Intended for healthcare professionals

Feature Quality Improvement

Can we save the NHS by reducing unwarranted variation?

BMJ 2017; 358 doi: (Published 23 August 2017) Cite this as: BMJ 2017;358:j3952
  1. Sophie Arie, journalist, London, UK
  1. sarie{at}

The Getting it Right First Time programme aims to cut waste by helping trusts to compare data. But can it deliver the £1.4bn savings its leader promises, asks Sophie Arie

“There is no way I would ask for more money for the NHS right now,” Tim Briggs, an orthopaedic surgeon, told doctors and managers during one of the many visits he has made to trusts around the country since his appointment as NHS Improvement’s national director for clinical quality and efficiency in 2015.

“The waste and variation out there is unbelievable, and we have got to get our act together across all the specialties to improve quality and unwarranted variation and complications.”

Briggs leads a programme called Getting it Right First Time (GIRFT). He thinks it could ultimately save the English NHS £1.4bn (€1.5bn; $1.8bn) a year by helping trust managers and hospital teams to use the masses of data they gather—on everything from procurement to types of treatment used and length of stay—to improve care and eliminate waste.

Peer pressure

GIRFT is a partnership between the Royal National Orthopaedic Hospital NHS Trust, which hosted the pilot programme, and the operational productivity directorate of NHS Improvement, which aims to improve safety and quality in the English NHS.

The programme consolidates the vast and varied sources of data that trusts hold into a single, user friendly dataset and then sends senior clinicians to meet managers and hospital teams, trust by trust, to talk through how they compare with their peers and how they could improve. Follow-up meetings with each trust a year later review the situation.

Comparing trusts’ data highlights unwarranted variation and shows which approaches may yield the best quality of care and value. GIRFT’s review of general surgery,1 published this month, for example, found that the length of stay for …

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