This briefing provides an overview of the Getting it right first time (GIRFT) programme, a partnership between the NHS Royal National Orthopaedic Hospital Trust and NHS Improvement, to support NHS trusts to improve care quality and increase operational productivity by reducing unwarranted variation in care. The programme encompasses 35 clinical and medical specialties delivered in acute hospitals, with work underway to expand into mental health services.

In August 2017, we set out our early views on the GIRFT programme, which had developed from initial feedback and issues raised in discussions with senior leaders from our member NHS foundation trusts and trusts.  In this we highlighted:

  • persistent variation in care quality is a long-term challenge for all health systems, not just the NHS
  • the necessity – and difficulty – of distinguishing between warranted and unwarranted variation, given a range of factors, including geography, case mix, and staffing profiles
  • the need for more rich and detailed data to gain true insight into variation than is currently available for most clinical specialties
  • while data is a good starting point to discuss tackling unwarranted clinical variation, it is only one step in a complex process to identify why the variation exists, establish whether it is warranted or unwarranted, agree what needs to be done to reduce the unwarranted variation, put in place a change programme to support this, deliver the necessary changes to clinical practice and unlock the savings required; the critical importance of a true partnership approach from the GIRFT team to ensure front-line clinical engagement and collaboration in devising solutions to reduce unwarranted variation;
  • the significant resource implications for staff to participate properly in GIRFT, and for trusts to respond appropriately to reduce variation and deliver improvement
  • the fact that even the best-case scenario for GIRFT-related savings and productivity outcomes offer a small proportion of the estimated funding shortfall for the NHS by 2020/21. The NHS will still need significant investment to successfully implement the GIRFT programme, at a time of significant operational challenge.

This briefing offers further exploration of these issues, through trusts’ views on the GIRFT programme and how the wider health and care system can ensure that GIRFT’s ambitions are realised in a sustainable and clinically-led way.  It has been informed by senior trust leaders’ feedback about their experience so far working with the programme and its national leadership team. We held telephone interviews with 11 senior clinical, operational and financial staff and received written views from six trusts. We also held a roundtable of 25 trusts with NHS Improvement to discuss operational productivity in the context of the Carter review, on 20 September 2017, that was attended by board-level representatives from across acute, specialist, mental health and community trusts.

The first part of the briefing offers an overview of the GIRFT programme’s origins and structure, the GIRFT methodology and implementation. The second part explores trusts’ perspectives on the programme, and our recommendations for trusts and national bodies to help ensure the programme can embed and succeed as a sustainable contribution to NHS-wide collaboration for clinical quality improvement.

If you would like to provide feedback on any of the issues raised, please contact Tim Connolly, policy advisor (finances) or Cassandra Cameron, policy advisor.