The author looks at the NHS in London two years after the report of the King's Fund Commission on London and the Tomlinson report and three years before the next general election. Policies shaping the NHS in London have become increasingly controversial. He argues that despite the growing resistance to the Government's policies for the NHS in London, the case for changes in the balance of services remains overwhelming. Primary care needs strengthening and adaptation in the particular context of the capital. Specialist care should in many cases be concentrated in a smaller number of units. Research and education should be aligned with fewer, stronger university based centres.