North central London elective orthopaedic network: accelerating how we improve surgical practice in the NHS

In the era of patient centred medical practice, we are forced to regularly adapt our approach to keep up with the growing demands of an aging population while focusing on quality improvement, and reducing unwarranted variations in access to health services as well as in quality and outcomes. In a mission to address some of these challenges, the five north central London (NCL) clinical commissioning groups and five NCL National Health Service trusts currently undertaking adult elective orthopaedic surgery collaborated to propose and develop dedicated elective orthopaedic centres. The goal was to create an orthopaedic clinical network that will join together orthopaedic services under one quality improvement umbrella. We present this process, which provides an innovative model of service delivery and the genesis of an orthopaedic network. We believe this model offers essential principles with which future integrated care systems could engage: clinical leadership, early public involvement, proposal transparency, co-design through multiple trust collaboration, addressing health inequalities and establishing a system to deliver best practice care. Our ability to all come together (hospital trusts, patients and the public) is a clear example of the collaborative potential that our healthcare system has, and can be seen as a blueprint for future endeavours. We hope that the transformation of the NCL elective orthopaedic network through elective orthopaedic centres will provide a beneficial template to colleagues and public communities attempting to meet the enhancing demand on current orthopaedic services, and that this will improve the delivery of health services beyond the constraints of our locality.