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Abstract

Background
The adoption and spread of innovation remain persistent challenges for the English National Health Service (NHS). Traditional top-down approaches provide authority but often fail to account for local context, while bottom-up approaches harness frontline knowledge but fail to overcome systemic inertia. The NHS InSites Programme offers a distinctive alternative that seeks to transcend this dichotomy by combining peer-led learning networks with centralised coordination. We aim to explore the factors that support or hinder the adoption and spread of innovation in the context of the NHS InSites Programme.

Method
This qualitative study draws on 25 semistructured interviews with 33 participants, including NHS staff, InSites Hub members and NHS England commissioners. Thematic analysis was conducted to identify key barriers and facilitators to innovation adoption and spread.

Findings
Participants generally expressed positive attitudes towards the NHS InSites Programme, viewing it as a valuable catalyst for collaboration, learning and structured innovation support, bridging the limitations of top-down and bottom-up approaches to innovation spread. Four overarching themes influencing innovation adoption were identified: ringfenced financial support; transcending hierarchical structures; harmonising processes to navigate fragmentation and challenging context. Our analysis also showed that the programme’s effectiveness relies on relational trust to enhance learning; harmonised processes to allow adaptation and institutional support to transcend hierarchical structures.

Conclusion
By providing dedicated resources, harmonising processes and enabling peer-to-peer learning, the NHS InSites Programme addresses several well-documented barriers to spreading innovation. Its long-term contribution will depend on sustained investment, continued policy support and the ability to scale its mechanisms beyond early adopter sites.

Publication Type:	Article
Additional Information:	© Author(s) (or their employer(s)) 2026. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: https://creativecommons.org/licenses/by-nc/4.0/.
Subjects:	R Medicine > R Medicine (General) R Medicine > RA Public aspects of medicine
Departments:	School of Health & Medical Sciences School of Health & Medical Sciences > Department of Population Health & Policy
SWORD Depositor:	Symplectic Administrator

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