Dear colleague,
Chair’s introduction
I am pleased to share with you the latest NEL newsletter, covering a number of important issues affecting practices and patients across North East London. This month’s updates include safeguarding considerations for vulnerable children who move out of area, rabies post-exposure arrangements, local contract changes, the LTC PCQOF and PCIT transition, NEL Single Point of Access, and shared care principles.
A common theme across these items is the need to ensure that system changes are safe, deliverable and properly supported. Practices should not be left carrying additional workload, clinical risk or operational responsibility without clear pathways, appropriate resourcing and meaningful engagement with LMCs and frontline teams.
I want to personally thank our LMC Officers for their dedication and support to all of us.
Please continue to share concerns, examples and queries with your local LMC representatives. This intelligence is vital in helping us challenge inappropriate workload transfer and represent the views of practice and GPs across NEL.
Dr Gabriel Ivbijaro MBE
Vice Chair
Waltham Forest LMC
Local guidance
Spotlight on: Vulnerable children who move out of area
Following a query from local safeguarding leads, Londonwide LMCs have looked at guidance for vulnerable children who have moved out of the practice area but remain registered. There are two competing safeguarding risks. Removing a vulnerable child may risk them becoming invisible to services if they are not re-registered elsewhere; however, continued registration with a distant practice may also create risk if the child cannot meaningfully access local primary care or wider health services.
The LMC view is that there should not be a blanket policy either to retain or remove these children. Practices should undertake an individual risk assessment, considering the level of safeguarding concern, whether social care is involved, confirmation of the child’s current address, whether the child is accessing healthcare, and whether registration with a local practice is realistically achievable.
Where children’s social care is involved, practices should ask them to support safe transfer to a local GP practice. If removal is being considered, practices should liaise with the allocated social worker, document the safeguarding rationale carefully, share relevant information where possible, and escalate concerns if the child may become unregistered.
Rabies post-exposure vaccination and immunoglobulin
Practices have raised queries following requests for post-exposure rabies treatment, including vaccination and infiltration of rabies immunoglobulin into and around the wound site.
NEL ICB has advised that there is currently no local primary care pathway for this. The ICB agrees that patients requiring immunoglobulin infiltration should attend A&E, as this is not work that would normally be expected of primary care and should only be undertaken by clinicians with the appropriate competencies.
The wider contractual position is that, since the 2021/22 GP contract changes, routine pre- and post-exposure vaccinations, including NHS travel vaccinations, sit within essential services and are funded through global sum. Post-exposure rabies vaccination is also considered immediately necessary treatment. Rabies vaccine is supplied free to practices on request by UKHSA or health protection teams, usually within 24 hours.
The LMC view is that practices should distinguish between administering post-exposure rabies vaccination, where clinically appropriate, and immunoglobulin infiltration, which should be directed to A&E or another suitably competent provider.
Commissioning updates
Local contract changes and affordability
NEL LMCs have developed principles for agreeing changes to local contracts with the ICB. This follows concerns that changes to specifications, workload or expectations can be introduced without sufficient engagement, implementation time or assessment of deliverability.
The proposed principles are intended to avoid unilateral imposition of changes and to set clearer expectations around mutual agreement, notice periods, sustainability, affordability and operational impact. Importantly, wording has been added to make clear that where funding does not increase, workload and ambition may need to reduce so that services remain deliverable.
The LMC view is that practices and PCNs cannot be expected to absorb increasing workload within a fixed payment envelope. Local contracts must be clinically realistic, financially sustainable and deliverable in practice. Londonwide LMCs will continue to work with the ICB to seek agreement on these principles for inclusion in the contract framework.
LTC PCQOF and PCIT transition
NEL LMCs continue to engage with the ICB on the NEL LTC PCQOF scheme development. This is important because practices and PCNs are expected to deliver against a scheme where operational dependencies — including templates, searches, dashboards, call/recall processes, indicators, targets and reporting arrangements — are still being worked through. Practices should not be financially penalised for delays or technical issues outside their control.
The LMC position is that year-one implementation must be proportionate, pragmatic and fair. Where practices have undertaken work in good faith, there should be protection from unfair clawback, particularly if final coding or template requirements were not available at the time the work was completed.
Londonwide LMCs will continue to press the ICB for practical mitigations linked to the PCIT transition and the delays in finalising the service specifications and targets.
Single Point of Access, Advice and Refer
The ICB has provided an update on Single Point of Access and Advice and Refer. In NEL, Advice and Refer directs Advice and Guidance requests and referrals, except two-week-wait and suspected cancer pathways, into a single access point at specialty or subspecialty level. Possible outcomes include advice back to the referrer, straight-to-test, referral into a community pathway, or acceptance onto an elective waiting list.
NEL LMCs have raised significant concerns about workload transfer, patient communication, clinical accountability, response times and whether the quality of existing arrangements has been properly evaluated before further rollout. The national specification sets response times of five working days for routine requests and two working days for urgent requests, with dashboard data available by provider and specialty.
The LMC view is that A&R can work well where there is genuine specialist input, clear relationships and timely responses, but it must not become a mechanism for shifting outpatient work into general practice. Practices need clear clinical accountability, including named accountable clinicians, and robust escalation routes where responses are unsafe, delayed or inappropriately transfer work. Practices should share anonymised examples of poor-quality, delayed or unsafe A&R responses with their local LMC; as well as raise NEL Quality alerts.
Local engagement
Shared Care Principles
Londonwide LMCs recently met with NEL ICB medicines leads to discuss the draft London Shared Care Principles. We welcomed the opportunity to influence the document at an early stage and emphasised that any shared care arrangements must prioritise patient safety, clinical appropriateness and properly resourced services, rather than being driven by pressures to transfer work from secondary care into general practice.
The LMC sought a number of important amendments, including making it explicit that shared care remains voluntary for practices and individual GPs, that specialists retain responsibility until a shared care arrangement has been formally accepted, and that national formulary classifications do not automatically create contractual responsibilities for general practice. We also highlighted the need for funding to reflect workload, activity and clinical risk, with any commissioning arrangements considered through a separate workstream.
The ICB welcomed the feedback and agreed to take a number of the proposed changes back to the London-wide medicines group. We also discussed the importance of earlier and more consistent engagement with Londonwide LMCs in the development of London-wide policies, helping to ensure general practice perspectives are reflected from the outset.
PCIT Data Processing Agreement and DPIA
Practices will have received a Data Processing Agreement from Primary Care IT Limited, relating to the transfer of the Primary Care Clinical Information Facilitation Service from CEG to PCIT on 1 August 2026.
Londonwide LMCs reviewed the DPA and DPIA at the request of NEL ICB and raised four areas of concern, including practice liability for licence/payment costs, the tight timescale for DCB0160 clinical safety assurances, use of anonymised data, and wording around PCIT’s use of practice data. NEL ICB accepted pragmatic amendments, including confirming that the ICB, not practices, is responsible for licence and maintenance costs; that anonymised benchmarking will not proceed in phase one; and that PCIT will process data only as instructed by practices as controllers.
Londonwide LMCs cannot approve or endorse individual DPAs, as each practice must decide whether to sign as data controller. However, the agreed changes provide greater clarity, reduce contractual risk and strengthen data protection safeguards.
Practices should review the DPA and, if satisfied, sign it. Practices requiring further assurance should seek advice from their GP DPO and consider the operational implications of losing access to the service.
Constituent engagement
Our NEL LMCs are working to optimise opportunities for engagement with our constituents, whether through newsletters, our website, individual practice meetings, discussions with PCNs or borough-level events, including PLTs. We are keen to listen to practices, to understand their concerns and the challenges they are currently facing – please let us know if you would like a call or a face-to-face visit from a member of your local LMC. Please email ian.williamson@lmc.org.uk for further information.
Please also visit the Londonwide LMC website for a one-stop shop on our support for practices—details of our services, practical resources (including template letters and guidance), and details and updates from our North East London committees, including previous local and NEL newsletters.
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!