The site uses anonymous third party analytic cookies: in accessing any element/area of the site outside of this banner, you consent to receiving cookies.

Knowledge Hub

New NHS framework takes aim at unwarranted variation

Oli Hudson, content director at Wilmington Healthcare, explores how the NHS aims to cut costs and improve efficiency to implement the Long Term Plan.

The NHS’s ambition to reduce unwarranted variation across a number of areas, including procurement, is a key theme within its recently published Long Term Plan Implementation Framework.

The framework makes it clear that more funding is available to implement the main aims of the plan. However, to access it, NHS healthcare systems must achieve certain goals, such as meeting a 1.1% annual efficiency target.

To support this, the NHS is focussing on reducing unwarranted variation in four key areas namely – procurement costs, patient outcomes, length of hospital stay and unnecessary procedures.

Getting It Right First Time (GIRFT)

This approach is encapsulated within the work of Getting It Right First Time (GIRFT) – an important national initiative that aims to improve patient care by reducing unwarranted variation in expenditure and efficiency across NHS Trusts.

GIRFT is referenced several times in the framework. One of the mentions relates to the need to maximise the buying power of the NHS through the use of Purchase Price Index and Benchmarking (PPIB), GIRFT-led procurement work and Supply Chain Co-ordination Ltd.

The framework also says that healthcare systems should use GIRFT’s data, tools and practical support to assess their performance on patient waiting times in order to access further transformation funding for planned care for major health conditions.

The framework says that no patient should wait more than 52-weeks from referral to treatment (RTT) for major health conditions. Healthcare systems should expand the volume of planned surgery year-on year. However, this must be balanced against the need to reduce the number of unnecessary procedures.

Improving efficiency and outcomes

GIRFT aims to improve outcomes for patients while helping to achieve cost efficiencies for the NHS of up to £1.4 billion by 2020/21. 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.

A total of 40 specialties have been selected for GIRFT to review and more are expected to be added to the list. Eight specialties have been reviewed so far and

Ophthalmology is the next report due to be published.

The extensive reviews focus on a range of areas including the cost of equipment, patient outcomes, surgical techniques and length of hospital stays. They also aim to encourage clinicians to think about the equipment they use and how much it costs.

The latest GIRFT guidance was published in January on the theme of spinal services. It found, for example, that the cost of performing complex instrumented correction of spinal deformity for Adolescent Idiopathic Scoliosis varied four-fold across trusts.

The report said: “This variation in cost will be driven by many factors, not least inaccurate coding and different approaches to cost allocation by trusts. But other factors have a direct and significant impact on costs, including length of stay in a critical care environment, length of stay in general, staffing costs, trust overhead costs and implant costs.”

In line with the Long Term Plan’s bid to move more care out of hospitals, GIRFT is looking at moving the administering of intravenous antibiotics for spinal infection into the community. This approach could not only cut the costs associated with hospital stays for this procedure, but also lower the risks of prolonged hospital stays, such as hospital-acquired infections.

The work conducted by GIRFT aligns with a separate NHS initiative, known as the Evidence-Based Interventions (EBI) programme, which is referenced in the framework. It aims to ensure that routine interventions are evidence-based and appropriate and supports the NHS’s bid to reduce unwarranted variation and improve efficiency.

It has produced guidance on four interventions that it says should no longer be routinely commissioned or offered. These are Snoring Surgery (in the absence of Obstructive Sleep Apnoea); Dilatation and curettage for heavy menstrual bleeding in women; knee arthroscopy for patients with osteoarthritis and injections for non-specific low back pain without sciatica. There is also guidance on a further thirteen interventions that should only be commissioned or offered when specific clinical criteria are met.


The NHS Long Term Plan Implementation Framework’s focus on unwarranted variation and evidence-based procedures is the shape of things to come as healthcare systems are increasingly required to evaluate and justify their spending and approach to patient care.

Work being done by GIRFT and similar initiatives within the NHS will directly affect products or techniques used; the outcomes expected and the risk profile; as well as industry’s relationship with clinicians and the relationship between clinicians and products.

It will be essential for medtech companies to keep abreast of GIRFT reviews in their therapy areas and localities, identify the clinicians involved and engage with them. Medtech must also consider the wider cost implications of its products, such as failure rates; inpatient stays and infection rates, and how they impact on spending in joined up healthcare systems.

Wilmington Healthcare’s Quantis translates healthcare data into actionable insight enabling you to demonstrate to your customer how you can help improve patient outcomes and identify variations in treatment. Find out more here.