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How we operate

Structure and governance

The National Joint Registry (NJR), which covers England, Wales, Northern Ireland, the Isle of Man and the States of Guernsey, collects information on joint replacement surgery and monitors the performance of joint replacement implants. It was set up in 2002 by the Department of Health (DH) and Welsh Government to monitor the performance of hip and knee joint replacement surgery in England and Wales and extended geographically to include Northern Ireland in 2013 and the Isle of Man in July 2015 and to incorporate ankle joints in 2010, and elbow and shoulder joints in 2012.

The NJR is 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.  

NJR is managed by a Steering Committee (NJRSC), which oversees its operational activity and strategic direction and monitors the NJR budget. The NJRSC is designated as an NHS England (NHS E)  ‘Expert Committee’. The NJRSC Chairman reports directly to the NHS E Medical Director, and committee members are formally recruited by the Department of Health Appointments Team with approval of the NHS E Medical Director.  Nine NJRSC sub-committees oversee key NJR work areas. 

NJR core services are managed under two contracts held with: Northgate Public Services:  for collection and management of data and technology and the University of Bristol:  for provision of statistical support and analysis of data, to support NJR outcome monitoring, research activity and publications.

The NJR management team is responsible for overall operational and contract management of the NJR and for supporting the work of the NJRSC and its sub-committees.

The NJR Steering Committee, which usually meets four times per year, is responsible for overseeing the strategic direction and for operational oversight of the NJR. It is an NHS England Committee of Experts.

Strategic plans

The NJR has grown considerably since 2002 and recognising its increased role and ability to support improvements in patient safety and clinical outcomes, the NJR reviewed its original mission statement and strategic goals as part of the development of the registry's plan from 2012 onwards.

Security and confidentiality

The NJR recognises that security and confidentiality of data and information is a concern for all of us. Find out more ►


The NJR is funded through a subscription service where payments from NHS and indpendent providers of joint replacement surgery are based on the volume of procedures carried out. Overall, this new model of funding is enabling significant savings to be realised across orthopaedic surgery providers. 

HQIP manages the payment collection and holds the NJR budget on behalf of the Steering Committee. Find out more ►


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