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.

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 more than 90 elective surgical hubs currently operational across the NHS in England, many of them set up with GIRFT support as a response to the Covid pandemic to maintain elective work.

In addition, a further 40 new hubs are planned to open over the next three years, via the Targeted Investment Fund (TIF) process.

Hub models

Elective surgical hubs 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. These ‘hub’ sites will play a crucial role in increasing elective activity by 10% in 2022/2023 (compared to 2019/2020) and 30% by 2024/25 and should be designated as system assets, with patient flows into the hubs from a number of different trusts or trust sites.

GIRFT’s role involves:

  • Improving the utilisation & productivity of existing hubsto ensure that all hubs realise their full impact for 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

It is supported by the Royal College of Surgeons and other key groups.

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:

GIRFT has developed a number of guides to support Trusts and ICSs establishing surgical hubs, and to improve elective performance across key specialties delivering high volume, low complexity procedures.

Click above to view the pdf

GIRFT is running a series of masterclasses to support trusts and ICSs establishing surgical hubs.

Click links below to view the masterclass recordings:

“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

Quality Improvement Resources