I am pleased to announce the Getting It Right First Time (GIRFT) Gastroenterology workstream kicked off in May 2018. I am the National Clinical Lead for Gastroenterology for this programme or Gastro ‘GIRFT-a-girl’ as my husband now calls me! I became drawn to GIRFT because, to me, this genuinely feels like the Holy Grail of modern medicine – pursuing higher quality care at lower cost. Higher quality care is what our patients deserve and managing to deliver this for less is what our cash strapped NHS so desperately needs. Reinvesting these savings into treating even more patients well is the perfect win-win.

GIRFT was born out of the ground-breaking work that Professor Tim Briggs did in Orthopaedics in 2012. This proved so successful that the Government announced in November 2016 that GIRFT would receive an additional £60m funding to expand and accelerate delivery of the programme. This programme has now been rolled out to include 35 different surgical and medical specialty workstreams. 32 of these are already underway, with the other 3 remaining workstreams kicking off imminently. Over 1200 GIRFT clinical lead visits have already been completed.

Gastroenterology is the 32nd GIRFT workstream and I feel it is very appropriate for a Luminal Gastroenterologist to be holding up the rear of the GIRFT programme! If you’re wondering what on earth could follow that, I can tell you it will be crash and burn! The next workstreams are Trauma Surgery, Plastic Surgery & Burns.

Professor Tim Briggs is a Consultant Orthopaedic Surgeon at the Royal National Orthopaedic Hospital (RNOH). He was very aware of the perfect storm in our NHS, of ever rising demand with an aging population at a time of financial austerity. He was also mindful of how expensive it is to put mistakes right, working in a tertiary Orthopaedic hospital. He managed to secure a grant of £200k to do an objective stocktake of Orthopaedic practice in England, with the key aim of improving quality of patient care and outcomes.  

Professor Briggs used available evidence from various sources – including the National Joint Registry, hospital episode statistics (HES), patient reported outcome measures (PROMs) and the national litigation authority. He sent out data packs on care and outcomes to each trust in England and then visited every one of these trusts to help them interpret their data. He travelled 17,000 miles, met over 1600 surgeons and over 400 senior managers and CEOs. These face to face, peer to peer visits allowed deeper insight into performance – identifying unwarranted variations, discussing challenges, debating solutions and disseminating good practice. 

At the end of this Orthopaedic pilot Professor Briggs wrote a national report making evidence based recommendations to improve care and outcomes. This report coined the term ‘Getting It Right First Time’, giving the GIRFT programme both its name and its mission statement. This pilot helped to deliver efficiencies and savings of up to £30million in the first year, with another £20million the following year, whilst improving care and outcomes for patients. It is no wonder the Government sat up and took notice of this return from a £200k investment! GIRFT is now a partnership between the RNOH and the Operational Productivity Directorate of NHS Improvement (NHSI).

Professor Briggs, who is now Chair of GIRFT and NHS Improvement’s National Director of Clinical Quality and Efficiency, has explained: “Because GIRFT is led by clinicians, frontline medics in the specialties being reviewed welcome the programme because they can share both their best practice and their challenges with people that understand clinical service”

I am seconded 2 days a week to GIRFT and am currently working on developing the Gastroenterology data packs using metrics that I hope will be a good barometer for quality of service across a range of our subspecialty areas – including Luminal, HPB, Nutrition, Endoscopy etc. Feel free to contact me if you have any suggestions for what areas of practice you feel should be covered in these data packs (beverly.oates@nhs.net). My GIRFT timeline is for pilot visits in early 2019, to test the data packs. Then once perfected these data packs will go out to all English trusts in spring 2019, after which I start my 2 hour deep dive visits of every trust in England. I hope to publish my national report in May 2020, after feedback from stakeholders including the BSG.    

I really am thrilled to have been given the opportunity to join the GIRFT team. I am very patient centred in my approach and I am keen to be involved in this exciting programme to ensure high quality patient care is paramount, and that NHS resources are used to their best effect for the benefit of our patients. We all face many similar challenges in our Gastroenterology practice.  As the late Jo Cox inspirationally said “we have more in common than that which divides us”. I know that there is a lot of great work going on in our hospitals and I am looking forward to being able to help disseminate good practice and enable teams to reduce unwarranted variation in clinical quality, productivity and efficiency. 
 

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Beverly Oates
GIRFT National Clinical Lead for Gastroenterology