For our special 75th episode of the General Practice Podcast we return to the subject of our very first episode; Stewart Smith from St Austell Healthcare. In Episode 1 Stewart described the evolution of St Austell Healthcare including the rescue of a failing practice by its neighbouring practices. Eighteen months on and Stewart reflects on progress including their multi-disciplinary team model and governance arrangements. He extols the benefits of the Primary Care Home and discusses the challenges and benefits of working at scale.