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The report, Leading health care in London: Time for a radical response, highlights that four out of the five most financially challenged NHS trusts in England are located in the capital and that the majority of its hospitals are struggling to meet new standards for the quality of care. It warns that, without major changes to reorganise hospital services, improve primary care and move more services into the community, London's NHS could become financially unsustainable and may not be able to guarantee consistently high standards of patient care.

While change is urgent, the report argues that the structures put in place under the government's health reforms are unlikely to deliver it. With a large number of organisations whose remits are not always clear and with no single body responsible for leading change, the health system in the capital is confusing and incoherent, adding to the risk that change will be delayed.

The report also warns that new requirements for competition regulators to scrutinise proposed changes are likely to add to delays and raise the possibility that changes will be rejected on grounds of competition. Given the pressing need for change, it calls for current rules on NHS mergers and competition to be revised or suspended in the capital.

The report proposes an alternative way of managing major service changes across the capital. This would see NHS England's London office take on a city-wide planning role, working with clinical commissioning groups. Hospitals would work together in large-scale networks, with a mandate to implement service change. The networks would be based on the three academic science networks, which already bring together hospitals to work in partnership across large parts of the capital, so could be implemented with little disruption. This would also ensure that major changes to services are overseen by London's most experienced managers and clinical leaders.

Chris Ham, Chief Executive of The King's Fund, said: 'Without change, London's health system is at risk of becoming financially unsustainable, and patient care could suffer. The stakes could not be higher, yet the structures now in place are not fit for purpose. Courage will be needed to implement a radically different approach capable of delivering the changes required.'

See more of our work on London

• Read the report: Leading health care in London
• Chris Ham's blog post on the need to improve London's NHS
• Details on London acute hospitals and their configuration
• Our infographic showing the relationships between health bodies in London
• More of our work on health and health care in London

Notes to editors: 

Leading health care in London: Time for a radical response is published by The King's Fund on Wednesday 26 June 2013.

For further information or to request an interview with Chris Ham, please contact The King's Fund press office on 020 7307 2585 (or 07584 146035 if calling out of hours).

The King's Fund is an independent charity working to improve health and health care in England. We help to shape policy and practice through research and analysis; develop individuals, teams and organisations; promote understanding of the health and social care system; and bring people together to learn, share knowledge and debate. Our vision is that the best possible care is available to all.