The National Orthopaedic Alliance Quality Improvement (including Clinical Audit) Network (OQICAN) has been set up to:

  • provide opportunities for the benchmarking of audits against and between orthopaedic trusts in national audit results
  • promote our own and each other’s improvement in clinical effectiveness through Clinical Audit and Quality Improvement activity
  • encourage cross-fertilisation of topic ideas and collaborative activity in local/specialist audits across the NOA
  • improve practice / create best practice using the results from clinical audits
  • be a national, collective, expert voice on orthopaedic Clinical Audit with the potential to help drive the quality improvement agendas of NHS England and HQIP
  • form an approachable and accessible group for advice and support with orthopaedic-related audits
  • offer opportunities to participate in CPD accredited training workshops, events and bespoke training and development sessions

On 25 November 2020, the NOA hosted an introductory webinar to launch the Orthopaedic Quality Improvement and Clinical Audit Network (OQICAN). You can read more about it and view the recording in the members area of our website.

A series of planning meetings have been held since December to create:

  • The network’s structure (assets, relationships, roles and responsibilities)
  • The network’s governance framework (e.g. terms of reference, data sharing agreements, policy, risk assessments etc.)
  • Our strategic objectives and workplan priorities (e.g. workshop themes and schedule, potential collaborative activities) including the development of a forward plan.

More details, resources and updates are in the members area of the website.


The pandemic has drastically changed the delivery of planned orthopaedic surgery. The NOA was eager to support its member organisations and the wider orthopaedic provider community during these extraordinary times and sought to develop and deliver a range of services.

As an alliance we support the orthopaedics specialty during the pandemic through:

  • Our COVID-19 webinar series which focuses on a range of issues including recovery of elective orthopaedics and waiting lists management. We have collaborated with organisations including the British Orthopaedic Association, Getting It Right First Time, Versus Arthritis, ESCAPE Pain and more to ensure we address key issues.
  • COVID-19 resource pages on our website and members’ area.
  • NOA team members have provided support at their respective Trusts.
  • Curating quarterly meetings to help address issues facing staff across our membership during these challenging times . Topics included workforce & wellbeing and waiting lists management.

More details, resources and updates are in the members area of the website.

Clinical Coding

The NOA commissioned a review of coding practice for each member by a coding expert and the creation of a report including guidance and best practice for orthopaedic coding. The lead for this work, Andy Wheeler, Head of Clinical Coding & Clinical Data Quality at the Royal National Orthopaedic Hospital NHST and co-lead of the clinical coding workstream for the GIRFT programme, collaborated with many expert coding leads from across the membership.

The complexity of the issues found, combined with the clinical coding issues raised by the GIRFT programme resulted in the creation of the GIRFT cross-cutting theme; clinical coding project, which moved the focus to a national level review of coding across all specialities. That work is producing best practice documentation as well as coding standards. Andy Wheeler remains the NOA clinical coding lead as well the GIRFT lead, and the NOA is taking an active part in shaping the orthopaedics work undertaken by the project.

More details, resources and updates are in the members area of the website.

Cost Improvement Programmes

In November 2018 one of our founder member organisations, the Royal National Orthopaedic Hospital (RNOH) asked the NOA for help setting up an exercise to share ideas and learning around the identification of CIP schemes for 2019/20.

The proposal generated a lot of interest across the NOA membership, and in March, 2019 the NOA held its first CIP sharing workshop.

The second CIP workshop was held on 20 November 2019. The day included presentations from attendees highlighting CIP achievements, challenges and lessons learned as well as themed breakout focus groups. The workshop which was chaired by the Royal National Orthopaedic Hospital and timed to help Trusts prepare for business planning 20/21. Read more about the day here.

A third CIPs workshop was held on 15 December 2020 as a virtual event. The afternoon was chaired by Amanda Gaston, Deputy Director of Finance from Royal Orthopaedic Hospital, Birmingham. 

More details, resources and updates are in the members area of the website.


There is much evidence which shows that the wellbeing of care providers positively effects patient outcomes.  Wellbeing is an issue important to the NOA and many of its member organisations. 

NOA wellbeing webinar series

The first in NOA’s wellbeing webinar series was held on 4 March 2021. It looked at some of the challenges and opportunities to improve staff wellbeing during the pandemic at NOA member trusts.  Find out more and view the recording in the members area of our website..

Wellbeing workshops

The NOA is committed to supporting the wellbeing of its members. Using feedback from staff at member organisations, we developed a series of wellbeing workshops. The workshops covered:

  1. Self-Care for Tough Times
  2. Spotting & Preventing Burnout
  3.  Resilience – Recharge the Inner Battery

Read more about the sessions run for the NOA by Work Well Being in our events section.

More details, resources and updates are in the members’ area of the website.


The NOA met with the Collaborative Procurement Partnership (CPP) in January 2018 to contribute to the Category Tower 4 strategy and has since maintained close ties with CPP through their delivery of Total Orthopaedics Solution (TOS) and the preparation stages of TOS2 roll out.

The aim of the NOA Procurement Group is to share information, pool expertise and maintain a discourse with central procurement bodies to ensure best value for our members.

Total Orthopaedic Solutions 2 (TOS2) will be rolled out on 3 February 2020. The NOA is maintaining a dialogue with the Category Tower Director – Tower 4 to ensure we help shape and influence the future category strategy and have been instrumental in the setting up of a National Category Stakeholder Group for Orthopaedics.

More details, resources and updates are in the members area of the website.


Following on from an open meeting across the NHS in March 2019 to start to build a national network for PROMs (more information below) hosted by the NOA and Northumbria Healthcare, the NOA held its own workshop in August 2019. The workshop focussed on the current processes in place for PROMs amongst our members and methods to share intelligence (including benchmarking).

Steph Wilson (NOA Senior analyst and Business Insight lead) led the day. Her presentation slides share the results of the questionnaire that was sent around members in the preceding weeks as well as the National data collection (what’s published and at our fingertips); increasing transparency; what can be achieved through further modelling; Trust reporting and patient level data.

Samantha Davies from RJAH, Irrum Afzal from SWLEOC, Dave Searle and Sian Gallacher from Royal Devon and Exter shared their journeys so far in collecting PROMs data.

More details, resources and updates are in the members area of the website.


For many years the NOA has been clear that the current system fails to appropriately reimburse providers of orthopaedic care, particularly when undertaking specialist and complex work. This underfunding threatens the ability of our members to deliver continued improvements in standards of care. It also undermines well-established principles around the centralisation of specialist care.

Based on the NOA’s evidence and analysis, we have engaged with NHSI and NHSE to agree on the need for changes to be made. 

Our issues were recognised and accepted during 2018/19 based on analysis of members’ PLICS data with further support added by GIRFT. Around £30m of funding was reallocated as part of the 19/20 tariff – £20m of tariff adjustments and some additional allocated direct to specialist orthopaedic trusts. NOA’s proposal going forward was to introduce a complexity uplift from 2019/20.

More details, resources and updates are in the members area of the website.