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J Epidemiol Community Health. 2007 December; 61(12): 1019.
PMCID: PMC2465667

“What shall we do about London?”

Edwin Chadwick in 1848 is reputed to have asked, “What shall we do about London?”, and health planners have often agonised since then about what to do about capital cities. These places are different in many ways, not least because they are on the doorstep of ministers of state, who find it even more difficult to avoid meddling in the minutiae of everyday operations than in health services elsewhere. Perhaps they are ever aware of their own potential treatment needs?

As we write, a new review of the British National Health Service seems to be at risk of coming up with solutions for the country as a whole based on the perennial weakness of their London system, where an unholy alliance of teaching hospital domination and private medical practice has prevented the development of strong primary care. The solution of polyclinics, in which hospital consultants see patients in their new, walk‐in specialist settings, is the obverse of what many people have been striving to create, with the skilling‐up of primary care workers and the development of areas of specialist expertise which can be readily accessed through their frontline contact.

The adage of “professionals on tap, not on top” is one we have touched upon before,1 and which appears to be pertinent here.


1. Ashton, John R. Professionals should be on tap, not on top. J Epidemiol Community Health 2003. 5782

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