The Department of Health in the United Kingdom is undertaking a major review of National Health Service policy (“the Darzi review”). Which options are most likely to produce an effective, efficient, and patient centred health service? The UK has made major progress in reducing avoidable deaths and improving care for chronic diseases.1 2 However, many areas still have considerable room for improvement.

Strong primary care is associated with reduced costs and improved outcomes.3 The review therefore needs to strengthen primary care. The UK system of universal registration with a single general practice promotes equity, provides a “medical home” for coordinating care, and is an effective mechanism for holding providers to account for the quality of care provided. This must be retained, even though patients may occasionally consult other practitioners—for example, a doctor near their workplace.

Much has been written about “polyclinics”—facilities that group together primary care practitioners with diagnostic and specialist services. Despite lack of clarity about their purpose, several are already planned. Part of the debate about polyclinics relates to a perceived need to merge …