providers visited, these savings would increase to an estimated at £40m to £60m. Furthermore, the trusts that responded forecast a further £15m to £20m of savings for 2015/16, estimated at £30m to £40m if replicated across all the orthopaedic trusts. Professor Briggs is currently carrying out revisits of all the trusts he visited during the first review to gauge changes and improvements since the initial GIRFT report.

Find out more about GIRFT’s data-led approach and best practice resources:

In March 2015, GIRFT published its national speciality report for Orthopaedic Surgery:

Click above to view the pdf report

In February, GIRFT published Orthopaedic Surgery follow-up report:

Click above to view the pdf report

Orthopaedic follow-up report:  Professor Briggs held his first deep-dive visits to trusts in late-2012, and the follow-up report’s findings show evidence of substantial improvement against all the key GIRFT metrics, meaning that the NHS is providing better quality orthopaedic care and getting better value for money.

Orthopaedic Surgery Academy Resources

Case Study : Reducing length of stay in elective orthopaedic arthroplasty through enhancing recovery approaches at University Hospitals Morecambe Bay NHSFT >

Case Study : Orthopaedic physiotherapy approaches to support daycase arthroplasty at South West Ambulatory Orthopaedic Centre >

Case Study : Using Orthopaedic Consultant Rotation to increase utilisation of elective hub site at United Lincolnshire Hospitals NHST >

Case Study : South Warwickshire’s Programme for enhancing recovery following orthopaedic hip and knee arthroplasty >

Case Study : Elective Hub at East Kent Hospitals NHSFT improves delivery of elective and trauma orthopaedic activity >

Case Study : Move to elective surgical hub allows staff to focus on orthopaedic length of stay at United Lincolnshire Hospitals NHST >

Case Study : Bradford Royal Infirmary deliver digital innovation with QR codes on plaster casts >

Case Study : St George’s Hospital NHSFT modular build to create elective surgical hub at Queen Mary’s Hospital >

Case Study : Resilience in ring-fenced hubs at South West London Elective Orthopaedic Centre >

Case Study : Improving waits for elective orthopaedic knee care (mass clinic model) at Imperial College Healthcare NHST >

Case Study : Implementation of orthopaedic PIFU at West Suffolk NHSFT >

Case Study : Management of orthopaedic DNAs at Norfolk and Norwich NHSFT >

Case Study : Trauma and Orthopaedic PIFU at Homerton Healthcare NHSFT >

Case Study : Four primary orthopaedic joints at United Lincolnshire Hospitals NHST >

Case Study : Introduction of Plastic Surgery and Specialist Hand Unit at Royal Devon University Hospitals NHSFT >

Case Study : Super Saturday sees 150 patients in consultant-led clinic at Royal National Orthopaedic Hospital NHST >

Case Study : Wide Awake Local Anaesthetic No Tourniquet (WALANT) orthopaedic procedures in an outpatient setting at Wye Valley NHST >

Case Study : Northumbria Healthcare NHSFT key principles for a top decile elective orthopaedic arthroplasty service >