North London Partners in health and care

Pre-consultation phase: Review of adult elective orthopaedic services

Orthopaedic review

We are reviewing Adult Elective Orthopaedic Services

We have now launched a public consultation into proposed changes to these services.  You can participate in this by visiting the consultation pages.
The information on this page gives an overview of the process that led to this consultation.
Adult elective orthopaedic surgery is planned (non-emergency) surgery of bones and joints, such as hip and knee replacements.  In 2016/17, north central London hospitals carried out over 23,000 operations across 10 sites. 

We think there may be opportunities to improve adult elective orthopaedic surgery in north central London by consolidating services onto fewer sites and we are undertaking a review of these services to see if these improvements can be achieved. Our review was launched, following agreement at the NCL Joint Commissioning Committee meeting on 1 February 2018.  It has been established by North London Partners in health and care on behalf of Barnet, Camden, Enfield, Haringey and Islington clinical commissioning groups.

The review has had extensive clinical involvement with nurses, doctors, surgeons, physiotherapists and other allied health professionals - alongside members of the public - involved in shaping how this kind of care could be delivered in the future. Our thinking was presented in summer 2018, in our draft case for change.

A Programme Board made up of all key stakeholders is overseeing the work of the review.  Clinical commissioners in Barnet, Camden, Enfield, Haringey and Islington (or joint arrangement with other commissioners, via committees in common) will make the final decisions on where and how future services are shaped.

Why are we reviewing planned bone and joint care?

We want to ensure that every adult in north central London that requires elective orthopaedic surgery, receives consistent, high-quality care, avoiding long waits or cancellations.  We are acting now, so that services are fit for the future.  We are:

  • Creating enough capacity to meet demand for services
  • Separating emergency and planned care to avoid cancellations
  • Ensuring that we have enough trained staff with the right skills to deliver the service
  • Ensuring operations are successful by giving access to top quality pre-operative and post-operative education and care
  • Providing consistent care and learning from other services around the country
  • Ensuring equality of access for all residents who need an operation

 Evidence shows that having ring-fenced services leads to the higher-quality care.


The review so far

Our review is a multi-stage process that has been designed to ensure that we consider all options open to us in future, draws on the expertise of those delivering the services both locally and nationally and involves patients at each stage.

So far we have:

  • Shared our early thinking by publishing a draft case for change [read more about this]
  • Heard feedback on the draft case for change, had this independently evaluated and presented the outputs from clinical design workshops (Joint Commissioning Committee, 6 December 2018) [read more about this]
  • Set out the governance arrangements for stage two of the review and the JCC has made a decision about final contract form (Joint Commissioning Committee: 3 January 2019)  [read committee reports]
  • Developed a 'clinical delivery model' - a description of how services could be managed in future (Joint Commissioning Committee, 2 May 2019) [read more about this]
  • Set out our 'options appraisal process' which describes how we will evaluate the different options from NHS healthcare providers (such as local hospitals) (Joint Commissioning Committee, 2 May 2019) [read committee reports]
  • Provided regular updates to interested stakeholders [see our newsletters]

To see information relating to each of these stages, click on the relevant links above.

Next steps

The clinical delivery model was reviewed and agreed at the JCC in May 2019.  Following this, potential providers of the service were invited to make proposals about how they might deliver the service in future and an options appraisal process determined the final options for consultation. 

The options appraisal panel who assessed the bids included local commissioners and GPs and also had equal representation from patients and residents, ensuring that the voice of patients was central to decision-making about how services could work in the future.

An update was taken to the Joint Health Overview and Scrutiny Committee (JHOSC) in late September and the NHS England assurance of the proposals is taking place in the autumn.

Download and see the paper that went to the JHOSC.

Our current plan is to consult at the beginning of 2020. 

Get involved

If you have questions or comments please  

If you have any concerns or feedback about any specific personal orthopaedic treatment you have already received, or you are waiting to receive, please speak to your GP or the hospital who provided this service.