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Insights & News
Contract Readiness. The Strongest Proposition May Not Be a Tender
Contract Readiness. The Strongest Proposition May Not Be a Tender
Most health and care organisations think about contract readiness in one way: will we be ready when the tender lands? That is important. Tender windows are short, questions are specific…
Creating Stronger Partnerships. Why reach beats rhetoric.
Creating Stronger Partnerships. Why reach beats rhetoric.
Partnership is the most over-used word in the NHS, and quite possibly the least delivered. Every strategy has it. Every board paper genuflects to it. Every reorganisation promises more of…
Technology Won’t Save You. But What If It Helps Someone Else Pull Ahead.
Technology Won’t Save You. But What If It Helps Someone Else Pull Ahead.
One of the things I find myself reflecting on when talking to practices, PCNs and federations is how often conversations about the future focus on structures rather than capability. We…
Neighbourhood Readiness. While You’re Waiting, Other Organisations Are Getting Ready.
Neighbourhood Readiness. While You’re Waiting, Other Organisations Are Getting Ready.
Neighbourhood Readiness One of the things I've learned over the years is that major changes in the NHS rarely arrive with a neat starting gun. There is no moment when…
Waiting Is a Strategy. Just Not Usually a Very Good One.
Waiting Is a Strategy. Just Not Usually a Very Good One.
Neighbourhood Readiness Over the past few months, I've found myself having variations of the same conversation with practices, PCNs and federations across the country. Waiting is a Strategy. Just not…
Running a neighbourhood is more like running a business than you might think
Running a neighbourhood is more like running a business than you might think
Put a well-run multi-service business alongside an NHS neighbourhood and they look like different species. One has customers, a chief executive, employees and a board. The other has patients and…
Bidding is the new business as usual
Bidding is the new business as usual
Once upon a time, a health provider could deliver good services, keep its head down and expect the contract to roll over. Those days have quietly left the building. Across…
CQC readiness: confidence beyond the inspection
CQC readiness: confidence beyond the inspection
Mention CQC and the reflex is much the same across the country: check the policies, tidy the shared drive and quietly trust that the practice manager knows where everything lives.…
Neighbourhood governance: the confidence commissioners are actually checking for.
Neighbourhood governance: the confidence commissioners are actually checking for.
Ask any neighbourhood partnership how they are doing and you will hear about good work. Committed teams, genuine collaboration, real progress on the ground. All true, and none of it…
Neighbourhood leadership: told to lead, left to it
Neighbourhood leadership: told to lead, left to it
There is no shortage of neighbourhood health policy. Frameworks, plans, ten-year visions and guidance on the guidance. What there is a shortage of is anyone to help you actually do…
A practical moment for general practice to shape neighbourhood contracting
A practical moment for general practice to shape neighbourhood contracting
After a couple of weeks to reflect on NHS England’s consultation, my thoughts have started to crystallise. The proposed Multi-Neighbourhood Provider and Single Neighbourhood Provider contracting models may sound technical,…
Our team will be speaking at Agilio Live 2026
Our team will be speaking at Agilio Live 2026
Building strong neighbourhood partnerships starts with having the right foundations in place. As neighbourhood models continue to evolve and new contractual frameworks take shape, primary care leaders are under increasing…
Great NHS Procurement Submissions Are Built, Not Written
Great NHS Procurement Submissions Are Built, Not Written
Over recent months, At Scale has supported several major NHS primary care and clinical service procurements. Each brought demanding requirements, complex mobilisation expectations and exceptionally tight timescales, reinforcing one simple…
CQC Ready on Paper — But Are Your Staff Ready Too?
CQC Ready on Paper — But Are Your Staff Ready Too?
Help your GP practice move beyond CQC evidence and assess staff confidence, governance understanding and inspection readiness with At Scale’s practical CQC Readiness Support. Take the 1st step by taking…
Nobody Wanted to Go to Abilene (So Why Is Your MDT Halfway There?)
Nobody Wanted to Go to Abilene (So Why Is Your MDT Halfway There?)
MDT's are in vogue, not because they are the next buzz word but because they are an enabler to fully integrated health and wider wellbeing.In 1974, management theorist Jerry Harvey…
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…
