Getting It Right First Time (GIRFT)

GIRFT is a national programme designed to improve the quality of care within the NHS by reducing unwarranted variations.

It is the brainchild of Professor Tim Briggs at the Royal National Orthopaedic Hospital in London. The programme is pursuing the holy grail of modern medicine – higher quality at lower cost. The programme began with orthopaedics and is now being rolled out to 35 different surgical and medical specialties across the English NHS.

By tackling variations in the way services are delivered across the NHS, and by sharing best practice between trusts, GIRFT identifies changes that will help improve care and patient outcomes, as well as delivering efficiencies such as the reduction of unnecessary procedures and cost savings.

GIRFT methodology

The programme comprises a series of 35 surgical and medical work streams, each led by a prominent clinician chosen from the specialty they are reviewing. Each clinician heads a project to compile a data and insight driven report into their specialty, combining publicly available information, including Hospital Episode Statistics (HES), other relevant registry or professional body data, and the results of a questionnaire issued to all the trusts being reviewed. The report will look at a wide range of factors, from length of stay to patient mortality, and individual service costs through to overall budgets.

A report is produced and issued to every trust being reviewed, which is then followed by a meeting at the trust with medical staff and senior trust managers. At each meeting the clinical leads review the findings with their peers, which provides more context to unwarranted variations and opens up a discussion around individual practice and any challenges the trusts face. It is also an opportunity to share best practice and any solutions that have already helped reduce variations.

After at least 40 trust reviews have been completed, the clinical lead oversees the creation of a national GIRFT report into their specialty. The report presents the original data, GIRFT’s findings, examples of best practice and an action plan of proposed changes and improvements. Crucially this action plan provides detailed evidence of the benefits changes can bring and is supported by an implementation programme managed by GIRFT.

At trust level the recommendations found in each specialty are collated into a single implementation plan. Trust data is uploaded to the Model Hospital portal (, which will be the gateway for accessing GIRFT information for all providers and commissioners.

How effective has it been?

It is led by frontline clinicians who are expert in the areas they are reviewing. This means the data that underpins the GIRFT methodology is being reviewed by people who understand those disciplines and manage those services on a daily basis. The GIRFT team visit every trust carrying out the specialties they are reviewing, investigating the data with their peers and discussing the individual challenges they face and are supportive and encourage change in behaviour and practice.

On the limited evidence to date, it is producing real gains in procurement, productivity and quality. The success of GIRFT will depend crucially on buy in from all stakeholders and sustained success will depend on engagement of both clinicians and managers and commitment to taking action.

Tip- before the interview check whether there is a GIRFT programme in your speciality and read it up on the website (ref 2 below)



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