Chair’s introduction
As we move through another period of significant change across the NHS, the LMC remains focused on representing and supporting City & Hackney general practice. We know practices continue to face intense workload pressures, alongside increasing system complexity and shifting expectations at the primary-secondary care interface. In this bulletin, we highlight several important local developments and the work your LMC is undertaking on your behalf to challenge inappropriate workload transfer, protect safe patient care, and ensure the voice of general practice is heard clearly across the system.
A key priority for us this year is strengthening engagement with our constituent practices. We are
pleased to have established named LMC links with each PCN and look forward to building closer, more regular dialogue with practices through these relationships.
Your experiences and concerns are essential in shaping our priorities and advocacy, and we encourage practices to continue raising issues through your PCNs or directly with the committee so that we can represent you effectively.
Best wishes,
Dr Vinay Patel
City & Hackney LMC Chair
City & Hackney LMC Memebrship and contact info
Member spotlight – Sweta Raj
Hello everyone,
This is my second term with our LMC, and I have been vice-chair since January 2025. I am a salaried GP at Statham Grove Surgery and have been a Hackney GP since 2015 in salaried, locum and partner roles.
Being a part of the LMC allows me to translate the day-to-day frustrations of working in general practice into meaningful dialogue (and change!). Our LMC meetings are once every two months and are attended by IPC and ICB colleagues.
Along with our chair, I attend monthly meetings with Chairs and Vice-chairs from LMCs across NEL. We are also in daily contact with Londonwide LMCs.
With recent changes at the ICB level and the ever-changing national GP agenda, our local medical committee voice has become more important than ever. Please do get in contact with us with your concerns.
Surviving the 2026-27 GP contract – webinar recording
A recording of the first run of Londonwide LMCs’ webinar is now available on the 2026-27 GP contract guidance page for those people who were unable to attend either session.
You can find out about the effect on London of the contract changes, with our unique patient population and commissioning arrangements, based on the documentation available at the end of April.
What has City & Hackney LMC been working on recently?
Constituent engagement
We are committed to improving our engagement with our constituent practices. We now have an LMC member assigned to each PCN and dialogue has started with your CDs. Some of our members will be attending your PCN meetings in the coming weeks and months and we intend for this to be a new two-way communication pathway for the longer-term. Such conversations are already helping to inform our LMC agenda and priorities.
If you have any issue in your practice that needs resolving at the LMC level, please ensure your PCN is aware. PCNs, if you are not in touch with an LMC rep to raise your issues with the committee, or any practice who would like to contact the LMC directly, please email the LMC’s committee liaison executive ian.williamson@lmc.org.uk.
Local contracts
The LMC and the Londonwide team are fully engaged with the City and Hackney IPC in the NEL Enhanced Services (LCS) review and the implementation of the new LTC Proactive Care Quality Outcome Framework. Updates on progress are provided in the NEL newsletters.
Homerton interface and the use of A&G
The LMC has discussed concerns at interface meetings with Homerton about the direction of travel on Advice and Guidance (A&G) and referral pathways. We are increasingly concerned that A&G may be used as a gatekeeping mechanism, making it harder for GPs to refer patients into trust services when specialist assessment is clinically required.
Updated GPCE/BMA guidance is clear that GPs retain the ability to refer where this is clinically appropriate; A&G and Single Point of Access arrangements must not delay, deflect or prevent access to specialist care, and must not shift unfunded work into general practice. The guidance also makes clear that where a GP needs specialist assessment rather than advice, the referral should explicitly state that a specialist consultation is required. If a referral is returned as A&G instead, practices may respond formally to clarify that this was a referral rather than a request for advice.
In short, where a GP believes a patient needs to be seen, they should make this clear in both the referral and any A&G request and insist that the trust accepts the referral.
Antenatal prescribing pathway
City & Hackney LMC is aware that Homerton maternity services have, at times, asked GPs to prescribe antibiotics. Locally, an interim agreement is in place for City & Hackney GPs to continue supporting this prescribing for now while a longer-term solution is put in place. We recognise this represents a workload shift into general practice and is not a sustainable arrangement.
Homerton is now working towards implementing electronic prescribing, which will allow prescriptions to be sent directly to patients’ community pharmacies and should remove the need for GP involvement in the prescribing purposed. We will continue to engage locally and keep practices updated as this work progresses.
Change to end-of-life medication process in the community
Practices should be aware of an important change to the process for end-of-life medicines in the community from 1 May 2026. Following agreement between the LMC and the community district nursing service, GPs are no longer required to complete MAR/MAAR charts for end-of-life medicines. Community nurses will now transcribe onto the MAR chart from the End-of-life Medicines Administration Request Form or the FP10, in line with the updated local policy.
For prescribers, the key requirement is to ensure that the prescription and supporting documentation are clear, complete and legally valid. Please make sure you provide:
- a completed End-of-life Medicines Administration Request Form for all community end-of-life medication requests
- a valid prescription signed by an authorised prescriber
- clear medication details, including drug name, formulation/strength, route, dose or dose range, frequency, and maximum dose in 24 hours where relevant
- for syringe pump medicines, the diluent and clear administration instructions
- for controlled drugs, all usual legal prescription requirements, including quantity in words and figures where required
Updated forms are available on EMIS – search ‘EOL’ in emis documents. Incomplete or unclear information may delay administration, so it is important that all sections are fully completed. For changes in dosage or medication a new form needs to be resubmitted. Full Clinical Guidance available from St. Joseph’s Hospice.
Completed documentation should be sent to the community nursing team together with a referral form to the Adult Community Nursing referral inbox.
MRI communications to patients
We are hearing that practices are often having difficult conversations with patients who are attending for MSK conditions, when they tell them that they are not able to request MRI scans for MSK anymore. The LMC has put together the statement below, that can be shared with patients to explain why this is happening.
“NHS North East London Integrated Care Board (NEL ICB) has changed the process for requesting MRI scans for most muscle and joint (MSK) conditions. This means your GP practice can no longer request these MRI scans directly in the usual way.
Instead, if an MRI is needed, your GP will refer you to the community MSK service. A senior MSK clinician within that service will assess your symptoms and decide whether an MRI is appropriate, and arrange it if needed. This is an ICB decision and applies across North East London.”
Public health
Last year’s measles outbreak has been declared over after a vaccination effort and the summer holidays, but still monitoring, especially as the Enfield outbreak has reached Islington.
The meningitis outbreak recently in the news was localised to Kent and specifically certain university/nightclub sites of transmission. Those in the affected sites will have been advised that they should have the vaccine and how – others should follow the usual vaccination schedule
Transfer of care for ADHD in children and young people
The LMC has been made aware of a proposal to change the CAMHS model for prescribing ADHD medication for children and young people, including arrangements for physical health monitoring. The proposal is for practices to accept a transfer of care for children 9 months stable on ADHD medication, who are routinely reviewed for height, weight and BP monitoring. The GP will be expected to take on this monitoring. They estimate that this will involve on average 2-4 patients per practice, each requiring 2 reviews per year.
The LMC has concerns that this transfer of care model does not include any general practice contract or resourcing to support the workload transfer involved. We are therefore seeking clarification from ELFT and raising concerns about any routine expectation that practices should accept transfer of care in these circumstances.
Changes to the Integrated Care Board
NE London ICB’s new, much smaller, structure has been announced. Staff taking voluntary redundancy have now left and recruitment to posts in the new structure is underway. The ICB’s capacity will clearly be reduced, and familiar contacts will be changing.
GPs and practices are advised to use, or at least copy in, the ICB general contact address nelondonicb.nel-primarycare@nhs.net as individuals may have left. Enquiries will be routed from the general address to current responsible staff.
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. There is also a NEL newsletter for the sector work – the April issue covered XYZ. You can read it here.
City & Hackney LMC
You can find contact information, meeting dates and membership information for City & Hackney LMC here.
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