Skip to content

This content is more than five years old


Tackling variations in clinical care

Assessing the Getting It Right First Time (GIRFT) programme

The Getting It Right First Time (GIRFT) programme aims to bring about higher-quality care in hospitals, at lower cost, by reducing unwanted variations in services and practices.

It uses national data to identify the variations and outcomes, shares that data with all those concerned with a service – not only clinicians, but also clinical and medical directors, managers and chief executives – and monitors the changes that are implemented.

The programme began with orthopaedics and is now being rolled out to 32 different surgical and medical specialisms across the English NHS. Through an informal assessment of the programme, this paper sets out what the programme is, why it is needed, what is different about it, what it has achieved, what challenges it faces and what potential it has. It also contains vignettes illustrating hospitals’ experiences of the programme.

Key findings

  • GIRFT is a clinically led programme, which brings together the clinical, performance and financial data for each specialist unit, making it easier to see the relationship between outcomes and cost.

  • On the limited evidence to date, it is producing real gains in procurement, productivity and quality. For example, in January 2016, 71 of the 142 orthopaedic units in England identified savings of between £20 million and £30 million after an initial GIRFT visit, with an additional £15 million to £20 million forecast for the succeeding 12 months.

  • The data is presented by leading clinicians in the given specialty, who are supportive and encourage change in behaviour and practice.

  • Some of the issues that need to be debated are directly in the control of clinicians, but without management, there is a limit to what the programme can achieve. It is important that clinicians and managers work together to seek solutions.

Policy implications

The evidence to date suggests that the GIRFT programme is achieving what it has set out to achieve – higher-quality care in hospitals at lower cost – with the engagement of both clinicians and management in the process. However, buy-in varied, and sustained success will depend on engagement of both clinicians and managers and commitment to taking action.