• Over 70 per cent of the country are covered by some form of scale GP group
  • Just one in ten 10 CCGs in England do not have any “at scale” GP organisations in their area
  • HSJ analysis reveals majority of large scale GP groups do not cover NHS England’s preferred population size of 30,000-50,000
  • One GP federation in East of England covers a patient population of 1 million

HSJ has collected data on the form, size and spread of large scale GP groups for 207 clinical commissioning groups across England.

Our analysis shows 328 scale GP groups in England, compared to 268 HSJ’s analysis identified last January. However, data shows variation in the types of group being set up. GP federations are still the most popular model, covering 60 per cent of the population of England.

This article explores the:

  • variation in the size of the groups and population coverage;
  • organisations’ geographical spread; and
  • variation in form of scale GP groups.

The chart below shows the different types of large scale GP group across England and their total population coverage.

Our analysis shows that loose partnerships, calling themselves networks, alliances and collaborations, are the second most popular form of large scale working in general practice. 

It is based on information provided by 207 of the total 209 clinical commissioning groups about the groups and large GP providers working in their area. We have excluded groups spread widely across many CCG areas, such as Hurley Group and the Practice Group from this analysis.

The second chart shows the variation in size of the groups, broken down by population coverage.

There is significant variation in the size of groups.

The biggest group in the country is Iceni Healthcare, a GP federation which covers 1 million patients across Norfolk, Great Yarmouth and Wavney. Last year, Alexin Healthcare, now second biggest, was the largest group.

The smallest group is South Essex Managed Care, which has just 7,000 patients across two practices.

The five biggest large scale GP groups in England

CCG areasGroup nameTypeNumber of practicesPopulation coverage

North Norfolk, South Norfolk, Norwich, West Norfolk, Great Yarmouth and Waveney

Iceni Healthcare




East Staffordshire, South East Staffordshire and Seisdon and Peninsular, Southern Derbyshire

Alexin Healthcare





Primary Care Sheffield




Ipswich and East Suffolk, West Suffolk

Suffolk GP Federation





Somerset Primary Healthcare




Of the 207 CCGs that responded to HSJ’s freedom of information request, 27 said they did not have a large scale GP group in their area, this is down from 37 last year.

Newbury, North West Reading, and Wokingham are three of the CCGs without any scale GP groups. A spokeswoman said there were several scale models currently being developed in the region, such as a group of practices in Newbury collaborating on specific issues such as workforce or the sharing of back-office.

She added: “We have also seen a number of practice mergers in the last two years leading to the creation of larger practices. This move towards at scale working reflects the direction of travel set out in our [General Practice Forward View] implementation plan, which recognises that scale is key to achieving a sustainable primary care sector which will in turn be a key component of our accountable care system.”

When HSJ carried out its analysis last year, Bedfordshire CCG had a large GP federation called Horizon Healthcare that went liquidation due to financial issues. There are now no large scale GP groups in the area.

Clare Steward, director of transformation at the CCG, said: “With funding from the GP Forward View, our aim is to put the GP at the centre of patient care and wrap multidisciplinary teams around them. Much of this will be delivered through integrated health hubs, working with primary care at scale, with local authorities and our wider system partners.”

Several CCGs told HSJ they had informal collaborations in place or were in the process of developing formal “at scale” models.



Half of large scale GP groups exceed NHS England's 'magic' size