Doctors were ambitious to radically transform health services in London but could “easily be crushed” by the weight of expectation and bureaucracy, a leading NHS manager has said.

Ruth Carnall, chief executive of the NHS London strategic health authority, said that GPs and their colleagues on clinical commissioning groups would find that delivering change was a “brutally exposing business.”

She said this was being shown by current attempts to reconfigure services in northwest London, where a proposal that nine emergency departments be reduced to five has met fierce opposition.

“Clinicians trying to lead change can be put under enormous scrutiny and pressure,” she said. She said that they could become stressed and disillusioned by the tendency of politicians who oppose the closure of local services “to reduce complex, finely balanced arguments to a soundbite” but should resist compromising …