Hubs, spokes and policy cycles : an analysis of the policy implications for the NHS of changes to medical staffing : a paper for the King's Fund London Commission

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This paper examines four major policy developments which are forcing changes in medical staffing arrangements and also in the reconfiguration of clinical services within and between hospitals. These developments are the primary care-led NHS, the New Deal on junior doctors' hours, the Calman report on specialist medical training and the Calman-Hine report on the organisation and delivery of cancer services. Drawing on new research, a review of the literature and interviews with senior doctors and managers, the study presents some interesting findings. The authors warn that a major test will be how the NHS responds to these developments in an environment where there is often opposition to change.

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