Working at scale within general practice is not new. In recent years, many practices have adopted different models, including super-practices, GP federations, primary care networks (PCNs) or through integration with other NHS providers such as trusts. Although there are many different approaches to delivering primary care at scale, common aims include: efficiencies, new ways of working above the provision of core general practice to improve quality or integrate care, and collaboration with other practices and healthcare providers to improve patient care or share resources.

Policy development has similarly reflected, and driven, consideration of the benefits of collaboration and of working at scale. Publications such as the Hewitt Review and NHS England's delivery plan for recovering primary care access recognise the need to make better use of data and technology (often applied across larger footprints), to create integrated teams of general practice staff and other health professionals, and to develop support services for multiple practices.

The Fuller Stocktake of primary care and integrated care systems focuses on the collaboration and coordination of multidisciplinary teams at a neighbourhood level to tackle inequalities, build capability, and meet demand and support the health and wellbeing of communities through a population-based approach. It advocates improving personalised care services, enhancing preventative care through general practice, and focusing on workforce and data as key enablers of change.

The case studies in this briefing bring these ideas to life and demonstrate the ways in which larger scale primary care providers are, and can be, integral to NHS services working together in neighbourhoods, in place-based partnerships and in systems.

Bringing together the experiences and expertise of several 'at scale' primary care organisations, these case studies highlight how scale can benefit organisations and contribute to wider system aims.

These examples particularly demonstrate how support from 'at scale' organisations has improved access to care by freeing up clinical capacity, strengthening relationships between community and primary care teams, and using data to target those in most in need of support. The case studies also explore how to ensure best value from multidisciplinary teams and the successful introduction of population health approaches and social prescribing to tackle health inequalities and address the determinants of ill health, reducing pressures on other parts of the system.

We hope this publication proves helpful to colleagues across the health sector. We would like to thank all of our contributors.

About the At Scale Primary Care Networking Group

The At Scale Primary Care Networking Group brings together the leaders of an influential group of large-scale primary care providers to share information, resources and ideas to help advance the development of primary care.

The group includes thought leaders from several well-known large-scale practices covering significant patient populations across the country, all with an interest in and commitment to innovation which improves patient care.