Robin, I'm not sure things are that different these days. GPs are still (generally) independent businesses, not NHS trusts, thought the premises may belong to PCT. They have a contract with PCTs who might, if there were concerns about poor health outcomes in an area without a GP, try to set one up. Doubt that SE23 is Lewisham's biggest health blackspot, though I don't know for sure. But the writing's on the wall for PCTs, they'll be gone by 2013 and in many cases before. GPs are going to be in charge of much of the commissioning work, so they and new agencies created by the government would take up this issue in future.

If there are any GPs with tired old surgeries in the area, perhaps lobby them (and PCT if it's their building) to move?