City and Hackney LMC Newsletter March 2025
Vice-Chair
We are happy to note that LMC member Dr Sweta Raj has stepped up to fill the Vice-Chair vacancy on the LMC. Dr Raj is a salaried GP at Statham Grove Surgery.
Infectious diseases
We received an update in February on infectious diseases from Public Health colleagues. Numbers seem to have peaked for a number of outbreaks including Flu, Covid, RSV, pertussis and measles. Norovirus numbers were still high. Vaccination remains important, with measles rates particularly low. GPs were advised to consider pertussis as a possible diagnosis as there were still cases in January.
Also GPs were advised to be alert to Clade 1 Mpox, of which there have been several UK cases among travellers to specific African countries or their household contacts. Cases without such travel history are more likely to be Clade 2, which has been circulating within the UK. City & Hackney Public Health have provided information, which can be found via this link.
Secondary care interface
LMC Chair Dr Vinay Patel has been participating in the interface meeting set up between local GPs, the Homerton and commissioners.
- The hospital plans to provide to GPs a list of services they do not provide, and we have advised that alternative pathways should be included in this.
- The hospital is working on providing fit notes, and initially this will be for elective inpatient surgery – an IT solution is being sought for other services.
- It is proposed that, as a pilot, the referral route for neurology outpatient services be via Advice & Referral (A&R) only. We have asked that GPs be involved in designing this change, which has therefore been paused while the hospital engages with the primary care clinical lead.
As well as the neurology A&R pilot there is also work on a gynaecology single point of access, which is intended to route patients to community gynae services where appropriate. It may ask GPs for information on cases. There could be a chance that it would seek to route interventions back to GPs, as Advice and Guidance / Referral tend to do. For any of these cases, where GPs are clear that referral is required, Londonwide LMCs has devised some wording that can be used.
As well as our local engagement with the Homerton, the LMC has raised issues with NE London commissioners about our patients accessing services at other hospitals such as the Royal London. Commissioners have responded positively and we hope for some action.
SMS messages
Practices will be aware that the ICB is working to keep practice SMS (text message) bills within its budget, and has announced a cap on the annual amount of messaging per patient. Londonwide LMCs has lobbied the ICB intensively to make the case for funding SMS as an efficient way to communicate with patients, promote the uptake of services and reduce unnecessary appointments and DNAs. The ICB has acknowledged that practices are reporting that DNAs have increased and vaccinations decreased as practices send fewer prompts and reminders.
As it stands, practices will face some limits on the number and length of messages they can send without being charged for the excess. Following LMC pressure, the ICB should be giving communications to help practices monitor and control their texting. IT facilitators are also visiting practices.
Practices may consider increasing their use of email to contact patients. Londonwide LMCs has provided some guidance. If you are texting a patient in AccuRx, an option to send by email may appear if you click on the word Mobile at the top right.
Withdrawing unfunded work
Given financial and workload pressures, practices may be considering giving notice to elements of unfunded, non-contractual work that they may have been providing to cover commissioning gaps. Londonwide LMCs has provided a letter template which can be used for this purpose.
NEL ICB review of locally commissioned services
The LMC is engaging with the ICB in response to their proposed review of locally commissioned services in NEL. In collaboration with other NEL LMCs, we have drafted key principles and priorities to inform the review process. Some of the key areas we are focusing on are:
- The lack of uplifts on service budgets over many years across NEL and the need to review tariffs in the light of cost pressures on practices (including the NI increase).
- The need to ensure that budgets are preserved at least at the current level. Any reduction in funding needs to be reflected in the new specs, with lower demands on practices.
- Demanding impact assessments on patient care for any changes to current services.
- Understanding disparities in investment levels across boroughs in NEL.
If GPs feel there are specific contracts which need looking at or are not worth participating in, please let us know. Contact Daniele Serdoz ([email protected]).
Care homes spec
The LMC has seen a new proposal for the Care Homes locally commissioned service (LCS) and has considerable concerns, including:
- A reduction in the tariff per care home bed compared to the value in the current specification.
- The shift in the payment model, which will see 50% of the payment dependent on achievement of 7 KPIs, which all have unrealistic targets.
- The significant workload involved in delivering all elements of the specification.
- The lack of acknowledgement of the level of resources involved in delivering this service especially in home where there is a high turnaround of residents.
We have provided detailed feedback to the ICB and raised our concerns around the sustainability of this service in the current proposal. As currently structured, the LMC cannot recommend implementation of this specification. We are meeting with the ICB to have further discussions.
Digital facilitation
There is a NEL ICB digital team, who support practices with engaging patients digitally – they can support practices in their work on channels such as the NHS app, and may potentially be able to attend a meeting with the practice PPG. Practices can contact City & Hackney senior facilitator Raymond Berry or team lead Chito Nwulu.
London Ambulance Service procedures
LAS have developed a decision-making tool for LAS staff to observe which clearly articulates the circumstances when crews should contact GP practices. These are agreed for the following situations:
- End of life care.
- Information sharing regarding/surrounding a safeguarding referral.
- Expected death.
- GP admission request where on arrival of the LAS crew the patient is refusing conveyance which the patient’s GP has arranged.
For all other situations there are other processes for ambulance crews to follow including accessing internal LAS clinical support and advice. Incidental findings will be shared with details of the London Care Record or via an electronic form – patients will be advised by the LAS crew to contact the GP for a routine follow up.
London General Practice Awards
The 2025 London General Practice Awards were celebrated in the Houses of Parliament on 6 February. City & Hackney was very well-represented: Richmond Road Medical Centre won the Non-Clinical Team award; Latimer Health Centre won the GP Nursing Team award; and Dr Joseph Spitzer (Cranwich Road Surgery) was commended in the Long Service award. The full roster of winners and commended nominations, with photos and report, is available here.
Annual conference of England LMCs
LMC members Dr Lisa Milverton and Dr Sweta Raj attended the annual conference of England LMCs in November. They reported that experiences had been shared from LMCs across the country, and debate of issues including progression of newer GPs and the status of Additional Roles staff. Dr Raj’s motion on general practice IT was chosen for debate and passed by the conference. A report of the resolutions from the conference is available here.