Changes to local services

We’re committed to creating better health and sustainable healthcare for the people of Bristol, North Somerset and South Gloucestershire by regularly reviewing, and, where necessary, improving local health services.

To do this we’re listening to our colleagues in the health system, our partners, patients and the wider public. 

When changes to health services are planned, you can read more about them here. 

Good Practice Guidance

There are times when the scale of improvement that can be achieved and the benefits that can be delivered, warrant a major service change.  It is for these large scale changes that the NHS England Good Practice Guide has been produced.

It takes into account national guidance published by NHS England on “Planning and Delivering Service Changes for Patients” and also on the role of Clinical Senates in providing clinical advice to inform NHS England’s service change assurance process.

Putting the needs of patients first

In line with national guidance from NHS England and our PPI strategy, we will put the needs of patients and the public first when developing proposals for major service change. 

Change will be clinically-led and underpinned by a clear evidence base. We will involve the local clinical community and health and social care partners, ensuring that we take advantage of the opportunities for integrating services. 

We believe that involving patients and the wider public is essential for the design of high quality services.

People with specific health needs, or people who care for them, are experts in that area, and we are committed to using their expertise in shaping the health services they use. 

This does not mean that our service change proposals will always prove to be uncontroversial. Rather it means that decisions will be reached through open and transparent discussions, where people are able to influence decisions and see how their feedback has been acted upon.

Involving people in our work will also help address health inequalities, aiming to ensure that services are available and accessible to all sections of our diverse community.

If we genuinely succeed in reaching all groups, we will have better opportunities to understand and respond to their needs. 

Our principles for service change

We aim to follow the following principles when planning and developing proposals for significant service changes.


Proposals we develop for changes to services will:

  • be based on available evidence about how best to meet local health needs and deliver good quality services within available resources
  • be informed by the health needs specified in the Joint Strategic Needs Assessment and the priorities agreed in the Joint Health and Wellbeing Strategy
  • take into account patient feedback we receive.

For all major service change proposals, we will conduct and make available publicly an assessment of the evidence when measured against the Government’s four tests for reconfiguration.


The views of patients and their carers, members of the public and key stakeholders, including South Gloucestershire Council, will be proactively sought and used in developing service change proposals.

Leadership and Clinical Involvement

The development of service change proposals will be led by our clinical leads, and will be formally agreed by our clinical leadership team at Commissioning Executive meetings.

  • clinicians in member practices and provider organisations will be given opportunities to contribute to the development of significant service change proposals.
  • Our Clinical Operational Executive will consider whether or not external clinical advice, which could include a peer review or an independent evaluation of clinical best practice, is required for the development of service change proposals.

Major service changes

There may be times in the future when we need to consider major service changes.

Such decisions require additional checks, as well as continuous engagement and communication, to which we are committed. The formal assurance processes and best practice guidance for major service change are complex, even for people who work in the NHS.

This diagram contains a flow chart which provides a guide for how we would approach the development of proposals for major service change.

Our approach to service change diagram

This diagram shows the process for involving patients and public in shaping health services.

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