The Big Picture - Background and Governance


This page describes our programme of work for The Big Picture and sets out our key milestones.

Early engagement

In autumn 2018 we launched our Case for Change which describes why we think change is needed, and invited local people to have their say. You can read more about our engagement activity. Overall we were able to talk to over 500 people during this time. Our case for change documentation was also widely distributed across North West Surrey and surrounding areas including GP practices, local libraries, borough councils and local community groups.

For more information on how we have engaged with key stakeholders in our area, please visit The Big Picture Engagement page of this website.

Option development

We are now considering future options for how we might configure urgent care services, in particular the designation of Urgent Treatment Centres. This work is ongoing and includes engagement with our Stakeholder Reference Group, collating of supporting data to help inform our discussions and engagement with local clinicians particularly through our Clinical Working Group.

Any options for change will be developed in partnership with our Stakeholder Reference Group and our Clinical Working Group.

Potential for public consultation

If the option/s for change mean substantial change to any services that are currently provided, we would of course move to a 12 week public consultation.

At this stage no options have been agreed and no decisions have been made.

Any final decisions would only be made following a full public consultation, if required.



Who is involved?

The local health and care organisations, including local authorities, are working together in a new partnership, the North West Surrey Integrated Care Partnership. This is helping us to think more creatively about how we can improve and join up services across health and social care.

Our partnership includes:

  • Ashford and St Peter’s Hospitals NHS Foundation Trust
  • CSH Surrey – community healthcare providers
  • Surrey and Borders Partnership NHS Foundation Trust – mental health providers
  • South East Coast Ambulance NHS Foundation Trust – ambulance services
  • Local GPs and our GP federation (North West Surrey Integrated Care Services Ltd)
  • Surrey Heartlands Clinical Commissioning Group – responsible for planning and buying your local healthcare
  • Surrey County Council – responsible for public health and adult social care
  • Local councils – Elmbridge, Runnymede, Spelthorne and Woking

How are decisions made?

There are several key groups that make up the governance of the programme:

  • Surrey Heartlands CCG Governing Body - final decision making body
  • Surrey Heartlands CCG Clinical Executive - decision making body, making recommendations to the Governing Body
  • The Big Picture Core Team - executive oversight of the programme
  • North West Surrey Integrated Care Partnership Programme Board - also considers all key recommendations
  • The Big Picture Stakeholder Reference Group - patients, public and stakeholder scrutiny/critical friend
  • The Big Picture Clinical Working Group - developing clinical proposals
  • NHS England - a staged assurance process, makes recommendations and decision making
  • NHS England Clinical Senate - undertakes reviews and makes recommendations on the safety and sustainability of the clinical proposals


We also regularly engage with Surrey County Council’s Health Integration and Commissioning Select Committee and the Surrey Health and Wellbeing Board.

Meeting our Equality Duty

Championing equality and reducing health inequalities runs throughout everything we do. Like other NHS and public bodies, the Big Picture programme has several statutory equality duties. These are contained in:

  • the Human Rights Act 1998
  • the Equality Act 2010 and the related Public Sector Equality Duty
  • the Health and Social Care Act 2012


We are commissioning an independent organisation called Mott MacDonald to carry out an equality impact assessment for this programme of work. Essentially, this methodology examines the varying impacts of proposals on people with protected characteristics (as defined under the Equality Act 2010) and specific vulnerable groups e.g. carers, looked-after-children.






The Big Picture   The Big Picture Engagement


Review Date: 2020-08-04
Review Due: 2021-08-03
Model Publication Scheme Class: Class 6: How we make Decisions