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Insights & News
The Phone Call Nobody Wants
The Phone Call Nobody Wants
CQC Practice Healthcheck At 9:17 on a perfectly ordinary Tuesday morning, the phone rings. The conversation is polite, professional and entirely expected. Yet somehow the effect is remarkably similar to…
Bid Readiness. Can You Tell Your Story Well Enough to Win?
Bid Readiness. Can You Tell Your Story Well Enough to Win?
Many organisations working in neighbourhood health and public sector delivery are doing genuinely good work. The problem is that doing good work and being able to present that work compellingly to…
Neighbourhood Stakeholders. From Mapping to Meaning
Neighbourhood Stakeholders. From Mapping to Meaning
Stakeholder mapping alone changes nothing. Excellence means translating population diversity into explicit service requirements, holding all providers accountable, and allocating resources where they actually work. You have done brilliant stakeholder mapping. You understand…
MDT Neighbourhood Delivery: Children and Young People (CYP) Care Coordinators model
MDT Neighbourhood Delivery: Children and Young People (CYP) Care Coordinators model
The NHS Neighbourhood framework provides some clear direction on targeting population cohorts. Knowing where to start can be the first hurdle. At Scale have been working with Children…
CQC readiness is neighbourhood readiness (and general practice is at the heart of it)
CQC readiness is neighbourhood readiness (and general practice is at the heart of it)
Over the last few years, and there have been many, I’ve spent a lot of time alongside GP practices and PCNs getting ‘CQC-ready’. And increasingly, I’ve noticed something: the teams…
Don’t Wait for Perfect Guidance, Positioning Yourself Now
Don’t Wait for Perfect Guidance, Positioning Yourself Now
The new Neighbourhood Health Framework doesn’t rewrite the future for general practice, but it certainly sharpens it.
Advanced Foundation Trusts: Why NHS System Leaders Should Start Thinking About Them Now
Advanced Foundation Trusts: Why NHS System Leaders Should Start Thinking About Them Now
At Scale works across a wide range of organisations involved in health and wellbeing, including NHS providers, primary care networks, GP federations, local authorities and voluntary sector organisations. That cross-sector…
Why We Are Called At Scale?
Why We Are Called At Scale?
Alice Benton People sometimes ask why we are called At Scale. The short answer is that we spotted the NHS Long Term Plan (2019) used the phrase a lot, but…
Public sector providers do not lose bids because they are “bad providers”.
Public sector providers do not lose bids because they are “bad providers”.
Mike Gill Running services and resourcing bids and business case development can be viewed as incompatible. But without the right framework, resources and credibility services risk being left behind as…
Neighbourhood Health: Don’t Wait for the Contract
Neighbourhood Health: Don’t Wait for the Contract
Alice Benton First, Penny Dash has spoken openly about NHS England’s concern over the rigour of management behind neighbourhood working. That resonated. Across the country there are committed teams doing impressive things…
Why Did You Call A Book “How to Survive Austerity”?
Why Did You Call A Book “How to Survive Austerity”?
Mike Gill In 2016 I wrote a book called How to Survive Austerity. What briefly outsold political memoirs in 2016 now reads like a manual for 2025. This series updates…
OPIC: What the Office of Pan-ICB Commissioning Means for You
OPIC: What the Office of Pan-ICB Commissioning Means for You
If you work in primary care, place-based partnerships, or local authority health integration, you may have spotted a new acronym emerging from NHS planning documents: OPIC, or the Office of…
The Magic Consultants: Why the NHS Deserves Better
The Magic Consultants: Why the NHS Deserves Better
Mike Gill BBC Radio 4's recent series Magic Consultants didn't pull its punches. Management consultants were portrayed as overpriced illusionists, revealing savings that were "always there" while obscuring their methods…
Unlocking Opportunity in a Changing Health and Wellbeing Market
Unlocking Opportunity in a Changing Health and Wellbeing Market
The private sector has partnered with our health and government sector for many years, innovation in technology, estates functions and state of the art asset and equipment through to GP…
Beyond the Vacancy Crisis: Neighbourhoods Need to Share People, Not Protect Silos
Beyond the Vacancy Crisis: Neighbourhoods Need to Share People, Not Protect Silos
The NHS and social care workforce crisis is often described as a vacancy problem. But at neighbourhood level, it’s something more fundamental: the loss of experience, relationships and judgement as people quietly leave, while…
Right First Time: The Greatest Hits Remix of Management Theory
Right First Time: The Greatest Hits Remix of Management Theory
After yet another stint with Radio 4, I found myself grumbling about GIRFT and marvelling at the genius of those who repackage 1970s quality control as ground-breaking in the public…
It’s Not the End of the World (But It Feels Like It)
It’s Not the End of the World (But It Feels Like It)
Mike Gill is Director at At Scale Limited and author of “How to Survive Austerity: A Field Guide for Public Sector Managers” Every generation thinks they’re living through the apocalypse.…
Navigating the Guidance Gap: What current uncertainty means for neighbourhoods, PCNs, and local systems
Navigating the Guidance Gap: What current uncertainty means for neighbourhoods, PCNs, and local systems
Across England, systems working on neighbourhood models, population health and out-of-hospital redesign are experiencing a familiar frustration. National momentum has slowed, guidance has yet to land, and key contractual frameworks…
Leading Through The Fog: When Policy Lags Behind Reality
Leading Through The Fog: When Policy Lags Behind Reality
We're now in 2026, and NHS leaders responsible for network transformation still lack clear national direction on neighbourhood working. Pioneer sites were meant to be implementing integrated neighbourhood teams, yet…
How to Survive Austerity: A Field Guide for Public Sector Managers
How to Survive Austerity: A Field Guide for Public Sector Managers
"How to Survive Austerity" was Mike Gill's field guide for public sector managers who suddenly found the ground shifting under their feet. Written in the aftermath of the 2008 financial crisis,…
The four pain points of primary care
The four pain points of primary care
Let’s start with the good news. Despite everything you hear, primary care isn’t in decline. It is busy, yes, and stretched, certainly, but it is also full of ambition and creativity. Across…
Neighbourhood – Providing Value & Managing Demand
Neighbourhood – Providing Value & Managing Demand
Our 3rd Neighbourhood Webinar focused on Data sharing & digital infrastructure and Measuring and Demonstrating Neighbourhood Impact Alongside catching up on what we had covered in the last 2 months, any…
Primary Care Network (PCN) Social Prescribing
Primary Care Network (PCN) Social Prescribing
The evolving ambition for neighbourhood working seeks to bring services closer to home and within communities, foster collaboration, and promote wider health and wellbeing. These interventions support key health ambitions;…
Enhancing Patient Outcomes with Integrated Care Frameworks
Enhancing Patient Outcomes with Integrated Care Frameworks
In the evolving landscape of health and social care, the need for cohesive, patient-centred approaches has never been more pressing. We find ourselves at a pivotal moment where integrated care…
Transforming Organisations with Leadership Growth Methods
Transforming Organisations with Leadership Growth Methods
In today’s rapidly evolving public sector landscape, particularly within health and social care, the need for effective leadership has never been more critical. Organisations face complex challenges that demand not…
Achieving Success through Collaborative Project Management
Achieving Success through Collaborative Project Management
In today’s complex environment, especially within the UK public sector and health and social care, the ability to manage projects effectively is crucial. We often find that success hinges not…
Don’t Wait for Someone to Move Your Cheese
Don’t Wait for Someone to Move Your Cheese
In health, and primary care in particular, it’s easy to feel torn between FOMO — the fear of missing out — and JOMO — the joy of keeping things familiar…
Transforming Organisations with Leadership Growth Methods
Transforming Organisations with Leadership Growth Methods
In today’s fast-evolving public sector landscape, particularly within health and social care, the need for effective leadership has never been more critical. Organisations face complex challenges that demand not only…
