Significant developments are taking place in day surgery, day treatments and non-invasive surgery. Follow-up services and clinics allow one to offer in local polyclinics a wide range of services backed up by the resources of a system. People will be satisfied with such services. It is important, however, that centres of excellence do not suck all the resources out of the system. In the days when people referred to hub and spoke in the context of hospitals, the hub grew fat and the spoke thin until the rim fell off. People have to be reassured that the provision at the centre is complemented by the maintenance of local services.