The NJR is funded through a levy raised on hip, knee, ankle, elbow and shoulder procedures.
Funding arrangement April 2003 to March 2014
Up until 31 March 2014, the NJR levy payment on hip, knee, ankle, elbow and shoulder implants was collected from purchasing hospitals by orthopaedic device manufacturers. Manufacturers processed the levy on behalf of the NJR and then made the payment to the registry.
In return for their role in administering the levy, manufacturers charge a supplier administration fee which was included in the calculation of the levy.
Therefore, the NJR levy comprised the NJR element (i.e. the amount per joint retained to run the NJR) and a supplier administration fee, with the applicable rate of VAT.
The NJR element was set for 2013/14 at the net rate of £15.20 per joint. The gross rate, including the supplier administration fee and VAT was £20.00.
Current funding arrangement (2014-15 onwards)
From April 2014, the way that the levy charge is collected changed to a subscription model to enable significant NHS savings to be made across England, Wales, Northern Ireland and the Isle of Man.
With effect from the 1 April 2014, the cost of the NJR levy is a new, lower rate of £15.60 [gross], £13 [net] per procedure.
Under these new arrangements, each provider organisation is issued with an annual invoice directly from the Healthcare Quality Improvement Partnership (HQIP) for an NJR subscription charge based upon the provider's prior year’s procedure volume.
The changes that have enabled this cost saving include:
off-setting the charge currently levied to providers, through securing a fair and proportionate contribution of the overall cost of the NJR from orthopaedic device manufacturers, and
- changing the levy collection arrangements to remove the Supplier Administration Fee
HQIP continue to manage the NJR income in a restricted fund that is overseen by the NJR Steering Committee and spent in accordance with the strategic plan.
Joint replacement operations subject to charge
Operations using the following implants are subject to the NJR charge:
- Hips: a one-piece (monobloc) acetabular cup or a modular acetabular cup outer component.
- Knees: any knee femoral component (including the femoral component of a unicompartmental or patellofemoral joint) or one-piece knee prosthesis.
- Ankles: the talar metal component.
- Elbows: a radial head component or an ulnar component. For clarity, this includes the Ulnar component (linked and unlinked), pre-assembled elbow system supplied as a unit, radial component monobloc, radial modular stem and radial lateral resurfacing head.
- Shoulders: a humeral stem. For clarity, this includes the humeral head and stem monobloc, humeral stem modular and humeral resurfacing component