A new report by the King’s Fund suggests current rules on NHS mergers and competition should be revised or suspended in London to address a major need for service change in the capital.

The report highlights that four of the five most financially challenged hospital trusts in England are in London, and the capital’s NHS faces growing pressure with services in need of urgent change.

It claims the majority of hospitals in London are struggling to meet new standards for the quality of care. It also warns that without major changes to reorganise hospital services, improve primary care and move more services into the community, London’s NHS may not be able to guarantee consistently high standards of patient care, and furthermore, could become financially unsustainable.

Structures put in place under the government’s health reforms are unlikely to deliver the change that is urgently required, the report argues. It claims that the capital’s health system is confusing and incoherent, because there are a large number of organisations whose remits are not always clear, and there is no single body responsible for leading change. All this adds to the risk that change will be delayed.

It suggests something that will add further delays – almost to the point of changes being rejected – is the new requirement for competition regulators to scrutinise proposed changes. As the need for change is urgent, the report calls for current rules on NHS mergers and competition in the capital to be revised or suspended.

Proposals put forward in the report are for NHS England’s London office to take on a city-wide planning role. Hospitals should be given a mandate to implement service change via working together in large-scale networks. The suggestion is for the networks to be based on the three academic science networks, which could be implemented with little disruption as they already bring together hospitals to work in partnership across the capital.

King’s Fund chief executive, Chris Ham, said: “The stakes could not be higher, yet the structures now in place are not fit for purpose. Courage will be needed to implement a radically different approach capable of delivering the changes required.”