The galactic black hole binary systems give an observational template showing how the accretion flow changes as a function of increasing mass accretion rate, or L/L-Edd. These data can be synthesised with theoretical models of the accretion flow to give a coherent picture of accretion in strong gravity, in which the major hard-soft spectral transition is triggered by a change in the nature and geometry of the inner accretion flow from a hot, optically thin plasma to a cool, optically thick accretion disc. However, a straightforward application of these models to AGN gives clear discrepancies in overall spectral shape. Either the underlying accretion model is wrong, despite its success in describing the Galactic systems and/or there is additional physics which breaks the simple scaling from stellar to supermassive black holes.