Ruth Carnall, chief executive of NHS London, said after the publication of the Darzi report on London’s health care last June that “This is the most ambitious and radical plan for the NHS in London since 1948.”1 The proposal that has attracted most media interest and public discussion is that of the polyclinic, typically the bringing together of a much wider range of services than that offered by most general practices. The Darzi report presents this development as something new in London and the UK. It cites an example from Europe, that of Berlin, to give an idea of how the polyclinic might work.

But a look back into history shows that the idea of the polyclinic is hardly new. Rather, it is the resurfacing of an idea that had a long and interesting history in London and in national policy in the 20th century. The first incarnation was in the Dawson report of 1920. Dawson, a physician at the London Hospital, was asked to report overall on the health services by the newly established (1919) Ministry of Health, rather like Darzi has been asked to report by the government today.

Dawson was in part inspired by the revolutionary changes in health care in the Soviet Union, where a system of polyclinics, bringing together specialist and other services, and based in local government, had been established after the October revolution.2 Dawson’s blueprint was a radical one. He envisaged replacement of the uncoordinated provision of the time by a network of primary and secondary health centres linked to district hospitals and then to regional hospitals. But …