GIRFT indicate that there is a wide variation in day surgery rates throughout the UK, with NHS Trusts in the lowest quartile admitting twice as many eligible patients as inpatients compared to those hospitals in the highest quartile. GIRFT suggests that this must be addressed, believing that day surgery should be the default setting for many more procedures.

In order to achieve the safe expansion of day surgery, GIRFT recognise the need to follow clear guidelines and create good pathways aimed at improving quality. For this reason, GIRFT produced the National Day Surgery Delivery Pack to serve as a guide to the development of day surgery services, that will allow all patients across the UK to receive the opportunities and clinical outcomes associated with high quality day surgery pathways.

Given the ever-increasing demand vs capacity mismatch for surgical procedures, there is now further incentive to maximise the movement of procedures down the intensity gradient.

For example, moving all appropriate work away from elective impatient theatres into a day surgery or outpatient pathway .

In the pack GIRFT recommends Key Procedures for improving day case rates. In orthopaedics two knee procedures are recommended:

• ACL reconstructions

• Uni-compartment knee replacement (PKR)