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When Lord Ara Darzi unveiled his radical plans for healthcare in London, he was forced to draw on examples from the USA and Europe because the polyclinics he advocates do not exist in the UK.

Critics of the new minister's Healthcare For London report, published last month, say proposals to downgrade hospitals and rehouse consultants alongside GPs in super-sized polyclinics will seriously jeopardise holistic elements in primary care provision and clear the way for privatisation of the NHS.

Londonwide LMCs has expressed concerns about whether Lord Darzi should be in charge of shaking up primary care at all when his medical experience is in secondary care.

After the report was published, however, his remit was extended and he will now oversee plans for a nationwide healthcare reconfiguration. Londoners, it appears, are going to be the test bed for his grand design.

By and large, doctors have been less than enthusiastic about plans to downgrade district hospitals but the government is determined to win over public and health professionals alike.

If successful, the transformation it envisages will be staggered across Britain and Northern Ireland - and some primary care organisations are already taking the plunge.

The Barnet, Enfield and Haringey clinical strategy board, which represents PCTs, secondary care trusts, councils and ambulance services locally, is currently in dispute with residents who do not want services at Chase Farm Hospital, North Middlesex Hospital and Barnet Hospital farmed out to polyclinics.

A Save Chase Farm political party returned two councillors at the last local elections. The area was deliberately excluded from the brief for the Darzi report because consultation had already begun and a report had been commissioned from the government's national director for emergency services, Sir George Alberti.

Barnet, Enfield and Haringey clinical strategy board chairman Sally Johnson said: 'A number of people were developing reconfiguration strategies prior to Lord Darzi's work. We're the first to go out to consultation but his work seems to mirror our ideas because we have both looked at the problems in London from a patient and clinical perspective.

'Nobody is forcing GPs to move but where we have embryonic prototypes in place in Enfield, the GPs are very pleased with them. Yes, some own their own practices, but in some parts of the area they open very limited hours or take a morning off a week and that is not what the patients want,' she added.

'They may find their lists drop off when people realise they get a better service at the polyclinic.

'In Enfield there are roughly 300,000 people but only around 100,000 work in Enfield. So how are those working outside the area supposed to get to their GP - it is simply a situation that has to change.'

She believed the idea of new ways of working would catch on more widely in time.

'I think the new generation of GPs understand that their career will have to adapt to change and many don't want to be burdened with a lifetime of responsibility and management.

'They just want to get paid to help people, which is why they got into the profession in the first place.

'Of course there is pressure on us because we are further into the process so people will be watching what we do. But I am confident that we have done our sums and I hope we get the green light to do this.'

The response of Enfield LMC chairman Dr Patrick Keating is guarded. He did not dismiss the proposals out of hand but warned they would meet resistance.

He said: 'We are only now getting together to discuss this. The trouble is there is a high percentage of single practices and they are feeling very vulnerable.

Inner-city boroughs

'Four out of every six practices in Enfield are PMS and of course they have concerns they could be forced into polyclinics by having their contracts terminated.'

But Dr Keating said more densely populated inner-city boroughs would benefit from polyclinics.

'It does make sense to have some procedures and general practice on one site and even in parts of Enfield a polyclinic could be a very good idea.

'But a lot of Lord Darzi's plans carry no truck with us. Eleven surgeries in Enfield, my own included, have buildings deemed not fit for purpose. I only hope money is invested in the right way and I am not convinced that a blanket of polyclinics is the best idea.

'He is talking up the idea, but in reality, there does not seem to be much money on the table.'

According to the Darzi report, the nearest London has to a polyclinic is the Heart of Hounslow Health Centre which opened its doors in February. Three GP practices and around 300 staff are now operating from the new buildings.

The site is still a long way from Lord Darzi's vision, because it lacks the diagnostic services that would be provided at a polyclinic. But it is going down well with patients, said Hounslow Patient Forum committee member Robert Hardy-King.

Mr Hardy-King added: 'There are teething problems, but on the whole it works very well. It's clean and it's bright.

'My only gripe is that the car park is quite expensive - more than the council charges - and that, along with the fact that the clinics are not on the ground floor, would be annoying for elderly people.

'But it is very good because if you need an injection or a blood test, they can just call upstairs and book you an appointment there and then, so you don't have to bother going to West Middlesex Hospital.'

But crucially, services at hospitals near the centre in Hounslow have not been correspondingly stripped back. If the Darzi report is acted on, will existing services be cut to provide the cash injections needed to build the new polyclinics?