New general surgery report indicates potential savings to the NHS

The Getting It Right First Time (GIRFT) general surgery report suggests the NHS could see a significant reduction in the amount of people unnecessarily admitted for emergency general surgery if more acute hospitals introduced consultant-led surgical assessments.

GIRFT is a national programme created and led by consultant surgeon Professor Tim Briggs, who ran a pilot programme in orthopaedic surgery which helped to save £30 million in the first year and a further £20 million in the second year. By 2021 it is expected the GIRFT programme will have created opportunities to improve patient care nationwide while also saving up to £1.4 billion annually. Professor Briggs is GIRFT Chair and our National Director of Clinical Quality and Efficiency.

What does this mean for providers?

Analysis by GIRFT shows this change would lead to up to 30% fewer general surgery emergency admissions a year where no operation is delivered, and would cut the annual cost to the NHS by £108 million.  

This is one of 20 recommendations from GIRFT aimed at improving general surgery in order to provide better outcomes for patients, and eliminate unwarranted differences between hospitals in areas such as effective procedures, length of stay, infection rates and procurement costs.

The recommendations of the general surgery national report will be delivered by us, the GIRFT’s implementation teams, alongside bodies including NHS England, NHS RightCare and the Royal College of Surgeons, as well as directly by the trusts, Clinical Commissioning Groups and Sustainability and Transformation Partnership footprints. 

Other opportunities to improve patient care and outcomes, and deliver potential efficiencies

  • a reduction in the length of stay for elective colorectal surgery patients from the current average of 10.2 days to the 5.5 days in the best performing hospitals, would ensure patients didn’t have to stay in hospital for so long and would free up to 84,000 bed days, equivalent to a saving of £23.6 million
  • a reduction in the length of stay for appendicectomy patients from an average of 3.5 days to 2 days would ensure people were back home more quickly and would free up 30,000 bed days for other patients, equivalent to a cost reduction of £8.5 million
  • reducing elective general surgical admissions without any surgical procedure, which are rarely necessary, would save close to £7 million a year
  • reducing some hospitals’ high levels of emergency readmission at 30 days for gall bladder surgery to the national average would save £1 million in bed days
  • similarly, if providers with high 30 day emergency readmission rates following appendicectomy reduced their readmission rates to the national average, this would free up £5.8 million worth of bed days
  • if all patients received gall bladder surgery within 14 days of diagnosis, as opposed to the national average of 23% of patients, fewer would be readmitted for later surgery, and up to £5 million could be saved
  • if all trusts reversed surgical stomas following colorectal cancer resection, where appropriate, in the recommended time frame of 6 months rather than 18 months, this would provide a better experience for patients and could save almost £2.4 million annually
  • if all hospitals procured surgical supplies at the lowest price, national costs would reduce by 59%

Further recommendations

Mr John Abercrombie’s recommendations were developed by reviewing data from all acute hospitals in England and visiting 50 general surgery departments. The recommendations have also been fully endorsed by the Royal College of Surgeons.

My recommendations provide a blueprint for better care that will be good for patients and good for the NHS.

Mr John Abercrombie, Colorectal Surgeon based at Queen’s Medical Centre, Nottingham.

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