The Getting It Right First Time (GIRFT) programme is designed to improve healthcare practice, techniques and processes for the benefit of patients and to reduce litigation costs. As part of ongoing work with NHS Resolution, new guidance has been produced in association with the British Hip Society (BHS), British Association for Surgery of the Knee (BASK) and the British Orthopaedic Association (BOA).

The new Guidance is both concise and practical and illustrates a standard of practice that should be followed for surgical documentation in modern hip and knee arthroplasty in the UK. Sean Doherty, Healthcare Partner at DACB has worked with GIRFT as a contributor to this excellent new Guidance: "This has been a great project to be involved in and this new guidance should improve patient care and safety. In the longer term it should also lead to a reduction in the number of orthopaedic claims and a reduction in costs allowing valuable resources to focus on delivery of quality care."


The cost of clinical negligence has been reported by the national audit office to be rising at a faster rate year on year than NHS funding, now representing over 2% of the annual budget. A GIRFT and NHS Resolution Orthopaedic Working Party worked with expert contributors including the BOA, BHS, BASK, NHS Patient Safety, NHS panel law firms, claimant law firms, expert witnesses and the medical defence organisations (MDU, MPS, MDDUS) with the goal of communicating lessons learned from previous and ongoing claims. A strategy was agreed to promote claims learning through GIRFT data packs provided to trusts and to produce best practice guidance, starting with hip and knee arthroplasty documentation.

A large series of hip and knee arthroplasty cases which involved claims to NHS Resolution were reviewed. Common themes concerning technique and documentation were collated and are highlighted in the documents. It is hoped that by bringing these themes together and to the attention of surgeons performing the surgery that the frequency of occurrence will be reduced.

The guidance aims to provide advice on aspects of surgery which should be available and clearly documented in a hip or knee arthroplasty operation record. The documents are not a comprehensive guide to hip or knee surgery but instead highlight what is considered best practice and, importantly, documentation guidelines. The strong message conveyed is that various components of the arthroplasty should be clearly documented to provide evidence of safe clinical practice, in addition to providing important information should a review or revision of the replacement ever be required. The Summary documents provide helpful and practical lists which are easy to follow and should be read in conjunction with the guidance documents which explain the themes alongside illustrative case studies. The documents can be found both on the BOA and GIRFT websites.


Our team of legal healthcare experts at DACB can advise upon the full range of issues that are raised by this new Guidance and assist with any responses to implementation. Please don't hesitate to get in touch and we would welcome opportunity to discuss the new Guidance with you and your colleagues.

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