Surrey Heartlands Commissioning Intentions 2026/27

Introduction

Our commissioning approach for 2026/27 is guided by three central principles:

  1. A decisive shift towards prevention, neighbourhood-based delivery and community-led care models, that reduce variation in inequalities of peoples’ experiences and access to health and care services.
  2. Continuous improvement of existing services to deliver better outcomes and value that matter to the population of Surrey.
  3. A clear financial framework that prioritises sustainability, productivity, and investment in transformation over hospital growth.

As we continue to work in a cluster arrangement with NHS Sussex ahead of merger from April 2026, whilst commissioning intentions have been set out separately to date, we will start to align these as part of our medium to longer-term planning.  Both NHS Surrey Heartlands and NHS Sussex’s commissioning intentions reflect the key ambitions set out in the 10-year health plan.

Setting out our commissioning intentions

Our commissioning intentions are set out in three sections:

Engagement

Earlier this year we undertook a comprehensive engagement programme with local people to understand people’s views and aspirations relating to the three ‘left-shifts’ as set out in the new 10-year Health Plan, namely:

  • Treatment to prevention
  • Hospital to community
  • Analogue to digital

What we heard is reflected in our over-arching commissioning intentions for next year, with the full report available on our website. Over the coming year, we expect to engage further with people and communities as we work to deliver these intentions and transform local health and care services.

Listening to Surrey's Voice on the 10-Year Plan

Published at:

1. Fundamental System Transformation

2026/27 marks a pivotal point in starting to reshape the quality of services to meet the needs of our population.  We intend to drive transformation across several core opportunities:

Neighbourhood Health

  • We will progress the development of modern, high-standard neighbourhood health centres across Surrey, offering a clear, replicable service model including urgent primary care, diagnostics, community nursing, frailty services, women’s and children’s health, and mental health support.
  • This will require enabling contract structures, co-location, and innovative commercial models, that will be developed with our partners and local communities over next year and beyond.

Rehabilitation and Specialist Therapies

  • We will explore a county-wide rehabilitation model, expanding community rehabilitation, stroke, MSK (musculoskeletal) and ESD (early supported discharge) services. This will reduce hospital length of stay and improve patient outcomes.

Real Prevention

  • We will move towards a single, contracted Surrey Prevention Service, focused on childhood immunisations, vaccination, cancer screening, CVD detection and treatment, and health checks – with outcome-based incentives, that will reduce variation in inequalities.

Urgent & Emergency Care

  • Building on Connected Care and integrated discharge models, we will consider new urgent care pathways, including navigation hubs, virtual wards, and the development of mental health emergency units co-located at major A&E sites to ensure peoples’ safety is paramount.

Elective and Diagnostics in the Community

  • We will explore a high street elective model, looking to shift specialities such as dermatology, audiology, ophthalmology and some diagnostics into community settings. This will include new contract structures at population scale that will improve access.

Dental Centres of Excellence

  • To address longstanding access issues, we will explore development of large-scale dental centres of excellence in high population areas across Surrey.

Digital Transformation

  • A fully standardised digital care record, population health platform, and expanded use of predictive analytics, virtual wards, and navigation hubs will underpin these models.
  • We will undertake a strategic review of virtual care products and source solutions that seamlessly integrate into our foundation clinical record systems and the Surrey Care Record.
  • It is our expectation that electronic prescribing must be rolled out across all Surrey Heartlands Trusts, improving efficiency and productivity across primary and secondary care.

2. Continuous Service Improvement

Alongside fundamental transformation, we will continue to build on the 2025/26 priorities, ensuring incremental improvement in the quality of our services is delivered. This includes the following areas:

Primary and Urgent Care

  • Expansion of patient navigation hubs and single points of access to bring scale to primary care triage and assist in ambulance redirection.
  • Improved call-handling and digital navigation to help manage demand and patient safety across primary and secondary care.

Elective and Planned Services

  • Completion of service reviews where work is underway in certain specialties - MSK, audiology, ophthalmology.
  • Refinement and expansion of the elective network model trialled in 2025/26. This will see an expanded focus on Independent Sector providers working with NHS Trusts to reduce waiting lists and treat long waiters.
  • There is a strong expectation for NHS Trusts to develop clear cohorts of patients that can transfer in a phased and organised way to the Independent Sector and to significantly improve their capabilities in the prompt operational transfer of patients.
  • Similarly, the Independent Sector will be expected to use a greater proportion of their contracted capacity to support reductions in NHS waiting lists and to prioritise treatment of those waiting the longest to prevent deterioration.

Mental Health, Learning Disabilities and Neurodevelopment

  • Building on our investment in mental health inpatient capacity we will work to develop the second phase of community crisis pathway improvement and intensive support.
  • Continuing work to implement new models and improve capacity to reduce waiting lists in children’s neurodiversity and eating disorder services.
  • Expand on our partnership models with Surrey & Borders Partnership NHS Foundation Trust and market partners to improve capacity and significantly reduce the costs of adult ADHD services, while standardising quality and commercial arrangements across the market.
  • Undertake review and future development work for Mindworks and children’s mental health services.
    Continue to strengthen significant review and process redesign work for Section 117 (free aftercare post discharge for patients detained under the Mental Health & Care Act) and complex case Learning Disability packages of support.

Women and Children’s Health

  • Development of community children’s services through the continued mobilisation our new children’s services contract.
  • Expansion of our pelvic health model across the Surrey Heartlands geography.
  • Development of intentions for maternity pathways and strengthening of a group model for maternity.
  • Commissioning of services for paediatric asthma.

Prevention and Population Health

  • Prioritising implementation of preventative models for CVD (cardiovascular disease) detection and treatment to target, health check delivery and diabetic support.
  • Exit of legacy services where value for money and impact has not been sufficient, incorporating this resource into our new Surrey Preventative Services contract.

This ongoing improvement work will ensure continuity of progress while enabling us to prepare for and embed system-level transformation.

3. Financial and Planning Principles

Now that allocations and planning assumptions for 2026/27 have been published by NHS England, we know that the next financial year will be increasingly challenging, particularly in light of proposed changes to the national financial architecture.

Historically, our system’s financial position has been managed on an annual basis, with support from non-recurrent and national deficit support funding (DSF).  In 2025/26 Surrey Heartlands received £26m of DSF. The phasing out of this funding will further increase the need for collective system-wide action to restore financial sustainability.

In addition, Surrey Heartlands currently receives approximately £100m above the national target allocation formula. NHS England is reviewing funding methodologies to rebalance allocations across over- and under-funded systems and this will represent a further challenge.

As well as reductions in funding as a result of both the withdrawal of DSF and the national rebalancing of allocations, our financial and planning framework for 2026/27 will prioritise resources towards the 10 Year Health Plan commitments including transformation, prevention and community shift. This shift in resourcing should alleviate pressure on secondary acutes (for example, by reducing the number of emergency admissions) and support overall cost reduction, as well as improving patient experience. 

To enable delivery of these priorities, all ICBs are expected to create an investment reserve; the quantum of the reserve and period of time over which any reserve is to be created is pending confirmation from NHS England.  

In terms of contracts and payment models, we will increasingly use outcome-based contracts, population health approaches, and risk/gain-share mechanisms to incentivise prevention and demand reduction. These models will be defined and embedded with providers in 2026/27.

Given the financial outlook for 2026/27, the imperative to reduce the overall cost base, minimise unwarranted variation and drive productivity improvements is evident, and should remain a core part of our planning. 

Delivery of an affordable financial plan, within allocations, should ensure national productivity targets are met, or exceeded, and are underpinned by ambitious and credible delivery plans.  All providers will be funded in accordance with national cost inflation assumptions less the mandated national efficiency requirement. We will work with partners to ensure alignment with financial and activity assumptions that support the delivery intentions detailed here.