The term ‘working at scale’ is described in NHS England’s General Practice Forward View report which was published in April 2016. Nationally and locally we have seen that many GP practices are now working at scale in practice groups or federations. This report highlights the key benefits that working at scale can provide to patients, GP practices, and the health care system as a whole:
- Economies of scale
- Quality improvement
- Workforce development
- Enhanced care and new services
- System partnerships
- Effective succession planning
- GP career development
The CCG is keen to support collaborative working across practices to ensure that “all emerging groups are able to benefit from opportunities to expand services, stabilise practice income, and realise the benefits that working at scale offers.” (NHS England, GP Five Year Forward View).
Investment in primary care at scale is essential to building a platform for longer term transformation, as well as being able to support the wider ambitions of the Sustainability and Transformation Partnership and future ‘neighbourhood’ commissioning intentions.
The CCG has been working in partnership with At Scale Limited to develop the Primary Care at Scale Programme. This programme has been commissioned using the CCG’s GPFV Transformation Budget for 2018/19.
At Scale is a company that supports the transformation of primary care with a focus on building resilience and sustainability. They have developed a readiness assessment and assurance framework which supports practices in their journey of at scale working. This framework contains a suite of tools which guide practices through development and mobilisation.
This programme will help practices to:
- develop robust inter-practice at scale working proposals
- develop formal business arrangements such as practice mergers
- develop CCG-wide framework of evidence requirements, activity, and due diligence
- deal with commercial issues.
This programme is open to all GP practices seeking to work at scale. This could include practices seeking:
- a formal merger
- shared service arrangements
- collaborative working in hubs or GP networks.
Regardless of whether practices have just started having informal discussions with partners or are six months into a formal collaboration or merger, every practice group or ‘at scale entity’ will have the opportunity to engage with this programme.
The toolkit is system-independent and works with whatever form of collaboration you choose.
Our aim is to support practices who wish to enter into either collaborative or formal merger partnerships by providing them with the necessary tools, expertise, and some financial support for the process that will enable them to achieve success.
The CCG has a budget to fund and support five at scale entities. This support package will include:
- access to the At Scale Framework
- access to the At Scale team for facilitative support and guidance
- backfill funding to build in capacity within the at scale entities*
Please note: practices will be expected to support any internal changes to their business. This offer does not include funding for professional fees.
* The backfill funding arrangements have not yet been specified. This will be formalised following review of the expressions of interest.
1. Introduce Programme Offer – open to all practices
- Host a series of workshops in each locality to introduce the programme offer, share experiences from the Octagon pilot, and give practices the opportunity to ask questions.
Workshops held w/c 25 June 2018. Please see the workshop slide deck here.
2. At Scale Readiness+ Tool and Diagnostic – open to all practices
- A free online self-assessment tool to review your current at scale plans
- To be completed by individual practices and/or aggregate practices already in discussion
- This will generate a free PDF report on your state of readiness
- Following your assessment and report, the At Scale team will be available to discuss your results further
The At Scale Readiness+ Tool will be launched w/c 23 July 2018.
Practices will need to complete this by 24 August 2018.
The ASR Tool is available here online - please refer to our guidance document and FAQ.
Each practice had been issued with a single-use coupon to be sued during sign up, please contact the Primary Care Team to confirm your coupon details.
Please note: If your practice would like to be considered for the next phase of the programme then you will be required to complete this assessment tool along with representatives from each practice in your proposed entity.
3. Identify at scale entities – CCG and At Scale
- We will work with At Scale to review the results of the At Scale Readiness+ Tool and identify the proposed five at scale entities.
- We will follow up directly with all practices who have expressed an interest via the Readiness+ Tool to advise on outcomes.
The review process will take place w/c 27 August 2018.
4. At Scale Support and Delivery – programme only
- Face-to-face support to at scale entities to scope and shape their development, develop plans, understand required evidence and completion of At Scale framework
- For practices about to start their at scale journey: use of At Scale Accelerator which provides end-to-end support using a pre-populated framework of tasks, results and objective, an on-line suite of tools, programme management templates and a ready-to-use document management library as well as innovative reporting facilities
- For practices already on the undertaking at scale activity: use of the At Scale assurance tool which provides assurance of existing at scale activity, identifies gaps, and provides a RAG-rated assessment of the evidence available and an action plan highlighting required actions.
The At Scale facilitative support will be ongoing from September 2018 to March 2019.
The At Scale framework licence will be available to the at scale entities from September 2018 to September 2019.
5. Sharing Best Practice – open to all practices
- A series of events will be held to bring practices together to share at scale learning, identify best practice, and review future at scale opportunities.
February to March 2019.
If you would like to find out more about this programme please contact:
Please see the collation of FAQs that came up from our recent Primary Care at Scale workshops:
Primary Care at Scale workshop frequently asked questions
If you have any other questions that have not been addressed in the attached please contact the project team who will respond directly.
Octagon Medical Practice is a recent merged group of practices in Greater Peterborough. This merger was led by Alan Ball who, along with the wider team, can offer first-hand experience of working with At Scale Ltd.
"Having managed over 20 mergers and acquisitions as CEO in a number of large organisations, the process of merging and the presentation of a project plan was, in fairness, second nature. However, engaging with the At Scale model was a fresh approach which we collectively developed into a model that is fit for purpose in the Health sector and, provides clear and visible progress on any at scale working."
Managing Partner and CEO of Octagon Medical Practice
"The process of uploading documents and evidence was really easy to do. The At Scale team was supportive and assisted where needed but it’s really intuitive. What I found to be really helpful was that the system looks at the evidence and can cross reference it to other parts of the project - this cut down on repetition and unnecessary work. I also liked the fact that when documents are uploaded, you can see the project wheel turn green - this gives you immediate visibility of progress and attention."
Project Manager of Octagon Medical Practice
"As Partners, it’s fair to say that our experience with mergers and project management is limited. Alan presenting the At Scale model made our role as a Board easier in that we could easily understand and establish progress. The model made it simple for us to see assurance against the plan and allowed us as a Board to give confidence to the other Partners that we had a robust action plan in place."
Dr Kevin Stanton-King
Chairman and Partner of Octagon Medical Practice