Surgical hubs

Helping to increase elective capacity

Surgical hubs are an important part of plans to increase surgical capacity and to offer hundreds of thousands more patients quicker access to some of the most common procedures.

Hubs focus mainly on providing ‘high volume low complexity’ surgery with particular emphasis on ophthalmology, general surgery, trauma and orthopaedics (including spinal surgery), gynaecology, ear nose and throat, and urology. Some hubs are also delivering paediatric surgery.

They bring together skills and expertise of staff under one roof – reducing waiting times for some of the most common procedures such as cataract surgeries and hip replacements. These operations can be performed quickly and effectively in one place.

Improving quality and efficiency will mean patients have shorter waits for surgery, will be more likely to go home on the same day, and will be less likely to need additional treatment after surgery.

As the hubs are separated from emergency services, surgical beds are kept free for patients waiting for planned operations, reducing the risk of short-notice cancellations due to other emergency admissions taking priority.

There are 123 elective surgical hubs currently operational across the NHS in England. GIRFT is also running a scheme to accredit all hubs by the end of 2026. While it is not mandatory for trusts to seek accreditation, the long-term goal is for every elective surgical hub to be accredited. See below for further information on the accreditation scheme.

Hub models

Elective surgical hubs may exist within a hospital, where the hub is a distinct unit, or a repurposed ward area or theatre. There are also standalone elective surgical hubs established on a site that is not part of a hospital’s core estate.

There are three distinct models:

Stand-alone hub – an elective surgical unit in a dedicated building fully separate from any acute provision. This would include, for example, specialist orthopaedic hospitals.
Integrated hub – elective surgical unit within an existing acute hospital site, with all facilities physically segregated from acute areas.
Ring-fenced hub – elective surgical hub exists as a dedicated area within an existing acute site, with ring-fenced elective theatres within the main theatre complex and with dedicated in patient or recovery area.

What defines a hub?

Exclusively performs planned surgery.
Has ring-fenced facilities and staff.
Has embedded – or is working towards – the principles of 6-day operating, 48 weeks per year, 2.5 session days and 85% theatre utilisation.

Key benefits

More efficient use of theatre capacity and increased throughput .
Increased resilience against winter pressures.
Streamlined pathways and shorter length of stay.
Application of innovative, more sustainable workforce
Reduced pressure on staff and improving morale, recruitment & retention.

GIRFT's role

Part of GIRFT’s remit is to support systems to ring-fence elective capacity and to support the creation of suitable elective surgical hub facilities to carry out low and medium complexity procedures at scale within defined standards.

GIRFT’s role involves:

Improving the utilisation & productivity of existing hubs to ensure that all hubs realise their full impact for delivering high volume, low complexity procedures (GIRFT HVLC).
Accelerating the effectiveness of new hubs, ensuring that the new units all work towards standardised clinical & operational principles from the beginning.
Developing guidance and peer to peer support with resources on FutureNHS.
Delivering an accreditation scheme to provide a clear framework of standards needed to accelerate progress.

Hub Accreditation Scheme

The hub accreditation scheme enables trusts to seek formal assessment of their hub sites against a defined set of criteria.

Accreditation is not mandatory, but it offers trusts and their hubs the external recognition that they work to a defined set of clinical and operational standards in the following areas:

The patient pathway
Staff and training
Clinical governance and outcomes
Facilities and ring-fencing
Utilisation and productivity

The scheme is supported by the Royal College of Surgeons and Royal College of Anaesthetists.

Benefits of accreditation

Provides trusts with a clear framework of standards needed to accelerate progressand deliver effective elective hubs at pace.
Provides a visible marker of high standards that could be communicated to patients and staff enabling better take up of hub treatment offers.
Represents an important improvement tool to improve patient flows and outcomes.
Recognises and rewards excellencein operational management, clinical standards and patient experience.

Accredited hubs

Click the links below to read about which hubs have been successfully accredited:

“By adopting best clinical and operational practice, we know we will achieve improved productivity and at the same time support our workforce to embed new ways of working and maximise the benefits of working together across systems.”

Professor Tim Briggs

GIRFT Chair, national lead for HVLC and National Director of Clinical Improvement for NHSE

Surgical hub resources and best practice guidance – some links will require registration for access to FutureNHS site:

South West London Elective Orthopaedic Centre (SWLEOC) has worked with GIRFT to share their working practices and experiences as an established hub. This is intended to provide support to systems and providers developing their elective hub provision.

Click to read our blog: ‘Do elective surgical hubs really make a difference?’, by Professor Tim Briggs, NHSE National Director for Clinical Improvement and Elective Recovery and Chair of GIRFT, and Dr Elena Bechberger, the former Elective Surgical Hub Programme Director for GIRFT