Identifying at-scale general practice providers in England: a cross-sectional study of routine NHS data

Background At-scale working is increasingly prominent in English general practice, but no registry of at-scale general practice providers (AS-GPP) exists. In the NHS Ten Year Plan, Multi Neighbourhood Providers have been proposed to deliver integrated, preventive, community‑based care for populations over 250000. As existing at-scale organisations will influence the success of widening at scale working for general practice, patients and commissioners; it is important to understand their geographic location, current activity and contractual/governance structure. We aimed to describe these factors for existing AS-GPP in England. Method All organisations from the Care Quality Commission registered primary medical service providers (June 2025) and NHS Integrated Care Board (ICB) expenditure data reporting transactions over £25000 (April 2024–May 2025) were gathered. A structured review was conducted to define these as AS-GPP (or not), alongside gathering information on their location, associated general practices, primary care networks, ICB, organisational activity and structure. Each AS-GPP was linked to list-size weighted administrative and census data from the associated practices Lower layer Super Output Area (LSOA); specifically deprivation, population density and age profile. Descriptive statistics were used to analyse AS-GPP, map their distribution by ICB and examine organisational activity and structure. Results We identified 165 AS-GPP providing services to > 100000 patients. The median number of patients served by each was 307183 (IQR: 200000–449060), with some serving > 4 million patients. The number of AS-GPP per ICB ranged from 0 to 11, representing important geographic variation. 69% of English practices were linked to one or more AS‑GPP. These were in slightly more densely populated areas than the average GP practice in England. The type of activity provided varied substantially with majority (84%) providing out-of-hours services (including extended access). Other frequent activities included at-scale back-office support, enhanced services and core general practice. Majority (58%) of these are GP federations or alliances, where practices remain organisationally separate but collaborate to share resources and services. Conclusion There is important variation in the geographic location and activity of AS-GPP. This variation will shape the success of future at-scale health policies, such as multi-neighbourhood healthcare, and warrant accounting for in their implementation, commissioning and evaluation.