It will always be for local commissioners to determine how to best deliver services to meet local needs. It is right that decisions on local services and service models are made by local commissioners, who can best assess how to meet the needs of people in their area.
NHS Getting It Right First Time (GIRFT), is a national clinically-led quality improvement programme that has made recommendations for improving orthopaedic services. These recommendations include the establishment of robust regional networks with regional centres to ensure appropriate critical mass for complex and low volume cases. There is good evidence that these centres offer patient excellent results.