Chair’s introduction
As we move into the summer period, I know that practices across City and Hackney continue to work under considerable pressure, balancing rising demand, increasingly complex patient needs and the steady flow of additional work from elsewhere in the system. Your LMC remains committed to representing these concerns, challenging inappropriate workload transfer and working with local partners to improve services wherever we can.
This month’s newsletter reflects several issues that members have raised directly with us. These include the inconsistent neighbourhood mental health offer, the growing use of Advice & Guidance and Advice & Referral pathways, long waits for respiratory testing, and the workload and clinical governance implications of the new obesity management requirements.
Your feedback genuinely matters. Survey responses, quality alerts and examples shared with LMC representatives give us the evidence we need to show where services are not working as they should and to press for meaningful change. I would therefore encourage practices to continue sharing their experiences with us, particularly where there are concerns about patient safety, delays or work being passed back inappropriately to general practice.
Thank you, as always, for everything you and your teams continue to do for patients across City and Hackney, and for your continued engagement with the LMC.
Dr Vinay Patel
Chair of City & Hackney LMC
City & Hackney LMC Membership and meeting dates
What has City & Hackney LMC been working on recently?
Survey on Mental Health Services
Members reported significant variation in the quality and consistency of neighbourhood mental health support across City and Hackney. Some practices described effective liaison arrangements, including regular consultant input and timely advice. Others reported long gaps without liaison meetings, poor quality triage outcomes, unclear referral responses, repeated requests for forms, and patients being bounced back to general practice.
The LMC is promoting a short practice survey to capture current experience across all PCNs, including access to liaison meetings, named consultant input, referral outcomes, communication quality and workload impact. The intention is to collate practice-level evidence and present this to mental health service leads so that the offer can be made more consistent and equitable across neighbourhoods.
We would be grateful if one representative per practice could complete the survey here by Thursday 23 July.
Quality alerts: making the system see the problem
The LMC supports the use of quality alerts to evidence interface issues and drive change more effectively. We are aware that the current system works reasonably well when used, but that alerts are still only being submitted by a small number of practices.
The LMC will continue promoting the use of quality alerts and will seek more regular reporting on themes, specialties involved, and the actions taken in response. Practices are reminded that quality alerts are not just an administrative process; they are a way of formally recording patient safety concerns, inappropriate workload transfer and repeated interface failures.
Link for NEL quality alerts is here.
Advice and Guidance / Advice and Referral
The LMC is concerned by the continuing expansion of Advice & Guidance and Advice & Referral pathways, the potential impact on GP workload, patient safety and delays where referrals are diverted or work is transferred back to general practice.
Practices are encouraged to use the local quality alert process whenever a referral is inappropriately bounced back, where there is unsafe delay, or where a response creates additional work that should sit with secondary care. Where a GP’s clinical judgement is that a patient needs to be seen, practices should make this clear and escalate if the referral is not accepted.
The LMC will continue raising these concerns through interface routes and asks practices to share examples and themes with their LMC representatives.
ACERS respiratory testing and spirometry waits
The LMC is raising ongoing concerns about the ACERS respiratory testing service, including long waits for spirometry and the potential impact on practices’ ability to deliver respiratory indicators within local contracts.
We are particularly concerned about proposals to review or remove patients from waiting lists where they had not re-presented with symptoms, especially where patients may already have been started on treatment because spirometry could not be accessed promptly. The LMC will seek clarification on how patients and practices will be informed, how safety risks will be managed, and whether additional capacity can be provided closer to patients, including through PCN-based locations where feasible.
The issue will be raised both locally and through NEL-level discussions.
Obesity management, QOF and GLP-1 prescribing
The LMC is concerned about the new obesity management QOF requirements and the lack of a locally commissioned service for medicines such as semaglutide and tirzepatide. Members are clear that adding activity into QOF does not make it core general practice work and does not necessarily fund the clinical delivery required.
The LMC view remains that practices should carefully consider the workload, clinical governance and future-year implications before taking on obesity prescribing and monitoring activity. Although the first-year cohort may appear small, the workload is expected to increase significantly in later years, while the funding remains limited.
Further LMC advice has been shared with practices via an e-alert and practices should review this carefully before deciding how to proceed.
North East London sector issues
Many issues affecting City & Hackney also affect other boroughs in NEL. We work closely with our counterparts in other boroughs to address and resolve them at sector level.
The latest issues of the sector newsletter contain important advice for practices on contractual issues to be aware of. You can read them here.
City & Hackney LMC
You can find contact information, meeting dates and membership information for City & Hackney LMC here.
Thank you to those who completed our Buying Group survey
Thank you to everyone that took part in our Buying Group survey, we plan to run another one in the autumn. We will be contacting the winners of the survey prize draw in the next couple of weeks and sharing details in our Londonwide LMCs newsletter.
- Hillcroft Surgery Supplies – Get next day delivery and industry leading stock availability, thanks to their investment in substantial warehouse facilities.
- Practice Index – Pick and choose what you need out of their learning platform, or software to manage HR, finance, compliance and rotas.
- Hippo Labs – Have your call-and-recall work smarter, reach more patients and improve QOF attainment. Hippo Labs automatically customises many types of message.
- Equity Energies – Reduce energy costs, save time, become greener and remove the administrative burden of managing utilities by having experts do it all for you.
- Surgery Connect – Automates more tasks within your phone system, integrates with clinical records and seamlessly bridges in and out-of-hours.
- MIAB – You existing policies may have more gaps than you think, particularly in developing areas like cyber and ARRS employment. Rely on MIAB’s specialist expertise to ensure you are fully covered.
- Restore Information Management – Whether it you need a room full of records doing or a steady flow of new registrations, Restore take the hassle out of digitising patient records.
- Tickets for Good – Reward yourself and your colleagues with free and discounted tickets to concerts, theatre shows, sports and more!