In 1992 the King's Fund Commission published a report `London health care 2010 : changing the future of services in the capital'. This report was unable to describe in any detail the actual delivery of acute medical care in London. This required a more indepth study of care based on the collection of data at the grassroots. Recognising this omission the Commission asked the Departments of General Practice and Public Health Medicine at the United Medical and Dental Schools of Guy's and St. Thomas' Hospital (UMDS) to undertake a series of studies that would describe the process of arranging an acute medical admissions to hospital for London residents. In view of the impending report from the Tomlinson Committee on the provision of medical care in London, the Commission asked for these studies to be carried out and reported on within a period of 12 months. They took place between September 1991 and May 1992 and the report was presented in October 1992 to the King's Fund Commission. This publication describes the results of these studies. The overall objectives were to describe the problems of admitting acutely ill patients into the wards of London hospitals, and to identify ways of facilitating the whole admission process and improve the experience of general practitioners, hospital doctors, nurses and patients. The chapters look at the view of service providers; emergency admission from a GP's perspective; workload and procedure in A & E departments; the patient experience of emergency admission; and district nurses and poorly planned discharges.