What does it take for general practice to lead system transformation rather than simply respond to it?

In this episode, Ben Gowland is joined by Dr Sunaina Khanna and Dr Imran Zaman to discuss how they have built a unified leadership model that is helping shape neighbourhood health across one of England's largest Integrated Care Systems.

Starting with a collaborative response to winter pressures, they explain how GP leaders came together to create the GP Partnership Board, giving general practice a stronger voice in system decision-making while developing services at scale. They share the practical lessons they've learnt about building trust, securing buy-in from practices, working alongside community providers, and creating leadership that is focused on delivery rather than representation alone.

The conversation also explores how general practice can prepare for the future NHS landscape, why working at scale matters, and the importance of demonstrating value through action.

Whether you're a GP Partner, PCN Clinical Director, practice manager or system leader, this episode offers valuable insights into building collaboration, influencing change and strengthening the role of general practice within neighbourhood health.

Introduction (00:09)

How winter pressures sparked a new model of GP collaboration (01:26)

Using population health to redesign services at scale (03:20)

Building multidisciplinary teams around neighbourhood health (05:59)

Why Birmingham & Solihull created the GP Partnership Board (08:25)

Winning practice buy-in through delivery, not persuasion (11:39)

Balancing uncertainty with opportunity in the changing NHS (13:10)

Evolving towards a 24/7 general practice leadership model (16:22)

Making general practice easier for the system to work with (17:33)

Building stronger partnerships across community services (19:30)

Why every area needs a unified GP leadership voice (22:19)

Practical advice for creating collaboration at scale (25:30)

Learning by doing and proving what works (28:30)

Final reflections (29:36)

For all enquiries about the Ockham podcast, please contact Ben Gowland here.

The Carr-Hill formula sits at the heart of GP funding, yet few people fully understand how it works, or the impact it can have on individual practices. In this episode, Ben is joined by Dr Matt Jones, GP Partner in Cardiff, who has spent years investigating the formula after discovering significant funding differences between seemingly similar practices. Drawing on Freedom of Information requests, published papers, and detailed analysis, Matt explains why Carr-Hill remains such a controversial issue and why a long-awaited review could have major implications for general practice.

Together they explore how the formula's different indices interact, why some practices can lose out by hundreds of thousands of pounds each year, the role of deprivation and fixed costs, and how funding inequalities can affect workforce capacity, patient access, and sustainability. Matt also shares his thoughts on what meaningful reform could look like and why greater transparency is essential if practices are to understand the challenges they face.

Introduction (0:09)

How did you become interested in the Carr-Hill formula? (0:19)

What prompted your research and submissions to the Welsh inquiry? (1:05)

Why is understanding Carr-Hill so important ahead of the current review? (1:54)

Is the problem really about deprivation, or is it more complex than that? (2:45)

Which parts of the formula have the biggest impact on funding? (3:18)

Why are some of the formula's deprivation measures now outdated? (4:12)

How do the different Carr-Hill indices compound to create large funding gaps? (6:14)

Do practices actually know their Carr-Hill scores? (7:49)

How large can the funding differences between practices be? (8:43)

Why do funding inequalities become harder to fix over time? (10:17)

What happens if the formula is adjusted to better reflect current deprivation? (11:31)

Does Carr-Hill underestimate the fixed costs of running a GP practice? (12:42)

Why does the age and sex index potentially exaggerate funding differences? (13:24)

How do fixed costs reduce clinical capacity in lower-funded practices? (14:27)

What changes could make the funding model fairer? (15:50)

Should national pay uplifts be separated from the Carr-Hill formula? (16:59)

Why are funding inequalities continuing to grow? (17:57)

What does this mean for access targets and patient care? (19:18)

Could funding be based on workload instead? (20:24)

What would Matt like to see from the Carr-Hill review? (22:11)

Why transparency around funding matters for practices and patients (22:50)

Closing thoughts (24:11)

Read Matt Jones' paper here.

For all enquiries about the Ockham podcast, please contact Ben Gowland here.

The proposed Single Neighbourhood Provider Contract could significantly reshape how services are commissioned and delivered at neighbourhood level, but with many details still to be confirmed, PCNs are being faced with important decisions now.

In this episode, Ben Gowland is joined by Robert McCartney, Senior Associate at Hempsons, to discuss what we know so far about the SNP Contract, the growing focus on neighbourhood footprints, and how local PCN DES variations could provide opportunities for PCNs to begin implementing change without waiting for national guidance.

They explore the practical steps PCNs can take to strengthen their position, including leadership, governance, incorporation, and service redesign. Robert shares why proactive PCNs may be best placed to influence the future of neighbourhood working, maintain control of local services, and demonstrate their ability to lead change across their communities.

Introduction (0:08)

What are PCNs and practices asking for support with right now? (0:41)

Why are some PCNs preparing for the future while others are taking a wait-and-see approach? (1:25)

What impact are funding changes having on PCNs and workforce planning? (2:46)

What is the Single Neighbourhood Provider (SNP) Contract? (4:09)

How could neighbourhood footprints affect PCN boundaries and membership? (6:01)

Can multiple PCNs work together under a neighbourhood model? (7:44)

Does collaboration increase the risk of another organisation holding the contract? (9:13)

What do the new PCN DES local variations mean for practices? (10:39)

Could local DES variations reduce the need for an SNP Contract? (11:11)

What opportunities do local variations create for service redesign? (13:47)

How do local variations differ from the SNP Contract? (14:50)

What should PCNs be doing now to prepare for the future? (17:44)

How can proactive leadership help PCNs retain influence and control? (19:58)

What practical steps should PCNs take to implement neighbourhood working? (20:36)

Do PCNs have the leadership and management capacity needed for change? (22:18)

Is incorporation necessary to prepare for the SNP Contract? (23:55)

When does setting up a company make sense for a PCN? (24:17)

Can federations provide an alternative to incorporation? (26:20)

How long does incorporation take and what are the common mistakes? (27:56)

Visit the Hempsons website here.

For all enquiries about the Ockham podcast, please contact Ben Gowland here.