'Heart czar' Dr Roger Boyle has said the cardiac care map of England needs to be redrawn to overcome an imbalance of treatment benefiting London and the South East.

Speaking at a conference on cardiac care hosted by London's Royal Brompton and Harefield trust, Dr Boyle - currently on secondment from his job as consultant cardiologist in York - said treatment must be targeted on areas of greatest need.

He said that variations in cardiac care between the north and the south of England were 'unacceptable'. He also said inequality was becoming more acute as cardiac death rates declined but the prevalence of cardiac disease rose.

'There is a fivefold difference in death rates between the best and the worst-performing areas. There is no match between levels of disease and money being spent. '

The London trust is at the centre of bitterly contested plans to create a super-hospital with St Mary's trust in Paddington Basin.

World-renowned transplant surgeon Sir Magdi Yacoub says the resulting closure of Harefield Hospital would destroy one of the best transplant teams in the world.

Dr Boyle said he had no brief for closing hospitals but wanted to provide a national service.

'At the moment one-third of all revascularisation [opening blocked arteries] happens in London and half the people requiring it live outside London. '

The national service framework for heart disease envisages major increases in the number of coronary artery bypass grafts and angioplasties carried out each year. To do this, it calls for a 10 per cent increase in cardiologist numbers and 4. 5 per cent more surgeons. But Dr Boyle stressed they needed to be in the right place. He said there were shortages in the West Midlands that forced 300 patients a year to travel to London for bypass grafts and angioplasty.

'If one takes that level of activity and makes sure it fits the flow of patients locally then it may well be that level of activity in London is not needed in the long term, 'he said.

Dr Boyle said trust and health authority chief executives had done 'a hell of a lot of work' to ensure main elements of the framework met a series of milestones. One of the main issues for managers was ensuring a methodical approach to the way systems were delivered.

'It is not all about the high- technology side of things. It is about doing the same small things repeatedly and well. '