The Ambulatory Care and Diagnostic Centre (ACAD) at Central Middlesex Hospital has its origins in the European polyclinic and the day surgery centres in the USA. By providing elective assessment and treatment by appointment and careful programming they aim to improve the integration of primary and secondary care into a more seamless service. It is the only facility of its type in the UK and this report provides an architectural and clinical evaluation so that lessons can be learned by the rest of the NHS.