Over the past decade, healthcare provision in England has grown increasingly complex, with more than a third of NHS trusts adopting shared leadership arrangements through provider 'groups'.

These group structures involve collaborations between separate organisations (or trusts) sometimes with multiple sites, and vary in their governance. It is assumed that larger size will raise efficiency through economies of scale in corporate and support services and also help to share best practices in leadership.

However, not all agree that the drift towards increasing size and consolidation of NHS organisations is always good thing. While some actively seek opportunities for further growth of their organisations, others argue that the ‘NHS model is not infinitely scalable’ and criticise an approach that they see as pursuing ‘scale for scale’s sake’. The absence of a clear central policy on the structure and configuration of NHS trusts, or a robust theory of change for the joint leadership model, has also fuelled scepticism.