Ara Darzi is an eminent and respected professor of surgery at Imperial College London, and he is now a junior health minister in Gordon Brown's government. It is clear from the academic literature that he knows an immense amount about surgery in general and laparoscopic surgery in particular. However, tragically it is equally clear, from reading his vision for transforming health care in London, Framework for Action, that he has learnt nothing about general practice and primary care. Given the robust evidence that a strong basis in primary care improves the effectiveness and efficiency of healthcare systems, and when primary care is responsible for 82% of contacts with patients in the NHS, it must be asked who thought it could possibly be a good idea to ask a tertiary care specialist to redesign the provision of primary care.

The key part of Professor Darzi's plan is a network of “polyclinics,” each serving a population of around …