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About the NJR

The National Joint Registry (NJR), which covers England, Wales, Northern Ireland, the Isle of Man and the States of Guernsey, collects information on hip, knee, ankle, elbow and shoulder joint replacement surgery and monitors the performance of joint replacement implants. Hip, knee, ankle, elbow and shoulder joint replacements have become more common and are generally highly successful operations that bring many patients improved mobility and relief from pain. Many thousands of such operations take place in the UK each year and we have been collecting data since April 2003, although data submission for NHS organisations has only been mandatory since April 2011.

A wide range of implants can be used in the joint replacement operations and by collecting data on outcomes, the registry monitors the performance of these implants and the effectiveness of their use in different types of joint replacement, with a key focus on patient safety and improving clinical standards; benefiting patients, clinicians and the orthopaedic sector as a whole.

The NJR brings many benefits to the hospitals in which data is collected by providing an annual clinical report on their performance outcomes and an NJR regional support network - an overview of these and other benefits can be found here.

We are hosted by the Healthcare Quality Improvement Partnership (HQIP), an independent organisation led by the Academy of Medical Royal Colleges, The Royal College of Nursing and National Voices. As host, HQIP is responsible for NJR’s compliance with the necessary legal and statutory frameworks.  

Our strategic direction, budget and operational activity is overseen by our Steering Committee (NJRSC), which is designated as an NHS England (NHS E) ‘Expert Committee’ and our Chair reports in directly to the NHS E Medical Director. Nine NJRSC sub-committees sit under the Steering Committee, managing and monitoring key NJR work areas. 

Our core services are managed under two separate contracts held with: NEC Software Solutions: for the collection and management of data; and the University of Bristol: for the provision of statistical support and analysis of data, work enabling NJR outcome monitoring, some research activity and  analysis for our Annual Report.

The NJR Management Team is responsible for overall operational and contract management of the registry and for supporting the work of the NJRSC and our sub-committees; as well as for communicating with our stakeholders about the work of the registry.

 

Timeline of registry data collection

 

  • The States of Guernsey joined in November 2019

  • The Isle of Man joined in July 2015

  • Northern Ireland joined in February 2013

  • Elbow and shoulder joint replacements have been collected on the registry since April 2012

  • Ankle joint replacements have been collected on the registry since April 2010

  • Hip and knee joint replacements have been collected on the registry since April 2003

  • The NJR was set up in 2002 by the Department of Health and the Welsh Government to monitor the performance of hip and knee joint replacement surgery in England and Wales and started collecting hip and knee data the following year

 

Our mission statement

 

'The purpose of the National Joint Registry, which covers England, Wales, Northern Ireland, the Isle of Man and the States of Guernsey, is to collect high quality and relevant data about joint replacement surgery in order to provide an early warning of issues relating to patient safety. In a continuous drive to improve the quality of outcomes and ensure the quality and cost-effectiveness of joint replacement surgery, the NJR will monitor and report on outcomes, and support and enable related research.'

 

Our goals

 

- Monitor in real time the outcomes achieved by brands of implants, hospitals and surgeonslebvel, and highlight where these fall below an expected performance level n order to enable early investigation and immediate follow-up action.

-  Inform patients, clinicians, providers and commissioners of healthcare, regulators and implant suppliers of the outcomes achieved in joint replacement surgery.

- Evidence variations in outcome achieved across surgical practice, in order to inform best practice.

- Enhance patient awareness of joint replacement outcomes to better inform patient choice and patients' quality of experience through engagement. 

- Support evidence-based purchasing of joint replacement implants for healthcare providers to enable quality and cost effectiveness.

- Support suppliers in the routine post-market surveillance of implants and provide information to clinicians, patients, hospital management and the regulatory authorities.

 

Our strategic plans

 

The NJR has grown considerably since its inception 2002 and recognising the increased role and ability to support improvements in patient safety and clinical outcomes, we regularly reassess our strategic goals as part of the development of the registry's three-year strategic planning work.

  • You can download our previous NJR Strategic Plan for 2015-18 and more recently for 2018-21, from the box on right hand side of this page.
  • We are currently working on our Strategic Plan for 2022-2025, which we will share here in April 2022, once it has been reviewed and approved by the NJRSC.

 

Data security and confidentiality

 

Staff use a secure electronic data entry system in hospitals to input informaton for each of their department's joint replacement prodedures.

This information is held securely within the registry and included with all the information about the implant used and type of surgery, the patients' personal information is also collected (subject to patient consent). This means that if there are ever any problems with any implant we can advise a patient's hospital that they should contact them to follow-up and check that everything is okay.

 All the data held on the registry is encrypted to provide secure protection.  

 

Who can use the data?

 

Patients’ personal data is treated as confidential at all times and cannot be used outside of the registry. This personal data is only available to the patient that it relates to and their surgeon.

Procedures are in place to protect the information and to keep it confidential. Data collected via the NJR may be used for research but only if the application to do so has been reviewed and approved by the NJR Research Committee and if the outcomes that are expected will provide significant benefits to the future healthcare of patients. However, any NJR data provided for research work will be de-identified, so that it is not likely to identify any individual.

In accordance with the Data Protection Act (2018), patients can request a copy of their personal information that is held in the registry, at any time. 

Please contact the NJR Service Desk for further information.

 

Governance

 

The NJR Steering Commitee (NJRSC), which meets four times per year, is responsible for overseeing the strategic direction and operational oversight of the NJR and is an NHS England 'Committee of Experts'.

 

The NJRSC is supported by the NJR Management Team, who are hosted by HQIP. The team is responsible for the overall operational and contract management of the registry and for supporting the work of the NJRSC and its nine sub-committees.

 

Funding


Delivery of the NJR’s strategic work programme is funded through a mandated annual subscription charge which is based on the contractual costs of running the registry and the work programme agreed. The NJR's income is overseen by our Steering Committee and is a restricted fund, spent in accordance with the agreed strategic plan.

Our Executive Committee undertakes an annual review of the pricing and resources required for delivery of our strategic work programme to ensure continued value for money in the delivery of our range of products and services. This exercise is underwritten and agreed by the Steering Committee and validated by NHS England.

The NJR is funded through a subscription service whereby payments from NHS and independent providers of joint replacement surgery are based on their surgical volumes for the previous year. 

With effect from the 1 April 2019, the NJR subscription has been at a rate of £16.54 [gross],£13.79 [net] per surgical procedure [England, Wales and States of Guernsey]; and at a rate of £17.63 [gross], £14.69 [net] per surgical procedure [Northern Ireland]

NJR income streams also include industry subscription to data and reporting services, cost recovery charges from data sharing requests and other ad hoc income.

HQIP manages the invoice subscription payment collection process and holds the NJR budget, on behalf of the NJR Steering Committee.


Surgical procedures using the following implants

are subject to the 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.

 

Updated November 2021

  

  
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