Long-term underfunding of family health services in the capital - currently 4 per cent less than other parts of the country - has led to a situation in which there are more elderly and single-handed GPs, with inadequate support staff, working from poorly equipped surgeries.
The report by the independent King's Fund Institute warns that health care in London may be unsustainable unless there is the political will to restructure provision, with adequate numbers of GPs and community services.
It is yet another salvo in the battle to reshape health care in London which may be decided next month with the publication of Sir Bernard Tomlinson's report which is widely expected to recommend the closure of several leading teaching hospitals.
Londoners receive a 'poor deal', the fund's report says. 'Inner-city residents have difficulty obtaining standard hospital services because of the preponderance of specialist provision in the city's central hospitals. People in outer London have to travel long distances for specialist care.'
The fund recommends a radical shake-up. 'London's health services must be planned and managed to serve the population rather than perpetuate institutions. Health care in London must become primary health care (GPs and family services) led.'
London Health Care 2010: Changing the future of services in the capital; BEBC, 9 Albion Close, Poole, Dorset BH12 3LL; pounds 15.