When the London Health Commission published Better Health for London in October 2014, one of its more concrete asks sat inside a chapter on primary care: get general practice working in networks, widen the range of services a GP surgery could offer, and make appointments available across longer hours so patients did not have to choose between seeing a work shift and seeing a doctor. Ten years on, GP access in London is a useful test case for the whole report, because unlike a strategy or an ambition, it produced a specific, checkable commitment. Some of it happened. Some of it is still unfinished business.
What the report actually recommended
The Commission’s primary care recommendations, chaired by Professor Lord Ara Darzi, were more specific than most of the report’s other 60-odd proposals. They called for GPs to work in networks so that a single practice could offer a wider range of services than it could alone; for patients to be able to move between GP networks rather than being tied to whichever surgery happened to be nearest; and for new providers to be able to open premises in the parts of London that were under-served. Underneath all of that sat a simpler, more visible target: access to a GP team from 8am to 8pm, on a day and at a time that actually suited the patient, rather than the traditional 9-to-5 slot squeezed around a working day.
What the record shows was delivered
The most immediately verifiable part of the promise is the extended-hours commitment. Within about a year of the report’s publication, 8am-to-8pm access had become the norm for many GP teams across the capital, driven by a Primary Care Transformation programme run jointly by NHS England London and London’s Clinical Commissioning Groups. That programme’s stated aims mapped closely onto what the Commission had asked for: rapid access to a GP, continuity of care rather than a different doctor every visit, multiple ways to book an appointment – phone, email, online – and opening hours that fit around patients rather than the other way round. On paper, this is the part of the primary care chapter that moved from recommendation to operating practice fastest.
Where the picture is more mixed
The harder recommendations to verify are the structural ones: whether GP networks meaningfully widened the range of services on offer, and whether new providers actually opened in the boroughs that had the fewest GP premises to begin with. The public record is clearer on intent than on outcome here. What is documented is that integrated care – linking hospital specialists into population health management and into new ways of working alongside primary care – has been an ongoing effort rather than a completed one, and that NHS commentary attributes at least part of the slower progress to pressure on social care and on wider local government funding, both of which sit outside a GP surgery’s control but shape how much capacity it has to absorb.
The table below summarises where each strand of the primary care recommendation sits, based only on what has been documented rather than assumed.
| 2014 recommendation | A decade on |
|---|---|
| 8am–8pm GP access | Delivered — became the norm for many GP teams within roughly a year |
| Multiple booking channels (phone, email, online) | Delivered as part of the Primary Care Transformation programme |
| Continuity of care with the same GP | Adopted as a stated programme goal; consistency across practices not separately documented |
| Hospital specialists integrated into primary care/population health | Ongoing – described as continuing effort, not a finished state |
| Adequate capacity given social care and funding pressure | Stalled – explicitly flagged as an unresolved challenge |
Why GP access matters more than it looks
Extended hours are the part of the primary care recommendation that is easiest to announce and easiest to measure, which is presumably why it moved fastest. But GP access was never meant to stand alone in the report – it was the front door to the wider ambition of catching problems earlier, reducing pressure on hospitals, and narrowing the gap in healthy years lived between London’s most and least deprived areas. A surgery that opens until 8pm but still cannot absorb a growing caseload, or refer quickly into an under-capacity system beyond its walls, has only solved half the problem the Commission described. The public commentary on integrated care and funding pressure suggests that is roughly where things stand: the visible, patient-facing part of the promise is largely in place; the less visible capacity behind it is still catching up.
What "ten years on" actually shows
Judged strictly against what was written down in 2014, GP access in London is one of the report’s clearer partial successes. The commitment that was simplest to specify – longer, more flexible hours delivered through a formal transformation programme – is the one with the most documented follow-through. The commitments that depended on deeper structural change, from network-wide service breadth to genuinely under-served areas gaining new provision, are harder to score because the evidence trail thins out precisely where the harder work would have had to happen. That asymmetry is not unique to primary care within the report, but GP access is where it is easiest to see: a well-executed front door onto a system whose underlying capacity questions were still being worked through a decade later.