ArticleBMJ open2026
Understanding implementation of the 'high volume, low complexity' surgical hubs programme in England: a qualitative study.
Article in BMJ open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveTo explore the implementation of England's high volume, low complexity (HVLC) surgical hubs programme from the perspective of senior leaders involved in its development and rollout.
designA qualitative design using semistructured interviews with service leaders.
settingFollowing the postponement of elective surgical care in England after the outbreak of COVID-19, NHS England and the 'Getting it Right First Time' (GIRFT) programme developed an elective recovery plan for the NHS, with surgical hubs as the chief innovation for building elective surgical capacity.
participants12 service leaders, directly involved in the development and/or implementation of the HVLC surgical hubs programme.
resultsFrom the service leader interviews, four interrelated themes explained the rapid diffusion of surgical hubs: a 'window of opportunity' created by COVID-19, which accelerated adoption by reframing elective backlog as an acute crisis and enabling targeted investment; leadership by respected clinicians and the use of peer-generated, data-driven protocols which built trust and engagement; an iterative, locally adaptive approach to implementation, framing oversight as supportive rather than punitive; and peer-to-peer accreditation, allowing for the showcasing of best practice and fostering a growing network for continued shared learning.
conclusionThe implementation of high-volume, low-complexity surgical hubs in England demonstrates how large-scale service reconfiguration can be accelerated under crisis conditions but sustained through clinical credibility, trusted data and improvement-focused oversight. Our findings highlight the importance of hybrid governance models that combine national direction with local adaptability, supported by peer networks and accreditation mechanisms. These features align with wider evidence on health system change, underscoring the need for organisational readiness, relational work, and supportive infrastructures to ensure long-term impact beyond initial investment and leadership momentum. Future research should explore how these hubs function in practice, and whether the views of surgical hub staff align with those given by service leaders.
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