Commentary on text of interview with Professor Lord Ara Darzi: 'Desirable? Yes; but is it achievable?'

This personal commentary explores some issues that arise in the text of the interview with Lord Darzi published in LJPC 6.6, from a point of view of an interest in health policy and change in healthcare organisations. It suggests that the vision is desirable but that there are four major questions about ready implementation that the field needs to consider: 1 Can primary care development and investment be protected in a cold financial climate? 2 Does the current marketisation of health care erode integration? 3 Does the health and social care system in London behave like a real system? 4 Is there really a cultural shift towards empowerment and organisational learning?