Junior health minister Professor Sir Ara Darzi has set out a radical vision of future healthcare provision in London that would see the end of hospitals in their current form.

In A Framework for Action, the surgeon, who was commissioned by NHS London to do the report before being appointed to the government, says one-size-fits-all hospitals are no longer appropriate.

Instead he revealed his blueprint for 'cradle to grave' healthcare, with super-GP surgeries - 'polyclinics' - envisaged as the centres for a wide range of primary care services, including mental health and social care as well as diagnostics and consulting rooms. The polyclinics would also have a 24-hour urgent care centre to act as the 'front door' for accident and emergency.

The other six settings for provision models would be: the home; local hospitals providing non-complex care; elective care centres for straightforward surgical procedures; major acute hospitals providing complex care; specialist hospitals - more would be needed; and academic health and science centres.

Major themes

Sir Ara told HSJ: 'The three major themes are to improve access, quality and safety, and the staying healthy agenda to address inequalities in London. There is no set of new policies that will create havoc, it's clinically driven to improve access, quality and safety.'

NHS London chief executive Ruth Carnall said she would be surprised if the strategic health authority and primary care trust boards did not vote in favour of the report's recommendations.

The SHA will consult with PCTs in the autumn.

'Overall the models will find support but at a local level there will be a debate as to where services should be located and that will be controversial,' she said.

Focus on outcomes

King's Fund chief executive Niall Dickson, who contributed ideas for the end-of-life care section of the report, said it was important to engage with clinicians and commissioners to persuade them to focus on outcomes rather than institutions. And he called for new systems to be in place before old ones were removed.

'The report has the best chance of doing what a lot of other reports have failed to do bring about a fundamental change in the way healthcare is organised,' he said.

Sir Ara acknowledged there could be opposition to the polyclinics. The report says: 'We are aware this proposal may be challenged as. de-personalising primary care.'

But it argues there is no reason polyclinics could not allow patients to maintain relationships with GPs.

They would also offer extended opening hours, which a survey of 7,000 Londoners found were the 'only aspect of GP services with which there was net dissatisfaction'.

NHS Confederation policy director Nigel Edwards, who was on the working group discussing acute care, described the recommendations as 'radical and exciting'.

The fact that Sir Ara was now junior health minister would give them a better chance of becoming reality, he added.

Challenges ahead

But he also said there would.be significant challenges in.bringing about this scale of change. 'A big issue is current principles.of practice ownership as GPs.value working independently from others.'

NHS Alliance chair Dr Michael Dixon said polyclinics were a good idea, but warned that GPs might be difficult to get on board.

'Some GPs will see it as some sort of attempt to homogenise them and put them in a straitjacket. But I welcome the idea as long as patients know who their doctor is.'

Major acute hospitals would be established in some of London's acute trusts, although the report did not specify where. Sir Ara said he envisaged three to four per London sector.

The report proposes that key criteria for these sites would be current clinical outcomes, good transport links and the provision of cover for both inner and outer London.

It also suggests two more trauma centres are established and that a clinical working group should join with the London Ambulance Service to design clear pan-London transfer protocols.

Royal London Hospital consultant trauma surgeon Karim Brohi agreed there was a need for at least one more trauma centre.

Click here to read Darzi's Framework for Action

For more on Darzi's overall review of the health service, see.'NHS split over Darzi review's reach'