Chair’s introduction
I can’t believe that it is already 6 months since the last Merton LMC newsletter.
At the time we were all shivering, wet and miserable and now we are all hot, sweaty and miserable. Whatever the time of year, the weather remains a constant source of debate and complaint.
As I mentioned last time, 2026 has indeed proven thus far to be “interesting”. There have been massive challenges and changes, and yet much remains the same.
The ICB remains in upheaval, financial deficits remain seemingly unsolvable and the demands on General Practice are ever increasing. However, I am delighted to be able to report that our new Committee colleagues elected last Autumn have quickly demonstrated their commitment to contributing to the work of the Committee, providing valuable insights and new perspectives, which has been also the case in our neighbouring LMCs.
I am also glad to report that we have successfully concluded our negotiations with Merton Local Authority regarding the GP LARC contract. This has resulted in a significant uplift to the contract, which is now also open to new practices if and when they wish to sign up. I would like to take this opportunity to thank Kate Milsted and her team at the Local Authority for the pragmatic, constructive and ultimately successful pursuit of an agreement that worked for all parties, but most importantly for our patients.
Our negotiations with SWL ICB about the NHS Locally Commissioned Services remain ongoing (more detail on this area further down the newsletter). These discussions have been very heavily impacted by the huge personnel changes at the ICB. However, despite the challenges, we are making progress and hope to be able to provide more detail in the coming month or two.
Merton LMC continues to be heavily engaged in the development of relationships with colleagues across the system. We have continued to contribute to the Primary Care/Secondary Care Consensus document and the associated Consultant to Consultant Referral agreement. We are actively contributing to the Merton Place Primary Care Collaborative, seeking to ensure that we have a strong and unified Primary Care voice within the Merton Provider Alliance.
Merton LMC remains acutely aware of the national challenges that affect us locally, be that the national GP Contract again imposed on General Practice and the ludicrous expectations placed on us through the new Online Access requirements.
We are also very much aware of the impact that the new, abbreviated List Cleansing exercise has on practices, both on basic core income, but also on list-based Locally Commissioned Services.
The national picture is one we can only hope to influence by providing information and proof of impact to Londonwide LMCs, who have been collating data and using this information in their discussions at regional and national level.
On a local level, we are working with our ICB colleagues to see what mitigations may be able to put into place.
In the previous LMC newsletter, I wrote that my LMC colleagues and I plan to come out to your individual practices to listen to your concerns and challenges. We still aim to do so, but of course, real life has a habit of making things easy to declare but rather more difficult to implement. We still want to undertake this exercise but are mindful that your individual practices may struggle to identify the time and space to do that.
Pending further, more concrete engagement plans, please feel free to contact me, or any of my committee colleagues should you need to do so.
Finally, many of you will be taking time out in the summer, spending it with friends and family. On behalf of the Committee, I wish you all some peace and quiet, and some time to recharge your batteries.
Dr Marek Jarzembowski
Chair
Merton LMC
What is the LMC and what do we do?
- We are the representative body for General Practice that is recognised in statute and are the professional voice of General Practice at a local level.
- We are the only directly elected body representing all local GPs, regardless of their career position or employment status
- We consult with NHS bodies, Integrated Care Boards (ICBs) and local councils and any other potential commissioning bodies, negotiating local contract terms for General Practice
- The LMC works for and with individual GPs and practices, providing support through our knowledge of contracts, systems and stakeholders at all levels, including borough, ICB, regional and national.
- We inform and engage with workforce development, planning, education and training for all roles within General Practice.
- Merton LMC works closely with neighbouring LMCs in SW London, as well as with LMCs across London, under the umbrella of Londonwide LMCs.
Your LMC
Your Merton LMC committee members are listed below, and their term runs until 31 August 2028. If you need to speak to any of the LMC committee members about any issue impacting general practice, please contact them using the details below, or alternatively via: david.moore@lmc.org.uk.
- Dr Paul Alford (vice Chair), Morden Hall Medical Centre
- Dr Caroline Chill, Sessional
- Dr Elizabeth Higham, Central Medical Centre
- Dr Marek Jarzembowski (Chair), Sessional
- Dr Andrew Otley, Cricket Green Medical Practice
- Dr Elisabeth Wood, Morden Hall Medical Practice
- Dr Shailey Vora, Vineyard Hill Road Surgery
- Ms Alison Kirk (PM rep), Central Medical Centre
- Dr Melanie Coulson (VTS rep), Sessional
- Dr Andrew Wiggam (VTS rep), Sessional
Londonwide’s LMC Team supporting Merton LMC:
- Dr Asiya Yunus, Medical Director, Asiya.yunus@lmc.org.uk
- Kate Hudson, Director of Primary Care, Kate.hudson@lmc.org.uk
- David Moore, Committee Liaison Executive, David.moore@lmc.org.uk
- Emma Smith, Committee Administrator, Emma.smith@lmc.org.uk
What has Merton LMC been working on recently?
Updates from recent Merton LMC meetings – the LMC regularly meets with senior representatives from the ICB, the Federation, and Public Health. Below is a summary of our discussions over the last few months.
LCS review and payments
As referenced in the Chair’s introduction, there is an ongoing piece of work the Committee is engaged with the ICB on, for the review of our Locally Commissioned Services.
Although we still anticipate reaching an agreement with the ICB, the review has been temporarily paused. The fundamental reasons for this pause are two-fold:
- The first is that over the course of the last 18 months the ICB has undergone very disruptive changes both in structure and personnel, making it very difficult to maintain a degree of continuity and progress. The LMC has devoted very significant time and resource to the review process and remains committed to achieving the best possible outcome for Merton practices.
- The other fundamental reason for the pause is that the LMC has been able to demonstrate to the ICB in an evidence-based manner that the current Locally Commissioned Services are between 40 and 60% under-resourced, which reflects the inflationary pressures practices have faced over the last 10 years. The ICB has accepted the evidence the LMC submitted but has not yet been able to determine how to proceed, hence a pause in the review discussions.
We will of course inform practices of further progress if and when that takes place. In the meantime, practices may wish to review the Locally Commissioned Services they are still currently delivering and whether they remain viable.
PMS reporting 25/26
- An update was provided; practices are encouraged to contact the ICB with any queries.
Federation contract
- Contract extended, enabling continued delivery of access hubs and care homes services.
Immunisation uptake analysis (Public Health)
- Review of childhood and adult uptake across Merton showed that deprivation and ethnicity alone don’t explain variation.
- Around one third of children have no recorded ethnicity, and this group shows significantly lower vaccination uptake.
- Public Health will conduct further analysis, including:
- Coding practices and data completeness.
- Differentiating missing ethnicity from declined to provide.
Merton Provider Alliance and INTs
- Mobilisation of Integrated Neighbourhood Teams (INTs) is underway with SROs leading workstreams on workforce, estates, data/digital, and neighbourhood implementation.
- First test-and-learn site will focus on frailty to reduce admissions and support proactive community care before wider rollout.
- GP involvement assured: GP leadership embedded in governance with GP clinical leads for each neighbourhood team.
Urgent and emergency care
- Proposal for a virtual neighbourhood urgent care hub to coordinate care for housebound patients needing urgent community services or discharge support.
SWL cardiovascular risk management (CVRM) Programme
- Progress update on plans to develop community-based models of cardiovascular risk management, supported by funded primary care services and multidisciplinary working.
Clinical pathways and sccountability
- Members raised concerns about responsibility for patients discharged to community rapid response services.
- Emphasis on the need for clear clinical pathways and accountability to ensure patient safety.
- SWL Cardiovascular Renal Metabolic (CRM) Pathway is being worked up across SWL to start in October 2026, tier 1 will focus on coding and case finding for CKD with tier 2 planned for 27/28. The financial envelope and business case is pending.
- SWL Frailty pathway. We are aware of early discussions about this new pathway. We are awaiting the specification, metrics and the financial envelope attached to this.
Events
UK Conference of LMCs
The UK Conference of LMCs was held in May, and Dr Marek Jarzembowski (Chair of Merton LMC), represented Merton LMC at the conference.
The conference is the primary forum for creating and influencing policy related to issues affecting general practice. These policies form the basis for the work that is delivered by the General Practitioners Committee, England (GPCE).
Policy is formulated at Conference through debate and voting on motions submitted from the Local Medical Committees (LMCs), motions that are relevant to all nations are addressed at the UK Conference of LMCs. Motions that are relevant to all branches of practice or are of wider interest are submitted to the Annual Representative Meeting (ARM) for consideration and have the potential to become policy across the BMA.
A summary of the motions that were passed in May can be seen here.
England LMC Conference
The next LMC conference is the England LMC conference and will be held in London in November. As per the UK conference referenced above, motions that have been submitted by LMCs across England are debated, and if passed, are then taken forward by GPCE when engaging with government.
If you wish to suggest any topics that you believe warrant a motion being drafted for submission to conference, please contact David.moore@lmc.org.uk
In the last few months, the LMC has been asked to comment on the following pathways, consultations and referral forms:
- Merton referral management proposal
- SEL/SWL Integrated Primary Care Weight Management Pathway (see update below)
SEL/SWL Integrated Primary Care Weight Management Pathway:
SEL and SWL LMCs are engaged in discussions with SEL/SWL ICB regarding a proposed Integrated Primary Care Weight Management Pathway. We are aware that community pharmacists have been invited to express interest in delivering this service in SWL and want to keep you updated on how this is developing in SEL, and how your LMCs are seeking to work with the ICB to identify and address outstanding concerns.
SEL/SWL ICBs aim to implement a 2 year, neighbourhood based integrated weight management pathway across South London, using general practice for proactive case finding and community pharmacy for delivery, supported by wraparound behavioural services. The model would also see at-scale primary care organisations take on the role of Pathway Owners of a Community Pharmacy delivered Weight Management Service.
The target cohort in SWL:
- patients with BMI ≥35 with early onset type 2 diabetes, age 18–49 and not on insulin (2000 patients in SWL)
The target cohort in SEL:
- Patients >18yrs old, BMI of 40 or more and 3 or more comorbidities, atherosclerotic CVD, dyslipidaemia and hypertension on treatment (950 patients in SEL)
This approach seems to reflect one of the first Neighbourhood contracts we have had sight of.
Whilst LMCs support the ambition to improve patient access we remain concerned that the current model is not yet safe, sustainable, or sufficiently clear to enable implementation.
Key issues raised:
- Clearer contractual, clinical accountability and governance arrangements are needed to avoid fragmented accountability across providers.
- Data-sharing, coding, system access, audit and communication processes need to be clarified and agreed before launch.
- Discharge and transfer-of-care arrangements must be explicit, funded and clinically supported before responsibilities move to general practice.
LMCs have warned that, without further work, unresolved workload, clinical and medico-legal risks may fall back to general practice.
LMCs have asked that these issues are addressed before procurement and implementation progresses further and remain willing to work constructively with the ICB to achieve this.
Contract negotiations
The LMC have also concluded negotiations with Merton Local Authority regarding the GP LARC contract. This has resulted in a significant uplift to the contract, which is now also open to new practices, if and when they wish to sign up.
Interface working
The LMC is represented on the SWL Primary Care/Secondary care interface group comprising representatives from primary care and the acute trusts. This group has been involved in the development of a consensus on the primary/secondary care interface working and the LMCs has commented on the draft.
A SWL primary care/mental health interface group will shortly be established and the LMC will be represented on that group.
SWL Clinically led strategy programme
SWL ICB is developing a clinical strategy as a mechanism to deliver the 10-year plan. As part of this work the ICB has set up specific clinical workshops and the ICB has invited LMC representation on the following groups: frailty and end of life care, LTCs and multi -morbidities, mental health, planned specialist care, maternity and neonatal, unplanned care.
The LMC role on these groups will be to ensure that General practice should not be expected to absorb additional work or fill gaps created by changes or reductions in other services or commissioning decisions and any new asks must not erode core GP capacity and practices cannot be expected to do more without additional funding.
GP survival guide
Londonwide LMCs provide, via their website, a GP Survival Guide, which is your quick reference guide to useful resources to help manage your workload and avoid unsafe situations for both practitioners and patients.
The Survival Guide is intended as an easy to refer to resource for use during clinical sessions, allowing practitioners to:
- easily understand what activity they are required to undertake and what they can push back against,
- explain to patients, trusts, commissioners and other bodies why a piece of activity should be provided elsewhere in the system, and
- seek help from their local medical committee or the Londonwide LMCs team where your ability to deliver safe care is compromised by an issue outside the gift of the practice to resolve.
It also draws together other resources to help you to design and make changes that support safe effective working.
Londonwide LMCs exists to care for, value and protect everyone working in London general practice so that you can care for, value and protect your patients. It is the role of LMCs and Londonwide LMCs to raise requests for inappropriate workload transfers into general practice with the organisations who make them and seek to change behaviours, so such requests stop.
A key resource contained within the guide is a link to a set of template letters, that can be utilised by GPs/practice staff, to quickly explain that a request should not be actioned in general practice and detail where is the appropriate setting for the request to be made, if there is one. These are outlined below:
- Referral rejection due to lack of proforma
- Trust request for non-contractual task(s) (prescription of medications, arranging investigations, following up results, undertake monitoring, issuing MED3s, refer patient back, postoperative checks)
- Automatic discharge of patient following DNA
- Response for delayed clinic letters
- Housing applications
- DWP appeals
- Flying when pregnant
- Letter to schools regarding administering medications to children
- Requests for sick notes for illness lasting fewer than seven days
Other services that Londonwide LMCs provides on behalf of general practice across Merton
GP Support team
The General Practice Support team comprises non-medics (Vicky Ferlia, Jan Swannell, Jacqui Perfect, Yvonne Frank, Vanessa Douglas) and Medical Directors (Dr Elliott Singer, Dr Kirsa Morganti, Dr Sara Riley, Dr Lowri Kew).
The team operates at different levels providing confidential, tailor-made, expert advice and assistance to individual doctors, practices and PCNs in difficulty. They offer contractual support to our primary care teams. Feedback/responses to papers & briefings to LMC reps. Policy influence at London level e.g. NHSE/ICBs, CQC. Attendance at Performance Advisory Group (PAGs) and Performers Lists Decision Panels (PLDPs). General Practice support includes:
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PCN Support
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For help or support please contact the GP Support team at gpsupport@lmc.org.uk .
Workforce-Training and Innovation (WTI)
Update from the Workforce, Training and Innovation (WTI) Team
Our refreshed Buying Group offer was relaunched in October, and we encourage you and your practice teams to explore the wide range of high-quality products, services, opportunities and offers now available to London general practice—at competitive prices and with excellent deals.
There is no sign-up required. Simply let the supplier know that you are a practice within the Londonwide LMCs area when placing an order.
Visit the Londonwide LMCs Buying Group to start benefiting from opportunities to:
- Save – access exclusive discounts, offers and deals
- Earn – benefit from rebates and funded projects, including research opportunities
- Sustain – support staff wellbeing and environmental sustainability
We also invite you to explore our training offer in the events brochure
If you have any questions or ideas, please get in touch at WTI@lmc.org.uk — we would be delighted to hear from you.
Ann Ayamah (Head of Workforce-Training and Innovation) on behalf of the team.
Well done to the prize draw winners from 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. The randomly selected winners of the gift vouchers were:
- Trudy Do, Havergal Surgery
- Karen Tobin, The Bromley Common Practice
- Anca Radulescu, St. Margarets Medical Practice
- Marian Negoita, Amersham Vale Practice
- Aparna Pal, Jubilee Garden Medical Centre
Our Buying Group suppliers are:
- 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 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!