Networks for future healthcare

Abstract

The Getting It Right First Time (GIRFT) process is designed to improve the care of patients in the NHS in England through in-depth review of services, benchmarking and presenting a data-driven evidence base to support change. It started as a pilot project targeting unwarranted variation in elective orthopaedic surgery. It rapidly became apparent that the approach of clinically-led deep dives to review the activity in individual orthopaedic units was effective in improving standards of care but also resulted in substantial cost savings that could be reinvested in the clinical service. GIRFT has now expanded to encompass 40 clinical specialties and is funded by NHS England. We describe the ethos of networks and give examples of GIRFT specialty programmes that have made networks a key component of their recommendations.

Keywords: GIRFT; clinical leadership; integrated stroke delivery networks; networks.

Fig 1.

The 20 individual integrated stroke delivery network regions grouped (by colour) into the seven NHS England regions. BNSSG = Bristol, North Somerset and South Gloucestershire; BSW = Bath, North East Somerset, Swindon and Wiltshire; ICS = integrated care system. Adapted with permission from NHS England. Integrated stroke delivery network footprints. NHS, 2020.

Fig 2.

The responsibilities and breadth of integrated stroke delivery networks covering the entire stroke pathway. ESD = early supported discharge; ICS = integrated care system; PCNs = primary care networks. Adapted from NHS England. National stroke service model: integrated stroke delivery networks. NHS, 2021.

Fig 3.

Cardiology network levels of service. All hospitals must be a part of a network with access to all four levels; supra-regional centres will provide more specialised services for more than one network. CRT = cardiac resynchronisation therapy; EP = electrophysiology; ICDs = implantable cardioverter defibrillators; NSTEMI = non-ST segment elevation myocardial infarction; PCI = percutaneous coronary intervention; PPCI = primary percutaneous coronary intervention; TAVI = transcatheter aortic valve implantation; TOE = transoesophageal echocardiography. Adapted from Getting It Right First Time. Cardiology: GIRFT programme national specialty report. NHS, 2021.

Fig 4.

Flexible pathology networks that reflect local needs. ICSs = integrated care systems; POCT = point-of-care testing. Adapted from Getting it Right First Time. Pathology: GIRFT programme national specialty report. NHS, 2021.