STRUCTURE: The London primary care trust, part of the north west London cluster, has a specific plan for 2011-12 - alongside the cluster strategy - which will see “a fundamental review of elective care pathways across providers”.

A strategy document for the Brent and Harrow boroughs said it would “introduce new pathways with appropriate tariffs and levers”.

It also said the borough must “develop and implement an intermediate care, case management and End of Life Care strategic plan that significantly reduces the need for emergency admissions to acute settings” and in mental health “introduce a new model of care that places greater emphasis on out-of-hospital services and care closer to Harrow.”