Frequently asked questions
The Surrey Care Record is undergoing a review in the light of a number of recent developments including the need to align closely with the new regional Thames Valley and Surrey Local Health and Care Record (TVS LHCR). No patient data is currently being shared and to ensure accuracy of advice to patients and the public, the content of this page is being revised to reflect changes in operational conditions. New material will be uploaded as soon as it becomes available. More information about Thames Valley and Surrey Local Health and Care Record can be found here.
In an integrated care system, NHS organisations, in partnership with local councils and others, take collective responsibility for managing resources, delivering NHS standards, and improving the health of the population they serve.
Local services can provide better and more joined-up care for patients when different organisations work together in this way. For staff, improved collaboration can help to make it easier to work with colleagues from other organisations. And systems can better understand data about local people’s health, allowing them to provide care that is tailored to individual needs.
By working alongside councils, and drawing on the expertise of others such as local charities and community groups, the NHS can help people to live healthier lives for longer, and to stay out of hospital when they do not need to be there. In return, integrated care system leaders gain greater freedoms to manage the operational and financial performance of services in their area.
Integrated Care Partnerships (ICPs) are local groups of health and care organisations, importantly including borough councils and voluntary/community sector members, working across the existing Clinical Commissioning Group boundaries (Guildford & Waverley, North West Surrey and Surrey Downs). Each ICP is developing its own priorities, reflecting the different needs of each local population, and thinking about how they will work differently in the future. Common themes are emerging, with more emphasis on wellbeing and prevention and on breaking down the barriers between organisations.
STP stands for sustainability and transformation partnership. These are areas covering all of England, where local NHS organisations and councils drew up shared proposals to improve health and care in the areas they serve.
STPs were created to bring local health and care leaders together to plan around the long-term needs of local communities. They have been making simple, practical improvements like making it easier to see a GP, speeding up cancer diagnosis and offering help faster to people with mental ill health.
In some area, STPs – including the former Surrey Heartlands STP – have evolved to become ‘integrated care systems’, a new form of even closer collaboration between the NHS and local councils. The NHS Long Term Plan sets out the aim that every part of England will be covered by an integrated care system by 2021, replacing STPs but building on their good work to date.
This collaborative approach has allowed local leaders across the country to plan around the needs of whole areas, not just those of individual organisations. They are led by well-respected figures from different parts of the NHS and local government, including chief executives of NHS trusts, accountable officers of clinical commissioning groups, local government senior leaders and clinicians.
Working together they are in a better position to deliver the NHS Long Term Plan’s aim for ‘triple integration’ of primary and specialist care, physical and mental health services, and health with social care.
Performance measures will include a new ‘integration index’ developed jointly with patient groups and the voluntary sector which will measure from patient’s, carer’s and the public’s point of view, the extent to which the local health service and its partners are genuinely providing joined up, personalised and anticipatory care
Our vision is to improve health outcomes and add value by working together and in doing so close the health and wellbeing, care and quality and financial gaps. By this we mean:
- Providing the best quality care for patients as close to their homes as possible
- Healthcare professionals working with patients and carers to ensure quick access to diagnostic tests and expert advice so that the right decision about treatment and care is made
- Ensuring, as modern healthcare develops, our local hospitals keep pace by using innovation to provide high quality services to meet the changing needs of our patients
- Avoiding people being unnecessarily admitted to hospital or having to use A&E services because we can’t offer a better alternative
- Caring for people in their own homes where possible
- Spending funding wisely to ensure the provision of consistently high quality care that supports improved health outcomes.
Details of our clinical programmes of work can be found here.
The Surrey Heartlands plan is about delivering on the stated NHS aim to close three fundamental gaps:
- The health and wellbeing gap: if the nation fails to get serious about prevention then recent progress in healthy life expectancies will stall, health inequalities will widen, and our ability to fund beneficial new treatments will be crowded-out by the need to spend billions of pounds on wholly avoidable illness.
- The care and quality gap: unless we reshape care delivery, harness technology, and drive down variations in quality and safety of care, then patients’ changing needs will go unmet, people will be harmed who should have been cured, and unacceptable variations in outcomes will persist.
- The funding and efficiency gap: if we fail to match reasonable funding levels with wide-ranging and sometimes controversial system efficiencies, the result will be some combination of worse services, fewer staff, deficits, and restrictions on new treatments.
We believe none of these three gaps is inevitable. A better future is possible – and with the right changes, right partnerships, and right investments we know how to get there.
The financial challenges faced by the NHS are well documented and careful decisions about how to be more efficient in the way we deliver healthcare need to be made. Although the NHS in Surrey Heartlands is expected to receive an increase in funding in the next five years, we know that expenditure is growing at a faster rate than the money that will be available to us.
If we do nothing differently, rising costs, inflation and increasing demand for NHS services will lead to a financial gap of more than £100m by the end of 2020/21. We aim to close this gap through working more efficiently, redesigning the way in which services are delivered, maximising the benefits that working across a large area can bring (working at scale) and using national sustainability and transformation funding.
The Surrey Heartlands Integrated Care System will look to deliver practical changes to improve people’s lives. These include things that patients often tell the NHS they care about – like making it easier to see a GP, speeding up cancer diagnosis and offering help faster to people with mental ill-health.
With a range of organisations and frontline professionals working together more closely, patients are seeing services work in a more joined up way, are only having to tell their story once and are receiving care better tailored to their individual needs.
The NHS is one of this country’s proudest achievements and it has always adapted to improve care. The growing number of older people in England is in part a testament to its success. But, with demand for care rising and new technologies emerging, the NHS needs once more to adapt to a changing world.
To achieve this, the NHS Long Term Plan sets out a renewed focus on joining up services and investing in ways to prevent illness and keep people out of hospital. Integrated care systems are the central way that local family doctors, hospitals, care homes and others will do this.
Many Surrey Heartlands senior leaders come from a clinical background and leadership teams often include clinical representatives.
The new proposals have allowed areas to think about long-term solutions to local workforce challenges, as well as supporting staff to develop their skills and provide the best care possible for patients. Surrey Heartlands includes Workforce in its priorities list.
Our proposals are based on local knowledge about the priorities and challenges locally and in different parts of the country. Frontline staff are crucial to understanding these issues.
The NHS Long Term Plan requires every sustainability and transformation partnership to become an integrated care system by April 2021. To aid this process local health systems will have access to expert advice and support through the regions including clinically focused transformation and access to technical expertise in a range of business issues such procurement, estates and corporate services.
Residents will be able to see practical day-to-day benefits as their local health and care system works to provide more seamless services, using improved understanding of data to deliver care better tailored to people’s individual needs. Communities will also see further moves to help avoid unnecessary trips to hospital and to support them in living healthier day-to-day lives.
Primary Care Networks are groups of local GPs and other partners operating at a very local level to plan and buy care for local populations of generally between 30,000 and 50,000 people. This will help put services even closer to patients. We now have 18 emerging Primary Care Networks across Surrey Heartlands.
You can see an NHS video explaining the role of Primary Care Networks here.
When fully operational the Surrey Care Record will be an extract of records from health and social care providers that can be seen and used by authorised staff in the health and care system who are involved directly in your care. Phase One of the project, commencing 29 August 2018, will see some information from GP records being made available to professionals within the A&E departments of the four local hospital trusts – St Peter’s, Royal Surrey, Epsom and East Surrey. The local hospitals will also begin sharing information into the Surrey Care Record for local GPs to access too. The remaining phases of the project are still under development.
Initially the Surrey Care Record will hold:
- Basic information such as your name, address, postcode, NHS Number, age and GP practice details;
- Limited information from your health records held by your GP Practice and Hospitals such as test results, medications and allergies
In time, additional health and social care providers will begin to share data into the Surrey Care Record. Each organisation will be responsible for deciding what information about their service users should be shared into the Surrey Care Record. This will ensure the most relevant and important information is shared.
The Surrey Care Record project follows many years of engagement by the NHS discussing the concept of shared records with the public nationwide.
You can talk informally to any health or social care professional providing you with care during an appointment and ask to see the information they hold about you.
Some GP Practices will also allow you to access your GP records online. You can check with your GP Practice to see if you are able to access a summary of your GP record via their website. If so, they can give instructions on how to access your record. The availability of this type of access is a matter for individual GP Practices.
In either case, you can go through any concerns you may have about the accuracy of the information with the relevant professional who will be able to update the records they hold about you. They will then be able to share accurate and up to date information with other professionals via the Surrey Care Record.
There are also proposals to extend direct access to patients, but these plans have yet to be finalised. In the meantime, only health and social care professionals will have access.
The Surrey Care Record supports the provision of direct care and enables health and social care providers to fulfil their legal duty to share information about patients where this will support their care. Where information is shared in this way, consent is not required under the GDPR and the regulator, the Information Commissioner’s Office (ICO), has specifically advised that consent should not be relied upon in these circumstances. Please see the Privacy Notice for full details of how the Surrey Care Record complies with the GDPR.
Under the Health and Social Care (Safety and Quality) Act 2015, providers of health and social care services have a duty to share your information where this is in support of your direct care. The Surrey Care Record helps those providing you with direct care to meet this legal duty, as well as ensuring your information is shared with those who have a need to know in order to provide you with the best possible care.
Professionals will be required to confirm that they have a lawful basis to access a Surrey Care Record before they do so. In most circumstances, professionals will inform you before accessing your Surrey Care Record. This will provide you with an opportunity to object if you are not happy for them to view the information.
Where this is not possible (for example if you are unconscious or otherwise unable to communicate), healthcare professionals may decide to look at the record because doing so is considered to be in your best interests.
All access to the Surrey Care Record will be fully audited to ensure appropriate access to shared records at all times.
The ‘Your NHS Data Matters’ campaign is unrelated and not relevant to the Surrey Care Record.
NHS Digital launched the ‘Your NHS Data Matters’ campaign on 25 May 2018. This is also sometimes referred to as the national data opt-out. This national initiative enables individuals to register their choice in relation to the use of their data for purposes other than direct care, such as research and planning. This replaces previous preferences individuals may have registered with their GP in the past and anyone who has registered an opt-out in the past will have been contacted directly by NHS Digital to explain the changes.
The Surrey Care Record is a local scheme across the areas covered by four NHS Clinical Commissioning Groups – East Surrey, Guildford & Waverley, North West Surrey and Surrey Downs. The Surrey Care Record will only be used to support the direct care of patients and is not used to support other purposes such as research and planning.
Even so, you can still choose to opt out of the Surrey Care Record. This will however mean that professionals involved in your care will not be able to access shared information about you through the Surrey Care Record. Details on how to opt out of the Surrey Care Record can be found below.
No. The Surrey Care Record will only be used by authorised health and social care professionals to provide you with care. Your Surrey Care Record will never be sold or given to insurance companies, drug companies or be used for research.
No. Other national programmes you may have heard of are completely separate. The Surrey Care Record is only integrating data in Surrey Heartlands and the area covered by NHS East Surrey Clinical Commissioning Group. We are only using the data to support your direct care.
The Surrey Care Record will only be used by authorised health and social care professionals to provide your direct care.
Your information will be stored securely inside the NHS network and will be encrypted. The Surrey Care Record will only be accessible to health and social care professionals who will only access your information where they or their team are directly involved in your care and have a lawful basis to access your record (e.g. your consent).
Shared records like the Surrey Care Record provide a range of benefits to both patients and medical staff including:
- Reducing the number of times you will need to repeat your medical history or social care information every time you deal with a new member of staff, service or organisation
- Clinical staff will be able to work with patients in their care to make the best decisions about their diagnosis, treatment and care plan
- Care professionals will be able to find shared information when they need it, such as test results, helping to avoid unnecessary appointments and further tests
- Where several organisations work together to support your care, sharing information via the Surrey Care Record helps the various teams to co-ordinate your care, resulting in more time spent on better co-ordinated and safer care and less paperwork.
Professionals will be required to confirm that they have a lawful basis to access a Surrey Care Record before they do so. In most circumstances, professionals will inform you before accessing your Surrey Care Record. This will provide you with an opportunity to object if you are not happy for them to view the information. If you agree, you don’t have to do anything and those caring for you will access your Surrey Care Record to support your direct care.
Where this is not possible (for example if you are unconscious or otherwise unable to communicate), healthcare professionals may decide to look at the record because doing so is considered to be in your best interests.
All access to the Surrey Care Record will be fully audited to ensure appropriate access to shared records at all times.
This is not a problem. You can contact any participating organisation who will ensure that the sharing of your Surrey Care Record is re-enabled.
Yes. If you want to opt-out of the Surrey Care Record you can contact any participating organisation who will ensure that the sharing of your Surrey Care Record is disabled. This will however mean that other professionals involved in your care will not be able to access shared information about you through the Surrey Care Record.
If you have already opted out of the national Summary Care Record with your GP Practice, your GP records will automatically be excluded from the Surrey Care Record. It is important to understand that if you do this, staff caring for you may not be able to access details from your GP Practice about care you have already received, your current medications, your allergies or any bad reactions to medicines you have had in order to treat you safely in an emergency. Your GP records will stay as they are now with information being shared by letter, email, fax or phone.
Please contact email@example.com for specific advice on the options available to you.
If you are sure you wish to opt out of the Surrey Care Record you can fill in a Surrey Care Record opt-out form and give it to your GP practice.
These are some of the key data items from acute hospitals which may be available in the Surrey Care Record in due course:
- Key medical notes/record
The Surrey Care Record has been designed to ensure that providing information does not affect existing GP services at all.
Sending data to the Surrey Care Record is an automated process that happens overnight, when no treatment is being provided, and therefore does not change the care you would normally receive.
Having data on the Surrey Care Record may improve the care you receive by providing the professionals who are caring for you with access to additional accurate information about you quickly and easily.
Please contact the health or social care provider alleged to be responsible for improper use directly to register a complaint. In Phase One providers will be:
- GP practices from:
- North West Surrey CCG
- Guildford and Waverley CCG
- Surrey Downs CCG
- East Surrey CCG
- Ashford and St Peter’s Hospitals NHS Foundation Trust
- Epsom and St Helier University Hospitals NHS Trust
- Royal Surrey County Hospital NHS Foundation Trust
- Surrey and Sussex Healthcare NHS Trust
Eventually it is planned to include a wider selection of health and social care providers:
- Surrey County Council
- CSH Surrey
- South East Coast Ambulance NHS Foundation Trust
- Surrey and Borders Partnership NHS Foundation Trust
- First Community Health and Care.
- Urgent Care and Walk-In Centres
- Locality Hubs
In its purest sense, devolution is the transfer of powers and funds from central government to local areas to enable greater local accountability and decision-making. With regards to health, devolution can be achieved through a range of mechanisms from parties having shared decision-making processes through to delegated or devolved control over specific functions.
The Surrey Heartlands agreement signals a commitment by NHS England and NHS Improvement to support the design and implementation of devolution in Surrey Heartlands. 2017/18 will be a “shadow year” in which the devolution model for 2018/19 and beyond will be further scoped and defined.
Statutory responsibilities will not change – this agreement signals a commitment by parties to work more collaboratively under the existing legal and regulatory frameworks.
NHS England will continue to discharge its direct commissioning functions. Statutory responsibilities will not change – this agreement signals a commitment by parties to work more collaboratively under the existing legal and regulatory frameworks.
Matthew Tait, Joint Accountable Officer of the Surrey Heartlands CCGs, will take up the role of NHS England Director of Commissioning for Surrey Heartlands and provide oversight of direct commissioning.
2017/18 will be a “shadow year” in which the devolution model for 2018/19 and beyond will be further scoped and defined. The scope being explored includes (but is not restricted to):
- Primary care, including GP services, dental, pharmacy and optometry;
- Specialised services;
- Public Health services (additional to the functions which Local Parties already have responsibility for);
Any future request for delegation or devolution of any direct commissioning functions would be subject to further discussion, development and agreement with NHS England, in accordance with NHS England’s maturity assessment process. Ultimate decision-making would rest with the NHS England Board.
 This refers to those specialised services that can be commissioned appropriately and effectively at Surrey Heartlands level
 This covers those public health services for which the local authorities are responsible, subject to the statutory ring-fence by NHS England on behalf of DH.
At the core of our STP is a set of proposals to eliminate variation by delivering consistent clinical and professional standards. Devolution is an essential component to unlocking far broader changes, accelerating integration and more effective collaboration in Surrey Heartlands.
Across Surrey Heartlands we have a strong history of working in partnership, both in collaborative commissioning arrangements and service delivery. Since their inception, the Clinical Commissioning Groups (CCGs) in this area have worked across Surrey and with Surrey County Council to commission all children and young people’s and learning disabilities services, as well as some elements of mental health. The development of the Surrey Better Care Fund plans and ongoing drive towards integration have helped to ensure relationships between partners are strong, with a shared vision for the future of health and care services.
No direct commissioning functions will be devolved in 2017/18. 2017/18 will be a “shadow year” in which the devolution model for 2018/19 and beyond will be further scoped and defined. Any future request for delegation or devolution of any direct commissioning functions would be subject to further discussion, development and agreement with NHS England, in accordance with NHS England’s maturity assessment process. Ultimate decision-making would rest with the NHS England Board.
The Surrey Heartlands agreement is different to the Greater Manchester agreement, reflecting the different size and complexity of the health economy. The Surrey Heartlands agreement signals the beginning of a longer journey with an intention to:
- Accelerate the integration of health and social care through much closer working between partners
- Increase public engagement and the involvement of the people of Surrey Heartlands and system leaders around the transformation of health and social care
- Increase local decision-making and flexibilities to achieve the best possible outcomes for the local population
A clear roadmap and supporting delivery plan will be developed and agreed with all parties in 17/18. The roadmap to devolution will include stepped increases in responsibilities and powers, underpinned by a clear set of financial and performance milestones and trigger points, robust risk and benefit share arrangements and aligned development of Surrey Heartlands governance arrangements. It will specifically enable regular reviews of progress against the key milestones drawn from the agreed aims and achievements.
The devolution footprint is aligned with our Partnership footprint. Our Partnership was developed to describe a wide range of health benefits and improved outcomes that will be realised for the population through the transformation of health and care services. At the core of the strategy is a set of proposals to eliminate variation by delivering consistent clinical and professional standards. Devolution is an essential component to unlocking far broader changes, accelerating integration and more effective collaboration.
The overarching ambition is for Surrey Heartlands to be a prosperous and healthy place with a high quality health and care system for the population that is sustainable for the long term. The agreement signals the beginning of a longer journey with the intention to:
- Accelerate the integration of health and social care through much closer working between partners;
- Increase public engagement and the involvement of the people of Surrey Heartlands and system leaders around the transformation of health and social care; and
- Increase local decision-making and flexibilities to achieve the best possible outcomes for the local population.
We anticipate the following benefits will be delivered through devolution:
- Improved health and social care outcomes;
- Greater integration of services and functions that will help to improve quality and reduce health inequalities;
- Increased freedoms and flexibility to achieve maximum public value;
- Increased public engagement in decision-making;
- Greater ability to develop standardised best practice in health and social care through commissioning and provision, in order to secure improved outcomes, efficiencies and effectiveness; and
- Greater ability to develop a sustainable financial balance.
Devolution will be a key enabler of transformation and closer integration of health and social care services in Surrey Heartlands. It will help to facilitate the delivery of the ambitions set out in our Sustainability and Transformation Plan.
Yes. Devolution will help to unlock far broader changes, accelerating integration and more effective collaboration in Surrey Heartlands. At the heart of our STP is the commitment to a place-based approach to joining up health and social care, including the development of new models of care aligned to the vision set out in the NHS’s Five Year Forward View. Through devolution, Surrey Heartlands’ ambition is to:
- Improve health and social care outcomes;
- Drive integration of services and functions that improve quality and reduce health inequalities;
- Standardise best practice in health and social care through commissioning and provision, in order to secure improved outcomes, efficiencies and effectiveness.
The agreement describes the aspiration for Surrey Heartlands to achieve transformation of health and social care at pace and scale. Local Parties, NHS England and NHS Improvement will continue to work together during the shadow year in 2017/18 to agree the preferred mechanisms, timescales and resources to achieve the aims and objectives described in the agreement.
A clear roadmap and supporting delivery plan will be developed and agreed with all Parties with the objective of achieving fuller devolution from April 2018. The roadmap to Devolution will include stepped increases in responsibilities and powers, underpinned by a clear set of financial and performance milestones and trigger points, robust risk and benefit share arrangements and aligned development of Surrey Heartlands governance arrangements. It will specifically enable regular reviews of progress against the key milestones drawn from the agreed aims and achievements, including relevant key milestones which occurred before the signing of this agreement. Further details on the roadmap are set out within the agreement.
New governance arrangements will be established this year to enable more collaborative working between partners. A Joint Committee (made up of representatives from the three CCGs and the County Council and with the interests of NHS England represented) will be established, with delegated authority from Surrey County Council and the three CCGs to make decisions within the authority provided; and an Executive Leadership Group will be established within the County Council, chaired by the County Council’s Chief Executive.
Clinical/professional leadership will be at the heart of these governance arrangements and a principle of subsidiarity will be rigorously applied, with commissioning and decision-making taking place at the lowest appropriate level.
During 2017/18 (the “Shadow Year”) Surrey Heartlands (through the Devolution Vehicle) will be able to access a ‘fair share’ of relevant transformation funds, held by NHS England and have freedoms to allocate the funds to achieve the best outcomes for the population, taking into account national priorities and fulfilling any agreed conditions attached to the funds.
Partners will work together in the shadow year to agree an approach to potential “fuller” devolution in Surrey Heartlands in the future. This will need to be explored and discussed with relevant bodies including the Department of Health.
The Surrey Heartlands Transformation Board will continue to be the executive partnership board with accountability for the delivery of the Surrey Heartlands Sustainability and Transformation Plan and be the primary forum for collaborative systems leadership across health and social care commissioners and providers.
The devolution governance model introduced in 2017/18 will work alongside the Transformation Board and will include a Joint Committee (made up of representatives from the three CCGs and the County Council and with the interests of NHS England represented), with delegated authority from sovereign organisations to make decisions within the authority provided; and an Executive Leadership Group within the County Council to be chaired by the County Council’s Chief Executive, David McNulty.
Matthew Tait the new Joint Accountable Officer for the Surrey Heartlands CCGs will also take up the role of NHS England Director of Commissioning for Surrey Heartlands. NHS England will also be recruiting a joint NHS England/NHS Improvement Director of Delivery, Assurance and Oversight.
This agreement is between Surrey Heartlands (Surrey County Council and the three CCGs), NHS England and NHS Improvement. It focuses on the elements of devolution relating to these organisations and their relationship with the provider community in Surrey Heartlands.
Whilst local providers have been engaged in the development of the devolution proposals through a number of workshops and discussions held locally, the focus of the agreement has been on commissioning and system oversight responsibilities. A second Memorandum of Understanding is being developed locally across the eleven partners (commissioners and providers) that form the Surrey Heartlands Sustainability and Transformation Partnership – this will set out how partners will work together to lead the health and social care system.
NHS England and NHS Improvement will include Surrey Heartlands in its Accountable Care System* development programme and the support they intend to provide to systems which are a member of this network.
In this agreement Surrey Heartlands has committed to collaborate with other shadow Accountable Care Systems to identify how delivery of these service improvement priorities can be accelerated, to solve problems jointly and to build population health management capabilities – including through new care models – in a way that other NHS systems can learn from.
* Accountable Care System (ACS) is an ‘evolved’ version of an STP that is working as a locally integrated health system. They are systems in which NHS organisations (both commissioners and providers), often in partnership with local authorities, choose to take on clear collective responsibility for resources and population health. They provide joined up, better coordinated care. In return they get far more control and freedom over the total operations of the health system in their area; and work closely with local government and other partners to keep people healthier for longer, and out of hospital.
The Government announced the first devolution deal with Greater Manchester in November 2014. It subsequently invited areas interested in a devolution deal to make a bid by September 2015. Greater Manchester’s ambition for health in its proposals prompted the inclusion of health and social care in many devolution bids.
Of the 38 devolution bids submitted to HMT and DCLG in September 2015, there are now approximately 19 that include health within scope to varying degrees. The number of those which contain health within scope is an evolving picture, with deals being revised, and proposals being refined throughout the process.
Following Greater Manchester (which is currently in implementation stage), eight other areas now also have ‘devolution deals’ agreed with Central Government (with health in scope to varying degrees):
- Cornwall (Local integration of health and social care)
- West Midlands Combined Authority (Mental Health Commission)
- Liverpool (Health and Employment)
- Sheffield (Health and Employment)
- Greater Lincolnshire (integration of health and social care)
- East Anglia (integration of health and social care)
- West of England (health and employment – National work and health programme)
- London (Collaboration agreement to explore devolution and integration options for London at borough, sub-region, and pan-London levels)