HSJ’s round up of the day’s must read stories and debate

A chicken and egg scenario

Is bigger better? Not according to Steve Field, the Care Quality Commission’s chief inspector of general practice.

The professor has claimed that while “scale” enables better communication, it does not dictate whether a practice provides good care.

The CQC’s State of General Practice report says inadequate practices tend to have an average list size of 5,000 and those rated outstanding an average of 10,000.

But despite the apparent correlation, Professor Field told HSJ that scale, or rather size, is not the key factor when it comes to outstanding rated practices.

Rather it is the practice’s leadership and whether they communicate well with other GPs and other parts of the system.

Essentially, he argues that increasing scale may help where GP leaders are not good at communication, but scaling up does not automatically mean practices will perform better.

There is also the question of what we mean by scale. Some would argue that having a list of 10,000 is not necessarily working “at scale”.

NHS England has certainly indicated the ideal is GP hubs working across populations of 30,000-50,000.

Professor Field’s comments add an interesting dimension to the debate of whether bigger is better in GP land.

There are clear benefits to working at scale and the rapid spread of models such as primary care home indicates that bigger can be beneficial; but does it necessarily improve care?

We seem to be in a bit of a chicken and egg situation – do better performing GPs tend to scale up or does scaling up make them better GPs?


Primecare, the company operating one of the first integrated NHS 111 and GP out of hours services, is to hand back the contract to the NHS early.

The provider was placed in special measures last month after its services in East Kent were rated inadequate by the CQC – only seven months after it started full operations. Failings included not having enough staff to meet patient needs and not assessing risks to patients’ health.

A meeting of Kent County Council’s health overview and scrutiny committee was told the company planned to return the contract mid term. The contract was for three years, with an option to extend for another two.

Simon Perks, chief accountable officer for Ashford and Canterbury and Coastal CCGs, told the councillors: “The contractor has given us notice and will be leaving the contract on 7 July next year.”

Getting the contract up and running was not without problems.

CCG board papers in early 2016 showed risks associated with the contract were “red” rated. However, a spokesman for the CCGs last May insisted they were “confident” the new service would be fully operation by late October 2016 and the CCGs had “a full and comprehensive understanding of the work required to establish the new service”.

Full mobilisation of the service was delayed from September last year to early January, with South East Coast Ambulance Service asked to continue providing 111 cover at just 12 days’ notice to enable a phased handover to the new provider.