'A Framework for Action' review

NHS London asked Professor Sir Ara Darzi to carry out a review of London's healthcare.

The Framework for action, published in July 2007, set out proposals for changing services in London over a period of 10 years. The report outlined the case for change, highlighting the fact that London experienced big inequalities in health and healthcare, with significant disparities of life expectancy between richer and poorer areas.

Darzi's proposals focused on the following principles:

• services should be focused on individual needs and choices
• services should be localised where possible and centralised where necessary: routine healthcare should take place as close to home as possible, but more complex care should be centralised to make use of the best expertise and equipment
• integrated care and partnership working would be vital
• prevention was better than cure: health improvement should be embedded in everything the NHS did.

His proposed service model included:

• the introduction of polyclinics (GP run centres offering expanded services)
• increased provision of healthcare at home
• the majority of inpatient care would be provided by local hospitals
• high throughput care should be provided in elective centres
• some hospitals should be designated as 'major' acute hospitals and hospitals should be encouraged to specialise
• academic health science centres should be developed in London.

On 29 April 2009, the first seven polyclinics opened in London. Health Minister Lord Darzi opened Loxford polyclinic in Ilford, east London, which would offer GP services, a healthy living café and a rehabilitation gym.

While the polyclinics were established with the objectives of making care convenient for patients and shifting services into the community, some argued that the model of 'super surgeries' was a top-down creation, which could damage personal relationships between GPs and their patients.