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Knowledge Hub

MedTech industry must meet demands of key NHS efficiency drive

Sue Thomas and Steve How, of Wilmington Healthcare, explain why the Getting It Right First Time (GIRFT) programme is critical for MedTech


Getting It Right First Time (GIRFT) is an important national initiative that aims to improve patient care by reducing unwarranted variation in expenditure and efficiency across NHS trusts.

It followed Lord Carter’s Operational Productivity and Performance in English Acute Hospitals: Unwarranted Variations report, which called for an efficiency metric for NHS providers.

Delivered in partnership with the Royal National Orthopaedic Hospital NHS Trust – which hosted a pilot project – and NHS Improvement, GIRFT will cover 35 surgical and medical specialties in total.

It is being led by frontline clinicians who are experts in the areas they are reviewing and aims to improve patient outcomes whilst saving the NHS up to £1.4bn per year by 2020/21, and between £240m to £420m in 2017/18.

How does GIRFT work?

GIRFT began in orthopaedics, with a National Review of Elective Orthopaedic Services in England, in 2015. In this pilot programme, Professor Tim Briggs and his team visited more than 140 providers, covering more than 200 hospital sites.

The subsequent report included a raft of recommendations, many of which have since been adopted by orthopaedic trusts and delivered real benefits. They include a recommendation to adopt cemented hip replacements for patients aged over 65, which has led to a 10 percent increase in the use of this method, saving an estimated £4.4m per year.

Since then, a further five out of the planned 35 GIRFT areas have been assessed – namely: general surgery; vascular surgery; cardiothoracic surgery; cranial neurosurgery and urology – and resulting reports and recommendations have been produced.

The programme is currently focussing on neurology, where more than 100 questions have been put to neurologists across England.  This data will be amassed, along with Hospital Episodes Statistics (HES) and procedures data. The two clinical leads for the programme will then visit every neurology unit to present the data and advise on improvements.

This interactive process will not only involve the neurologists but also the finance manager and the unit general manager of the hospital. Although it is not mandatory for trusts to participate in GIRFT and follow the guidance that it issues, they are strongly encouraged to get involved in this programme.

How is GIRFT impacting on MedTech?

GIRFT presents real opportunities to MedTech companies that can successfully market themselves within this context since products that are endorsed in GIRFT-style scenarios will be promoted as best practice to other localities across the country.

MedTech companies must keep abreast of GIRFT reviews in their therapy areas and localities, identify the clinicians involved and engage with them. In tandem with this, they must also understand what is happening within the 11 Procurement Category Towers, which are increasing transparency around the cost of goods for the NHS.

While MedTech companies are used to working closely with clinicians and Key Opinion Leaders (KOLs) when developing their products, they must engage with payers too and help them to understand how a product could deliver added-value across an entire care pathway. This involves thinking about the wider cost implications of a product such as failure rates; inpatient stays and infection rates.

When looking at heart valve replacements, for example, some valves may be more expensive than others but can be inserted through minimally invasive techniques. This reduces critical care bed usage, patient length of stay and patient complications thus increasing hospital capacity and providing better outcomes. Detailing how this benefits both the patient and the NHS provides a persuasive story for the longer-term savings that could be delivered by a more expensive product which a MedTech company could create into a compelling proposition.

Working in this way requires a clear understanding of market segmentation for a product in order to identify where it is highly competitive in terms of the whole pathway cost. It may be necessary for a company to risk stratify a particular client group and market its product to that particular group, rather than the entire NHS.

At Wilmington Healthcare, we use data and analysis to help clients map out care pathways and the cost of optimal care versus sub-optimal care. This style of thinking is endorsed by the NHS RightCare programme, which has defined optimal care pathways across a wide range of areas.  We also help clients to utilise GIRFT methodology in order to demonstrate their cost value proposition.


Reducing unwarranted variation is key to making the NHS sustainable for future generations. The GIRFT programme is providing a blueprint for how this can be achieved across wide-ranging surgical and medical specialties.

To succeed in this fast changing, efficiency-focussed environment, MedTech companies must demonstrate the impact of their products across the whole care pathway and show how they can offer value for money and improve patient outcomes.