The Care Quality Commission, quality regulator for the NHS, has placed Priory Avenue surgery, a Caversham practice part of the North and West NHS CCG, in special measures after judging it inadequate on a number of counts. The practice has been given an inadequate rating and must produce and execute a plan to remedy its failings. GP services are under pressure nationally and especially in the Thames valley. Here, the high cost of living and accommodation, makes the area expensive for training or newly-qualified doctors. Traditional GP partnerships, where incoming partners have to buy their share of the practices assets are finding it increasingly difficult to recruit new partners able and willing to buy their share of the practice. When the existing partnership could no longer continue and the partners resigned, a tendering process resulted in the selection of Specialist Health Services Ltd., a company centred on Bracknell GP practices, to provide the service. An eight-year contract was awarded, of the type known as "Alternative Personal Medical Services", which allows freedom to adjust the contracted services. In this case extended hours were specified as part of the tender process. The practice continues and is formulating and executing its plan to remedy the defects found by the CQC .