High turnover, low complexity hub model

Case study summary

Implementation of a hub for recovery of paediatric dental services across Greater Manchester.

This case study is part of a suite of examples designed to support the contents of the children and young people’s elective recovery toolkit.


Greater Manchester (GM) was one of the hardest hit areas by COVID-19 in the country, facing stricter restrictions for a longer period than other regions. It has since demonstrated the strongest elective recovery of paediatric dentistry.


In August 2021, GM became the first area of England to establish a high turnover, low complexity hub for paediatric dentistry. Recovery of paediatric dental services was led by a collaborative, including the Managed Clinical Network for Paediatric Dentistry, the Operational Delivery Network, anaesthetic leads, and operational teams who reported into the Regional Elective Recovery Group for children’s surgery and enabled a pan-GM response to ensure equitable recovery.

Impact and benefits

  • The hub continues to deliver 180% of pre-pandemic activity levels for CYP, requiring routine extractions under general anaesthetic.
  • The hub has freed up capacity in the children’s hospital, allowing GM to subsequently recover surgical services for CYP with additional needs or those requiring more complex treatment.
  • Similar hubs have been introduced for children’s specialised and non-specialised surgery. The hubs have been spread geographically across GM to ensure equitable recovery across the system.
  • The surgical team operates within a consultant-led service and operators are selected from a “safe hands” list – a team of dentists who have been trained and quality assured by the consultant team and who will treatment plan and operate in line with national guidance.
  • The anaesthetic staffing model includes an additional anaesthetist and operating department practitioner to increase theatre efficiency and the number of CYP who can be safely listed.
  • Patients are prioritised by clinical urgency, using the national Surgical prioritisation guidelines for paediatric dentistry and those waiting longer than six months receive a welfare check (a pdf will automatically download).
  • GM has made significant efforts to reduce higher levels of poor oral health experienced through initiatives, such as a child friendly dental practice scheme, distributing dental packs to vulnerable children, supervised toothbrushing in schools and promotion of dental checks before the age of one. The impact of this work will take time for absolute numbers of extractions and levels of decay to decline.