Aims : Although the competence and scope of primary and community care is increasing, the majority of patients in our hospitals today have complex problems that challenge our current ways of working. This symposium draws on the knowledge and experience of the London Respiratory Network, which represents the professionals who are interested in respiratory health in this city of 8 million people. In London, £685 million is spent every year on respiratory care. Despite this, there is still room to improve respiratory outcomes. This session focuses on children and adults with complex needs and provides some scalable exemplars of good practice.