Getting It Right First Time (GIRFT)

Getting It Right First Time (GIRFT)
Name	Getting It Right First Time
Abbreviation	GIRFT
Formation	2012
Headquarters	England
Region served	United Kingdom
Leader title	National Medical Director
Parent organization	National Health Service (England)

Getting It Right First Time (GIRFT) is a national quality improvement programme established to improve clinical outcomes, reduce unwarranted variation and deliver cost savings within National Health Service (England). Launched with involvement from senior clinicians, NHS England leaders and national policymakers, the initiative conducts specialty-level reviews and produces detailed data-driven recommendations to support local service redesign across hospitals in England, engaging academic partners, professional bodies and regulator networks.

History and development

The initiative was announced during activity involving figures from NHS England, Department of Health and Social Care, and senior consultants, following prior work associated with Lord Carter of Coles and analyses referencing variation highlighted by bodies such as Care Quality Commission, British Medical Association, King's Fund, Monitor and NHS Improvement. Early deployment drew on existing review models used in specialties connected with Royal College of Surgeons of England, Royal College of Physicians, Royal College of Obstetricians and Gynaecologists, and collaboratives that included leaders from Barts Health NHS Trust, Great Ormond Street Hospital, and university hospitals linked to University of Oxford, University of Cambridge and University College London. National rollout occurred alongside policy initiatives from ministers in the UK Parliament and with engagement from healthcare regulators including NHS Resolution.

Objectives and principles

The programme sets objectives aligned with priorities espoused by leaders such as the National Institute for Health and Care Excellence and the Academy of Medical Royal Colleges: to reduce unwarranted clinical variation, improve patient outcomes and increase efficiency across specialties including orthopaedics, cardiac surgery, urology and neurosurgery. Principles emphasize clinician-led review, specialty-specific benchmarking using administrative datasets derived from sources like Hospital Episode Statistics and linkage to registries such as the National Joint Registry and Society for Cardiothoracic Surgery in Great Britain and Ireland data. The approach is framed to complement other national programmes including Right Care, Five Year Forward View and initiatives backed by NHS Long Term Plan stakeholders.

Structure and governance

GIRFT operates as a programme with clinical leads drawn from surgical and medical specialties with reporting pathways into governance bodies such as NHS England executive teams, professional colleges and trusts including Guy's and St Thomas' NHS Foundation Trust, Royal Free London NHS Foundation Trust and regional sustainability partnerships. Oversight intersects with commissioning organisations like Clinical Commissioning Group predecessors and national contracting stakeholders, while data governance aligns with standards promoted by Information Commissioner's Office procedures and linkage agreements consistent with modernising programmes championed by Health and Social Care Information Centre practices.

Clinical reviews and methodology

Clinical reviews are structured around peer-to-peer visits, specialty-level data packs and multidisciplinary workshops involving consultants, nurse leads and allied professionals from trusts including Manchester University NHS Foundation Trust and Imperial College Healthcare NHS Trust. Methodology combines routine datasets such as Hospital Episode Statistics with audit datasets like the National Hip Fracture Database, registry evidence from bodies including National Vascular Registry and outcome metrics similar to those used by NCEPOD (National Confidential Enquiry into Patient Outcome and Death). Reviews generate recommendations that reference clinical governance frameworks used by General Medical Council-registered practitioners and align with standards promulgated by British Orthopaedic Association and specialty societies.

Key findings and impact on NHS services

Reports have highlighted variation in rates for procedures, length of stay and complication rates across trusts such as South Tees Hospitals NHS Foundation Trust and University Hospitals Birmingham NHS Foundation Trust, with suggested consolidation or pathway redesign analogous to proposals seen in Cardiac Surgical Services reconfigurations and regionalisation debates involving centres like Papworth Hospital. Findings have informed commissioning discussions, contributed to reductions in length of stay and elective cancellations, and influenced workforce planning debated in forums including Health Select Committee sittings and briefings to ministers. Economic analyses drawn from GIRFT outputs have been cited alongside other efficiency work by Lord Carter of Coles and service improvement metrics tracked by NHS Digital.

Implementation and adoption

Adoption has involved local implementation teams, clinical networks, and national programme support with participation from trusts across regions including North West NHS region, East of England, London and West Midlands. Implementation pathways have intersected with capital investment plans, regional elective recovery strategies tied to directives from NHS England and collaboration with academic health science centres such as Academic Health Science Network partners. Change management techniques reference engagement with stakeholders including chief executives, medical directors and local councillors where proposals affect service footprints and patient flows between providers such as Oxford University Hospitals NHS Foundation Trust and Cambridge University Hospitals NHS Foundation Trust.

Criticisms and controversies

Critiques have come from trade unions like British Medical Association representatives, commentators in think tanks including King's Fund and others who argue that emphasis on efficiency risks understating workforce constraints flagged by Royal College of Nursing and British Medical Association. Concerns have been raised about data granularity, potential impacts of service centralisation on access cited by local authorities and MPs from constituencies across House of Commons debates, and tensions with regulatory timelines of Care Quality Commission. Defenders point to clinical leadership and documented savings, while opponents highlight the complexities of implementing recommendations amid competing priorities such as elective backlogs and capital funding constraints.

Category:National Health Service (England)