Dear Colleague,
Happy new year to you all. It seems that 2026 promises to be a year of traversing unchartered waters. There is the restructuring of the ICB, significant reductions in the number of ICB Clinical Leads and widespread changes in several Local Enhanced Services across NEL to steer through.
This year, LMCs will be invigorating our approach to constituent engagement. Your LMC wants to hear from you, including what you need for your practices, to remain a beacon of light for your patients. Successful borough level engagement events have already occurred in Tower Hamlets, Redbridge and Waltham Forest; with other boroughs to follow the same course. Collaboration, communication and cooperation are key for us to work together and manoeuvre our way through the storms ahead.
Although we are sailing into turbulent times, please rest assured that your Borough LMCs and the Londonwide LMC team have strapped themselves to the mast and that we are here to help you navigate to calmer seas. Best wishes,
Dr Shabnam Quraishi
Associate Medical Director
Londonwide LMCs
Spotlight on policies and guidance
Shared care
Shared Care guidelines are commonly used within the NHS to facilitate the transfer of prescribing and other work usually done in secondary care services to general practice whilst retaining a degree of specialist oversight.
Such work is by definition not part of the core GP contract, and so participation in shared care arrangements is discretionary; GP clinicians are not obliged to accept Shared Care and should only do so where they are satisfied that it is clinically appropriate and safe. Clinicians can decline to take on Shared Care arrangements as a policy, or on a case-by-case basis – as long as the decision is made on grounds which are not in any way discriminatory.
Such transfers of work are usually funded, and Local Enhanced Services for Shared Care are commissioned in a number of other ICBs in London and across the country. However, there is currently no Shared Care Local Enhanced Service commissioned by the ICB across North East London. As a result, any transfer of work to primary care under Shared Care arrangements is currently unresourced. Londonwide LMCs are currently in discussions with the ICB about securing funding for this work.
Read the Londonwide LMCs guidance here, which now also includes a patient facing letter.
Commissioning updates
Enhanced services review
Londonwide LMCs have written to the ICB on behalf of NEL LMCs to raise significant concerns about the Enhanced Services Review and related commissioning decisions now being progressed through governance. The ICB continues to reference implementation from April 2026 despite key details about the proposed schemes still being outstanding. We have warned that the current timescales are unrealistic for NEL-wide commissioning and safe practice implementation—particularly in boroughs facing more substantial changes—and that decisions are being advanced without sufficient borough-level impact assessments, including modelling of potential practice income changes. We have therefore asked the ICB to roll over current schemes for at least six months, to commit to a more coherent, properly resourced programme with continued engagement. If April implementation is still being pursued, to agree appropriate transitional mitigations such as income protection, to protect service continuity and patient care. We await the ICB response.
Changes to local MSK pathways
The ICB has responded to our letter on recent changes to the MSK pathway. They confirm the MRI restrictions were introduced from 17 November 2025, citing national guidance and an expectation that senior MSK clinicians within the community service will request imaging where clinically indicated. They also report current waits of around 2 weeks (urgent) and 6–8 weeks (routine), set out plans to publish monthly waiting-time reporting, and describe ongoing work on digital exclusion, patient communications and longer-term pathway changes, including a move towards a single point of access and potential re-enabling of FCP MRI requesting (subject to governance).
We have written back welcoming the stated intentions, but highlighting several outstanding concerns that require clearer, immediate assurance. In particular, we have asked the ICB to confirm that patients will not be discharged back to general practice because they cannot get through by phone or miss narrow call-back windows, and that provider-cancelled appointments are automatically rebooked with proportionate DNA processes that do not disadvantage vulnerable patients.
We have also asked for clarity on MRI governance (including why accredited FCPs may order MRIs while GPs cannot) and asked to join the community MSK specification working group to help secure minimum service standards and avoid unnecessary workload shifting back to practices.
Proposed GP ADHD pathway
LMCs discussed a proposed new NEL GP ADHD specification with the ICB; patients would be referred to an RTC provider to assess, initiate, titrate and stabilise medication. Once stabilised, care would transfer to the GP for ongoing prescribing and monitoring, with access to advice and escalation support via ELFT/NELFT. The proposal also includes payment for ongoing management and potential accreditation/quality requirements for providers.
We have raised concerns that, without clear definitions of “stabilised/unstable”, robust and timely specialist escalation (not just A&G), and properly funded capacity, this model risks shifting significant clinical and medico-legal responsibility into general practice by default. We have also highlighted persistent issues with variable RTC/private diagnoses and stressed that any model must include a properly funded shared care arrangement, independent training for clinicians in general practice, and reliable wraparound support when patients destabilise or experience adverse effects.
GP phlebotomy proposal
Following review of the GP phlebotomy specification proposal for 2026-27, we met with the ICB to reiterate our strong objections to the decision to remove the domiciliary phlebotomy tariff. We are concerned this will reduce access for the most vulnerable patients—particularly frail, elderly and housebound people—because many practices will be unable to absorb the additional time and staffing costs without dedicated funding. Unfortunately, the ICB will press ahead with this decision. We have asked the ICB to ensure the business case properly reflects the risks and mitigations, including the lack of complete community-provider data to underpin a robust impact assessment. We have also highlighted patient safety concerns, particularly for urgent post-discharge blood requests (including A&E) where timing is critical and discharge information is not always received promptly in general practice. We have therefore urged the ICB to proactively notify hospitals and A&E teams of the changes and to review referral pathways into domiciliary phlebotomy to avoid avoidable delays and harm.
Local engagement
Change in formulary status of DOACs
This month we had discussions with the ICB around a potential change in the NEL formulary of the status of DOACs from Amber to Green, despite LMC objections. In practical terms, this change is advisory: it may influence local prescribing expectations, but it does not alter a GP’s clinical discretion to prescribe (or not), nor does it create any new contractual obligation for practices to take on non-core workload associated with DOAC prescribing.
Our concern is that, in reality, formulary changes can be misinterpreted by clinicians and services unfamiliar with the contractual requirements, as a signal that “GPs must now do more” (e.g. additional monitoring, stabilisation or administrative processes), which is not the case unless separately commissioned and resourced via a local enhanced service.
Practices should continue to apply safe, clinically appropriate prescribing decisions, and should not assume that a Green status means acceptance of unfunded additional work.
ICB clinical leadership
We have written collectively to NEL ICB to express serious concern about the rapid reduction of GP clinical leadership following the ICB restructure, and the potential consequences for patient safety, quality, and workforce sustainability. While recognising the financial pressures and the requirement to reduce running costs, we have emphasised that embedded GP clinical leadership is essential for whole-pathway oversight, early identification of unintended consequences, and credible clinical challenge—particularly as more care is expected to shift into the community. We have asked the ICB to pause further dismantling of GP clinical lead capacity until transparent, clinically led impact assessments are completed, and to engage meaningfully with frontline clinicians and their representatives to co-design a future model that is both financially responsible and clinically safe.
NEL dementia pathway and referral form
We have reviewed the new NEL dementia pathway and referral form. Overall feedback is that both are reasonable and the form layout is improved, but they must be treated as guidance, not a rulebook. GPs are concerned about referrals being rejected for missing cognitive scores (e.g. 6CIT/GPCOG), especially where testing isn’t feasible due to language barriers or vulnerability; the pathway should allow this to be recorded and give appropriate weight to collateral history and clinician concern. We have also emphasised that use of the form must be voluntary and not a basis for rejecting referrals, with clearer signposting to local dementia services and improved secondary care messaging to avoid inappropriate referrals after acute confusion/delirium.
Oliver McGowan Training
There are now more dates available for individuals to book onto the Tier 1 Part 2 Webinar sessions through this link.
There are currently sessions available until the end of March 2026; more will be added for future months. Please do share this with your staff that require Tier 1 part 2.
Further Tier 2 sessions will be available for April onwards; the ICB expects to have approximately 300 further sessions in the next financial year so hopefully this will give plenty of opportunity for everyone to book on.
Follow the page at this link and you will get notifications when new sessions are published.
London General Practice Awards 2026
James Asser MP and Dr Tamara Hibbert
On Thursday 5 February Londonwide LMCs held the annual London General Practice awards event in Parliament. Among the winners were Springfield Park PCN from Hackney who won the nursing team award and Dr Tamara Hibbert, Chair of Newham LMC who won the LMC member award for NEL.
The nomination for Springfield Park PCN said: “This project reflects the tireless dedication of a multidisciplinary team who responded rapidly to a local MMR outbreak with daily and Sunday clinics and home visits. This co-designed project significantly improved the MMR coverage from 17% in May 2025 to 48% in August 2025, delivering 2,584 vaccines in three months, demonstrating its replicability and impact on health equity.”
The nomination for Dr Hibbert described here as: “… a long-standing and active voice for GPs in Newham, speaking up about the challenges they face. A very effective communicator who is always willing to step into new situations. She explains complex issues in a clear, friendly way and deals with challenging topics calmly and with an excellent command of details and examples.”
The event was held in Parliament and provided an opportunity to engage with MPs as well as recognise local successes, pictured is James Asser, MP for West Ham and Beckton with Dr Hibbert.
Londonwide LMCs Buying Group member MIAB, providers of specialist GP insurance for over 20 years, kindly sponsored the awards.
Full list of winners, judges and event photos
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