Chair’s introduction
As we continue to navigate the challenges facing general practice, maintaining a strong and collective voice remains as important as ever. I would particularly encourage colleagues to attend our upcoming Practice Engagement Event on Thursday 12 November, jointly hosted by the LMC and City & Hackney Integrated Primary Care. This will be an important opportunity to discuss the pressures facing practices, share concerns and explore how we can work together to protect safe and sustainable patient care.
I would also like to draw your attention again to our Mental Health Services Survey. We are aware of significant concerns regarding access to and the quality and consistency of mental health provision across City & Hackney, with considerable variation between neighbourhoods. With the local mental health transformation programme due to restart in November, we have an important opportunity to influence discussions and advocate for meaningful improvements. However, we need evidence from practices to strengthen our representation. Responses so far have been very limited, so I would strongly encourage every practice to take a few minutes to complete the questionnaire and share their experiences.
Elsewhere in this newsletter, we highlight several ongoing challenges, including the Adult ADHD LES, unfunded workload associated with DOAC monitoring and weight-loss prescribing, and continuing difficulties with community referral pathways. The LMC remains committed to challenging inappropriate transfers of workload and ensuring that the concerns of frontline general practice are heard and acted upon.
As always, thank you for your continued hard work and engagement. I look forward to seeing many of you in November.
Dr Vinay Patel
Chair
City & Hackney LMC
City & Hackney LMC Membership and meeting dates
What has City & Hackney LMC been working on recently?
Practice engagement event
This is to be in-person event on 12 November 2026, from 6.30-8.30pm at the Tomlinson Centre. It will be a joint event between City & Hackney Integrated Primary Care and the LMC, focused on key issues affecting general practice and how we can work collaboratively to protect safe, sustainable patient care.
Complete this registration form
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.
To give us some weight of evidence to get these issues addressed, please would one representative per practice complete the survey here, if possible by Thursday 19 November.
Adult ADHD LES
Practices were asked to sign up to the LES by 9 October 2026. NEL LMCs’ position on this specification remains largely unchanged from previous communications – the final version of the specification has not addressed all of LMCs’ serious concerns raised. These included that the pathway does not appear to be NICE compliant, care is transferred not shared, the tariff is far below comparable schemes elsewhere and NHS national payment guidance, and there is still no formal NEL accreditation for Right to Choose providers. Therefore Londonwide LMCs is not able to endorse this specification. There is a fuller statement in the NE London sector newsletter.
During discussion, Londonwide LMCs secured an improvement in the form of a clarification that patients should only transfer to general practice once medication has been initiated, titrated and stabilised, with ELFT/NELFT providing specialist advice and re-titration support. However, this support is not yet live and LMCs remain unconvinced that the providers will be able to meet the stated 24-hour urgent and 72-hour routine response times.
The LMC view is that practices should think very carefully before accepting any scheme that transfers specialist prescribing and monitoring responsibilities without adequate funding, safeguards and continuing specialist support. Practices should consider these risks carefully before making any decision to sign up.
Private providers – requests for patient information
Curaleaf and similar private services are increasingly asking GPs directly to confirm there is “no reason” a patient should not go ahead with treatment, effectively asking GPs to underwrite a private provider’s clinical decision using information the provider has not obtained itself. This was also seen last year with private weight-loss clinics prescribing Mounjaro.
We recommend a short, standard reply telling the provider to obtain the information directly from the patient, who can now share their full record via online access. If the provider wants a formal suitability assessment, GPs are entitled to charge for it as a private service. You should still also reply with any obvious red flags (for example, active psychosis or substance misuse) that are on the record and which you therefore know about.
There is a template letter prepared for similar requests from private providers, here which GPs can adapt for similar requests from services like Curaleaf.
DOAC monitoring: keep delivering it, but under protest
There is a long-running standoff over funding for DOAC monitoring. The LMC’s assessment, backed by the BMA’s own list of services that should attract funding beyond the core contract, is clear: DOAC monitoring is not core GP work and should be commissioned separately. Tower Hamlets had its local funding withdrawn in April, and London region ICBs now appear to be coordinating to avoid paying for this work anywhere in the capital.
Londonwide LMCs are escalating this at London region level and will keep you updated on progress.
Mounjaro and QOF: doing the work may cost your practice money
There is a genuinely messy situation with the new QOF indicator for weight-loss injection prescribing. NHS England appear to have made the misguided assumption that putting this into QOF would create an obligation to deliver the work and that the QOF payment would cover delivery costs, neither of which is true: QOF is an incentive scheme, not a funding mechanism, and this means that practices may decline to undertake the work and choose to forgo the points. The inclusion of a target in QOF also does not absolve the commissioner of a responsibility to commission a service either from practices or from another provider (to provide a service where practices have declined).
There is also a coding exclusion available if there is no commissioned secondary care service to refer into, though using it means forgoing the QOF payment for those patients rather than being excluded from the calculation altogether.
The LMC have undertaken a review of the work and funding available under QOF: for an average practice, year one is roughly cost-neutral, but the workload, and financial loss, grows significantly in years two to four as the patient cohort builds, potentially costing an average practice around £2,000-£2,500 a year in loss-making clinical time. It is worth deciding as a practice whether you will deliver this work, refer into a commissioned pathway (such as Voy), or hold the line and decline unfunded work, with full awareness of the trade-offs either way.
Please read the Londonwide LMCs briefing on obesity QOF and Tirzepatide policy in NEL.
MSK/physio referral pathway remains difficult for patients and practices
The single point of access booking system for physiotherapy is generating ongoing frustration: patients are given a reference number and told to call a booking line, only to frequently be told no appointments are available and to call back another day. Separately, correspondence back from the service is poor, so practices often have no way of knowing what is happened to a patient who was referred weeks or months ago, and end up referring again “just in case.”
We will be liaising directly with Locomotor to try to improve these issues.
Quality alerts: making them easier to use is now a priority
Feedback from practices is that quality alerts are a good process in principle but are underused: they are not integrated into EMIS workflow, there is no visible feedback loop showing what raising them actually achieves, and clinicians, particularly those who are not partners, don’t always feel supported or confident using them. Raising an alert with a trust outside North East London (for example, a neighbouring ICB) is also currently very difficult and has to be routed through the ICB, often with a lot of chasing.
What is planned: the LMC is working on a consensus “interface” document (already adopted in North Central London) setting out expected standards for discharge letters, referral responsibility, and results ownership between practices and hospitals, which should give quality alerts more teeth. In the meantime, expect more regular information in future bulletins on how to raise a quality alert and what impact it is having across City & Hackney, and a practical, hands-on demonstration of the process is being planned for the autumn practice engagement event. NEL Quality Alerts can be found here.
Spirometry waiting times: ICB now aware and looking into it
The current spirometry service in City & Hackney has a waiting list of around 12-16 months for a first appointment, considerably longer than in some neighbouring boroughs where the service runs directly through primary care. The provider (ACERS – Adult Cardiorespiratory Enhanced and Responsive Service) has said it has run out of funding and is planning to remove patients from long waiting lists under new eligibility rules, some of whom may have already been waiting six to twelve months.
This has now been raised directly with the ICB’s new primary care lead, who has committed to looking into the contract and getting back to the LMC. If your practice is seeing the impact of this waiting list on patients, it is worth flagging specific examples to the LMC to support this.
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 issue of the sector newsletter contains a spotlight on guidance on the GP Reimbursement scheme, commissioning updates on LES reviews, Same-Day-Access and others, and other sector news including ICB Clinical Director roles, and our proposed secondary care interface principles. You can read it here NEL Newsletters.
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