Award Winning Collaboration on Orthopaedic Implants Leads the Way

Orthopaedics can be a difficult area in which to standardise products due to the complexity of the varying supplier brands used in joint replacement. These medical devices often come with different design philosophies, however decisions on implants always take into consideration the unique and dedicated instruments that are used to implant them during surgery.

Individual trusts had previously standardised with some success, the next logical step for South Yorkshire ICS trusts was to standardise as an ICS. A multidisciplinary team, including over thirty surgeons, Procurement, Finance, Operations, Theatres and the NHS Supply Chain Northeast Orthopaedic team, delivered a wide range of successful outcomes.

In addition to financial savings there was a strong clinical drive to achieve collaboration. Value added benefits included, operational efficiency in the trust and across the wider ICS, opening up cross ICS working and leveraging the market to support other solutions.

Typically in NHS orthopaedic contracts, solutions are found which meet the needs of that individual NHS department. Clinical training and preferences weigh heavily on the decision-making process as the contracts need to be fit for purpose and reflect the needs of their patients.

In the past decade, five NHS Orthopaedic departments* independently conducted hip and knee projects, each resulting in cost savings. Each held independent contracts with a range of suppliers. However, this decentralised approach posed a collective cost pressure of £800,000 net per annum. This highlighted a need to mitigate the increase whilst establishing new contracts and also presented an opportunity to review the requirements of each department as part of a collective clinical conversation. It was essential to have a clinically led approach, leading to best-in-class products as well as state of the art, innovative technology.

*Barnsley Hospital NHS Foundation Trust, Doncaster & Bassetlaw Hospitals NHS Foundation Trust, The Rotherham NHS Foundation Trust, Sheffield Teaching Hospitals NHS Foundation Trust, Chesterfield Royal Hospital NHS Foundation Trust

The overarching project objective was to achieve orthopaedic standardisation across the Integrated Care System (ICS) by fostering collaborative relationships with clinical partners, thus addressing unavoidable cost pressures. In developing a comprehensive contract benefiting all ICS members, it was acknowledged that prioritising patient outcomes remained paramount. However, clinicians also recognised the importance of cost savings and contract compliance, though concerns existed about altering established clinical practices.

To address the concerns the project was conducted in a clinically centred way, focusing on staffing, instruments, storage provision and Patient Related Outcome Measures (PROMS) data collection to establish project goals. This resulted in new contracts, supporting the transformation of care and the evolving care pathway.

The project team comprised both product and commercial expertise to guide clinical and non-clinical stakeholders. Multiple supplier alternatives which incorporated each clinician’s requirements, were evaluated and the process drove innovations that could support the common aspirations of each department.

The project demonstrated true collaboration, highlighting the crucial parts played by: South Yorkshire ICS clinicians and wider stakeholders, Executives and NHS Supply Chains’ Clinical team and Category and Customer Engagement Teams. This fully inclusive group operated with a shared vision, ensuring that all voices were heard in the pursuit of common goals.  

NHS Supply Chain provided a full clinical engagement stage process for standardisation:

• Multi discipline team involvement
• Full review of current practices per trust
• Future mapping for trusts with shared objectives
• Market engagement
• Options review

A face-to-face supplier day was instrumental in ensuring full engagement and buy in into the process and it reinforced everyone’s commitment to the project, with over 100 stakeholders involved.

Practices were discussed and, in some cases, healthily challenged between clinical peers, resulting in a consensus that met all needs.

Rationalising hip and knee products is a huge undertaking for any NHS Trust. Doing so across five NHS Trusts is an even greater undertaking and at the start of this process, many clinicians were sceptical about reaching a positive outcome. The project which was managed by NHS Supply Chain’s clinical engagement team meant we had relevant information onto which informed decisions could be made by the group. This expertise allowed us to review our practice in the region and focus, not just the products from the suppliers, but also innovation, advanced technology clinical support and training; all of which impact on patient care and looked to the future of how we want to undertake that care. Along with the significant savings which were generated, this allowed us be at the centre of the decision making process and be fully empowered to make that happen. Now that the contracts have gone live, we are reviewing various technologies from the suppliers which will, if adopted, release even greater efficiencies in that patient pathway across South Yorkshire.

Mr A J Anderson MBBS MRCS(Ed) FRCS(Orth), Consultant Orthopaedic Knee Surgeon and Clinical Lead, Trauma and Orthopaedic Dept, Rotherham NHS Foundation Trust. Honorary Senior Clinical Lecturer, University of Sheffield

Standardisation on hips and knees has been fully implemented and now the value-added elements are being worked on and brought to life. The next phase of the project will be to work in partnership with suppliers on other elements of the contract such as theatre efficiency programmes, post-op monitoring and reporting, operational investment, and enabling technology.

Implementation, standardisation and training has been achieved – Standardising as a department to one system for each operation type significantly reduces the number of implants and instrumentation needed for each surgeon, thereby streamlining, and simplifying processes and allowing clinical specialisation opportunities. Ultimately, this results in better and more predictable patient care which improves immediate outcomes and patient experience.

Supplier partnering – The ICS trusts are now a key customer and centre of excellence for the suppliers who are investing and offering further innovation with robotics/navigation, virtual reality and augmented reality training platforms, patient rehabilitation apps and pathway efficiency programs. By rationalising across the ICS for each procedure (primary hip and primary knees) a complete refresh of supplies stocked, training and clinical support was established. 

Cost savings and value-based outcomes – We are on track to achieve the £3.6m efficiencies initially forecasted in the project.

Cultural change and changes in working practice – The process has brought procurement, the clinical teams and the regional NHS Supply Chain orthopaedic team into an ongoing working group. All clinical and non-clinical departments have a partnership which is working to a common set of goals.

Improving patient outcomes and increased clinical engagement – Working with the awarded suppliers we will be embracing technology and innovations to help with the end-to-end patient pathway. Trusts who require it, will be looking to establish enhanced patient pathways with appropriate day case surgery programs for the least complex patients. 

Social value, sustainability and environmental improvements – Reducing variation through multiple implant systems for hips and knees within a department has been shown to improve productivity, product education and training.

Standardisation in hip and knee brands means a two thirds reduction in stock on theatres shelves, improved instrumentation provision for week-to-week activity, consignment which is fit for purpose giving better replenishment: all allowing theatre teams to manage lists more effectively.

The reduction in range means products can be managed more effectively, which in turn leads to less waste.

There has been significant improvement with collaboration across the network, peer to peer learning, relationships between clinicians and procurement and working with suppliers.  The South Yorkshire ICS has established two Elective Orthopaedic Centres (EOCs) which will take in patients and clinicians from across the ICS trusts. These two EOCs hold the state of the art, innovative equipment and staff working in them, from various trusts, sharing knowledge, thereby bolstering human resources and career opportunities for staff.

This project established a single overarching contract and service level agreement and converted an £800k forecasted cost pressure into a £1million saving on annual implant spend, representing a swing of £1.8million. 

This project was entered for the HCSA Clinical Procurement in Partnership Award in December 2023 and judged against six other strong entries to be the awarded winner in this category.

When the proposal that the ICS should unify the procurement of hip and knee arthroplasty implants, I initially scoffed. Even amongst our unit in Sheffield there was a divide. We had three implants for knees and a similar number for hips. I personally thought getting our own unit to agree would be difficult and the whole region would be impossible. However I was very wrong.

The support of the Hip and Knee project team was outstanding. They were understanding and compassionate and highly professional. They oozed knowledge and it was immediately clear that this was a project that they could handle, no matter how impenetrable it seemed to us.

The team were fundamental in this work. The turnaround of data and financial savings was rapid and clearly explained. They clearly had a clear goal in sight all along and organised industry open days (a massive task), liaison amongst surgeons and liaison with local, regional and national procurement bodies.

Without their massive support we would not have been able to unify our implant portfolio. The turnaround of data and financial savings was rapid and clearly explained.

We have been so impressed with this group that we have returned and unified our revision hip and knee portfolio and are doing the same for bone cement and other consumables.

Andrew Gordon, PhD, FRCS (Trauma & Orthopaedics), Consultant Orthopaedic Surgeon, Clinical Lead Lower Limb Arthroplasty. Sheffield Teaching Hospitals

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