The Specialist Orthopaedic Alliance aims to be a primary source of support and expertise to the NHS and elsewhere on the provision of orthopaedic services in order to promote high quality outcomes for patients and better value for money through productivity and long term cost savings. At its most basic this can be described as supporting the NHS to ensure that its policies and systems promote appropriate orthopaedic referrals getting to the right experts, in the appropriate setting, at the right time who, by getting it right first time, reduce complications, and use evidence based treatments. Coupled with appropriate innovation and different modes of working, this approach will improve the quality of care for patients.


Specialist orthopaedic services deal with a higher proportion of complex work than general elective orthopaedic services and there is significant evidence that excellence in general orthopaedics is supported by specialist services being delivered in a critical mass in specialist units. However this evidence base needs to continue to be expanded. To this end, the SOA is facilitating an expanded evidence base for demonstrating what defines a “better outcome” for patients in orthopaedics and thereby underpins our belief that specialist services deliver this more effectively and at lower cost.


In addition to providing specialist activity to an appropriate critical mass to achieve better outcomes for patients with complex conditions, specialist units should also act as hubs which drive forward best practice, innovation, teaching, research, development and trialling new technologies across all providers of orthopaedic services, in primary care and secondary care general hospitals. The Alliance therefore collates and promotes evidence of best practice, innovation and translational research that improves patient outcomes in the NHS and cascades this across the members of the SOA.


The Commissioning landscape in the NHS is changing significantly and the SOA welcomes the direction of travel to move the commissioning of all services defined as specialist to new regional specialist commissioning teams run directly by the National Commissioning Board.International experience is that case mix related funding systems, such as the Healthcare Resource Group system “Payment by Results” used in the NHS struggle to reflect case mix complexity of specialist services. The sustainability of specialist orthopaedic services in the NHS is dependent on a funding system that, as well as driving best practice and efficiency, also reflects complexity appropriately. The SOA therefore works closely with the Department of Health Payment by Results team and the transition teams for the National Commissioning Board (and hopes to extend this Monitor in the future) to review and refine the way the specialist orthopaedic care is recorded and funded.


The Specialist Orthopaedic Alliance also interfaces with MPs, Ministers, Health Select Committee, the National Commissioning Board, specialist commissioners, and partner bodies such as the British Orthopaedic Association, Royal College of Surgeons, and the British Orthopaedic Directors Society. Our role is to supply information, reporting, commentary and other support and expertise on national or local policy initiatives that impact the delivery of orthopaedic services.

Rob Hurd
Chair, Specialist Orthopaedic Alliance
Chief Executive, Royal National Orthopaedic Hospital NHS Trust