London GP practices need £1bn investment, says Darzi report

BMJ 2014; 349 doi: (Published 15 October 2014) Cite this as: BMJ 2014;349:g6238
  1. Jacqui Wise
  1. 1London

The chair of the London Health Commission has called for £1bn over five years to rebuild or refurbish every GP practice in London, in what would be the biggest investment programme of its kind since 1948.

Last year the mayor of London, Boris Johnson, asked Ara Darzi to chair the commission. Darzi’s 170 page report, Better Health for London,1 contained 64 recommendations, including a ban on smoking in public parks, Oyster card discounts for commuters who walk some of their way to work, a restriction on fast food outlets near to schools, and the appointment of a London health commissioner.

In a letter to Londoners at the beginning of the report, Darzi said, “All of us should be ashamed at the state of many of London’s GP practices: the condition of most practices is poor or only ‘acceptable,’ and a staggering three quarters of London’s GP practices are in need of rebuild or repair.

“One third of practices are inaccessible for people in wheelchairs. This is the sign of chronic underinvestment from a capital expenditure system that has fundamentally failed.”

The report noted that £1bn would be just 4% of total capital spending in the NHS over the next five years and 26% of the anticipated capital spending in London, which still meant that 74% of the capital budget would be invested in hospitals and other care facilities. It added that investment must be joined with reform and called for an end to professional isolation, whereby every GP practice joins in a network of local practices.

The report said that around £1.5bn of NHS estate was unused, underused, or misused—costing the health service more than £50m a year in maintenance alone. It called for a withdrawal of the public subsidy from hospitals that hoard assets, to force them to use these for patient care or release them for housing. And NHS hospitals should be allowed to use some of their land to build affordable housing for their staff and other key workers, it said.

The report included a number of public health initiatives. It said that London should follow the example set by New York, Paris, and Hong Kong by banning smoking in public parks. It also called on the mayor to use his byelaw powers to make Trafalgar Square and Parliament Square smoke-free and to direct the Royal Parks Board to do the same for all of the parks and open spaces that they manage in London. This would give people fewer opportunities to smoke and would set a better example to children, the report said.

London has the highest rate of childhood obesity of any major global city. The report recommended that all London councils should follow the lead of Waltham Forest, Barking and Dagenham, and Tower Hamlets by refusing to allow fast food outlets to open within 400 m of schools. Also, it said that London councils should use licensing arrangements to require all chain restaurants and food outlets to include “traffic light” labelling on all menus, adding that London boroughs should be supported if they choose to pilot a minimum 50p price for a unit of alcohol, through their byelaw and licensing powers.

Another recommendation was that the mayor should invest 20% of his Transport for London advertising budget to encourage Londoners to walk 10 000 steps a day; in turn, Transport for London should set up a scheme, paid for by employers, to incentivise people to walk the last mile to work and the first mile home. Employees tapping in or out with their Oyster card at least one mile from their registered place of work could collect points and be eligible for employer financed transport rewards, the report said.

It also called on the mayor to accelerate planned initiatives on air quality in London, including the conversion of all taxis to zero emission capable vehicles.

London is ranked seventh of 14 comparable cities around the world on a number of health measures including life expectancy, said a 2011 report for the London School of Economics. Darzi’s new report called for London to do better and become the healthiest major global city, adding that many of the ideas and proposals could just as easily apply to other big cities in the United Kingdom.

Chris Radburn/PA Wire/Press Association Images


Cite this as: BMJ 2014;349:g6238


View Abstract

Sign in

Log in through your institution

Free trial

Register for a free trial to to receive unlimited access to all content on for 14 days.
Sign up for a free trial