Dear colleague,
Chair’s introduction
I am pleased to share the July NEL newsletter, covering a number of issues currently affecting practices across North East London. These include the development of a NEL interface position, the new LTC PC QOF framework, DOACs, ADHD shared care, FP69 patient deductions, weight management prescribing, data sharing and wider concerns about workload transfer into general practice.
A consistent theme remains with the need for early engagement with practices and LMCs before changes are implemented, with realistic expectations, clear clinical accountability and proper resourcing. Where new pathways, specifications or data processes create additional workload, clinical risk or operational pressure, it is important that concerns are identified early and raised through the right routes.
Please continue to contact your local LMC representatives with any concerns, examples or queries from your practice or PCN. The more intelligence we receive from practices, the better we can represent your views and challenge proposals where needed.
Dr Tamara Hibbert
Chair of Newham LMC
Local guidance
Spotlight on: Minor surgery commissioning arrangements
We have received queries from practices regarding minor surgery arrangements. Cryotherapy, curettage and cautery are treated as “minor surgery” additional services under GMS.
Practices can opt out of providing these additional services, in which case a deduction is applied to their global sum. Where a practice has opted out, it should receive a 0.6% global sum deduction and is not contractually required to provide these services. In these circumstances, the practice is within its rights to refer patients to another appropriate provider where minor surgery is clinically indicated.
Where a practice has not opted out, it is funded through the global sum to provide this level of minor surgery. In these cases, there is likely to be an expectation that the practice can provide the service itself where it considers this clinically necessary.
Practices receiving queries about minor surgery should first check whether they are opted out of the relevant GMS additional service, as this determines the contractual position.
Commissioning updates
DOAC Monitoring and prescribing
Londonwide LMCs have produced an NEL briefing on DOACs ahead of further London region discussions about the commissioning arrangements for DOACs monitoring across London. The briefing sets out the contractual position, variation across NEL and the impact of previous local arrangements being withdrawn in some boroughs.
The LMC position remains that general practice should not be expected to absorb additional DOAC monitoring, prescribing or review responsibilities without clear commissioning arrangements and appropriate funding. Changes in medicines status or pathway design should not automatically create new unfunded obligations for practices.
NEL LMCs are awaiting the response from commissioners. In Tower Hamlets, the LMC has indicated that repatriation of patients may need to be considered if the issue is deferred without resolution. Practices should continue to share examples where DOAC-related work is being transferred into general practice without clear agreement, funding or accountability.
Adult ADHD Shared pathway proposal
NEL LMCs continue to raise significant concerns about the proposed adult ADHD locally commissioned service. A Londonwide LMCs NEL briefing has been issued to practices highlighting concerns about workload, clinical risk and the proposed tariff. The proposed payment is significantly below the level paid to other providers under Right to Choose arrangements. LMCs remain concerned that the proposal risks transferring prescribing, monitoring and clinical responsibility to general practice without sufficient specialist oversight, training or funding.
There is also a risk that federations or other primary care providers could be approached to deliver this work at an unsustainable price. Practices should carefully consider whether any ADHD scheme is safe, deliverable and adequately funded before signing up.
Children ADHD Shared care
NEL LMCs have raised concerns about children’s ADHD shared care in parts of NEL, where there is transfer of prescribing and physical monitoring responsibilities to GPs. Practices have reported requests from CAMHS services for annual medicals and ECGs before CAMHS will prescribe. LMCs are clear that shared care is voluntary. GPs should not sign shared care agreements or continue prescribing where they are not in a position to accept the medicolegal risk.
There are particular concerns about requests for paediatric ECGs, where practices may not have access to appropriate services or the expertise to interpret results. This creates clinical risk and should not be treated as routine general practice work.
Shared care concerns remain something that are actively being discussed with NEL ICB, in the expectation that we can achieve a safer, appropriately funded system. LMCs will continue to press for safe, properly supported arrangements.
Weight management prescribing and OB005
Londonwide LMCs have published briefing on NEL ICB’s policy position on weight management and OB005. Although the wording of OB005 refers to NICE-approved weight management medication, the LMC understanding is that semaglutide does not count for this purpose. Semaglutide remains red on the NEL formulary and NICE guidance limits its use to specialist commissioned services. The LMC position is therefore that the OB005 indicator relates to tirzepatide only.
Safe weight management prescribing requires clear local pathways, eligibility criteria, monitoring arrangements, wraparound care and appropriate funding. Practices should not be expected to prescribe or monitor medication where this is outside commissioned arrangements or where medicines remain restricted to specialist services.
Local engagement
New provider of Primary Care Clinical Information and Facilitation Services
The transition from CEG to the new Primary Care IT provider from 1 August remains a concern for NEL LMCs, due to the tight timescales of the mobilisation, the risk of service gaps and the interdependency with the new LTC PC QOF scheme. The NEL team at Londonwide LMCs had an introductory meeting with the new provider; members highlighted the importance of maintaining continuity for practices and avoiding disruption to services, reporting and funding. Particular concerns were raised about the impact on local enhanced services, public health programmes such as NHS Health Checks and sexual health, and the need to ensure that changes to reporting arrangements do not adversely affect practice income.
Londonwide LMCs stressed the need for clear, regular communication with practices throughout the transition, alongside pragmatic arrangements from commissioners where reporting challenges arise during the early implementation period. Weekly updates, FAQs and stakeholder engagement sessions are being established, and LMCs will continue to monitor progress, ensuring concerns are addressed promptly.
FP69 list cleansing and patient deductions
NEL LMCs remain concerned about increased FP69 list cleansing activity and patient deductions. NHS England and PCSE appear to have escalated list maintenance activity, with London and NEL disproportionately affected. This process may be financially destabilising for practices and may also remove vulnerable patients who remain resident but do not respond to correspondence. This is a particular concern in areas with high deprivation, high population mobility or language and communication barriers.
In October 2025 PCSE changed from giving practices six months to confirm that patients with an FP69 flag were still living nearby and wished to remain on their list, to only three months. Londonwide LMCs have produced guidance for practices, including resources to communicate with patients and a form for practices to report how they are being affected. They are also escalating the problem to NHS leaders, media, politicians and others in positions of influence.
NEL Primary / Secondary care interface
Interface issues remain a significant concern across North East London, with practices reporting requests to arrange investigations, chase results, issue fit notes, re-refer patients, prescribe or undertake follow-up where responsibility should sit with the provider managing the pathway. ICBs across London have developed position statements around interface, to support discussions between primary and secondary care. NEL LMCs recognise that a policy document alone will not resolve these issues, but a clear interface position will provide a stronger basis for escalation and challenge.
NEL LMCs have been invited to attend a NEL interface workshop in July and will press for the development of a NEL interface position document to support practices in challenging inappropriate workload transfer between primary and secondary care. LMCs will also continue to press for effective implementation, clear escalation routes, named points of contact, and better feedback loops when quality alerts or interface concerns are raised.
Quality alerts
Practices continue to raise concerns about the effectiveness of quality alerts, particularly where alerts appear to be handled in isolation by organisations and there is no clear feedback loop to the practice raising the concern.
LMCs recognise that quality alerts can be an important mechanism for identifying patient safety issues, inappropriate workload transfer and recurrent pathway problems. However, they need to be supported by transparent processes, clear ownership and evidence that learning is being acted on.
There are indications that some providers are investing more resource and software support into quality alert tracking, likely linked to wider national reporting requirements. LMCs will continue to press for quality alert processes that are meaningful for practices and that result in clear feedback, escalation and system learning.
Constituent engagement
Local intelligence from practices is essential in helping LMCs identify emerging issues, challenge inappropriate workload transfer and represent general practice effectively in discussions with the ICB and provider organisations.
Please continue to contact your local LMC representatives with concerns relating to contracts, prescribing, shared care, interface issues, data, access, workload transfer or service changes. Specific examples are particularly helpful where LMCs are challenging proposals or seeking clarification on practice obligations.
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!