London's hospital trusts are clamouring to be named specialist stroke centres as the capital embarks on centralising major acute services.
Around 10 hyper-acute stroke units will be needed but 17 trusts have expressed an interest.
Primary care trusts under the umbrella of Healthcare for London have invited plans from trusts to host hyper-acute units, standard stroke units and rapid diagnostics. The standard stroke tariff will be split for hyper-acute and standard services.
PCTs will assess submissions on quality and designate enough units for one to be reachable by anyone in the capital within half an hour.
The move comes ahead of consultation early next year on centralising major trauma services and PCTs take more services out of hospital with the designation of London's first polyclinics.
The changes follow Lord Darzi's recommendations in the 2007 plan A Framework For Action and add to pressure for acute reconfigurations.
Islington PCT chief executive Rachel Tyndall said commissioners would "manage" change to ensure continuity of services.
"We have a clear picture of centralising where necessary," she said. "The standard of stroke care in London is not good and this is about improving that."
Ms Tyndall said trusts were also localising where possible. The stroke strategy, published last week, calls for extended community rehabilitation services and new standards.
Chelsea and Westminster Hospital foundation trust submitted its business case for becoming a hyper-acute stroke centre this week. Director of strategy Amit Khutti said that, with one of the highest quality services according to the National Sentinel Stroke Audit, it would be reluctant to accept not being chosen.
He said: "I would struggle to see the benefit of not commissioning a unit that scores among the best."
London School of Economics professor of health economics Alistair McGuire, who was involved in modelling demand for stroke services for the strategy, said the London Darzi process had settled on concentrating several services to improve quality.
He said there would be challenges for commissioners. "Partially commissioners have to buy into it, and partially providers have to accept that there are going to be winners and losers, but the point is providing a better level of care."
HSJ's forum Urgent Care 2009 is in London on 20 January.