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Understanding implementation of the 'high volume, low complexity' surgical hubs programme in England: a qualitative
Pete Lampard1, Arabella Scantlebury2, Peter Sivey3
1York Trials Unit, Department of Health Sciences, University of York, York, UK pete.lampard@york.ac.uk.
BMJ Open
|July 17, 2026
Summary
England
Area of Science:
- Health Services Research
- Surgical Innovation
- Healthcare Management
Background:
- Elective surgical care in England was postponed due to COVID-19.
- NHS England and GIRFT developed an elective recovery plan, featuring surgical hubs.
- High-volume, low-complexity (HVLC) surgical hubs were designed to increase surgical capacity.
Purpose of the Study:
- To explore the implementation of England's HVLC surgical hubs programme.
- To understand the perspectives of senior leaders involved in the programme's development and rollout.
Main Methods:
- Qualitative study design.
- Semistructured interviews conducted with 12 service leaders.
- Participants were directly involved in the development and/or implementation of HVLC surgical hubs.
Main Results:
- Four themes facilitated rapid diffusion: COVID-19 created a 'window of opportunity' for investment.
- Respected clinical leadership and peer-generated, data-driven protocols built trust.
- An iterative, locally adaptive implementation approach and peer-to-peer accreditation fostered shared learning.
Conclusions:
- HVLC surgical hubs show crisis-driven acceleration can be sustained by clinical credibility and supportive oversight.
- Hybrid governance combining national direction with local adaptability is crucial.
- Organisational readiness, relational work, and supportive infrastructures are key for long-term impact.
