Dear colleague,
Chair’s introduction
General practice across London continues to face significant challenges. We know that all of you are working hard to meet increasing patient demand, adapt to changing commissioning arrangements, respond to new service expectations and maintain high-quality care in an increasingly complex healthcare environment. Alongside this, your LMCs are continuing to work on your behalf to influence decision-making, challenge unfunded workload transfer and ensure that the voice of frontline general practice is heard at every level of the system.
The commissioning landscape continues to evolve, with changes to structures, leadership teams and decision-making processes within NEL ICB and the wider NHS. While this has made engagement and negotiation more complex, your LMC representatives remain committed to building productive relationships, maintaining constructive challenge where needed and advocating for safe, sustainable and properly resourced general practice.
In this edition, you will find updates on a range of commissioning, contractual and service developments, alongside information on local engagement work, operational issues affecting practices and areas where your LMCs continue to represent and support practices across North East London.
We hope you find the bulletin useful and, as always, we welcome your feedback and engagement as we continue to support general practice through a period of significant change.
Dr Vinay Patel
Chair
City and Hackney LMC
Surviving the 2026-27 GP contract – webinar recording
A recording of the first run of Londonwide LMCs’ webinar is now available on the 2026-27 GP contract guidance page for those people who were unable to attend either session.
You can find out about the effect on London of the contract changes, with our unique patient population and commissioning arrangements, based on the documentation available at the end of April.
New PCSE list cleanse approach causing practice stability concerns
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 are hearing examples of practices losing figures in the region of 5% of registered patients since this change, with greater numbers expected to follow. They 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.
Spotlight on policies and guidance
Provider Selection Regime (PSR) – what GP practices need to know
Londonwide LMCs have published 3 guides for general practice on the Provider Selection Regime (PSR). You can find them at this link.
- Provider Selection Regime – What GP Practices need to know
- PSR and Direct Award B
- PSR and Direct Award B – EOI selection questions
NEL ICB are undertaking several procurements of healthcare service using PSR procurement routes. These guides explain in simple terms what PSR is, why it is relevant to General Practice and what practices need to be aware of, if they wish to apply to deliver the services.
NC LES contracts and PCQOF sign-up for 2026-27
NEL LMCs have raised concerns about the way the ICB issued 2026/27 local contract documentation, including the Long-Term Conditions Proactive Care Quality and Outcomes Framework. Practices received documents with significant gaps in the information provided; and confusing deadlines and communications across boroughs. NEL LMCs position is that practices and PCNs must be given sufficient time, clear documentation and the ability to make informed decisions.
Londonwide LMCs wrote to all NEL practices on 21st May 2026 to highlight some of the pros and cons of signing up, including what practices need to consider before signing up. We are aware that approximately 50% of practices have so far signed up to the NC LES for 2026-27. Practices that sign up for the LTC PC QOF scheme are in the first year guaranteed to receive 80% of the overall funding associated, with only the final 20% based on achievement against a set of clinical indicators currently being negotiated with the LMCs. If you have not received the communication from Londonwide LMCs, please do let the team know by emailing Daniele Serdoz (daniele.serdoz@lmc.org.uk).
Adult ADHD LIS
NEL ICB has issued its 2026 Adult ADHD LIS specification for monitoring and prescribing. NEL LMCs have raised significant concerns about the proposed model, which requires practices to accept transfer of care, rather than true shared care with ongoing specialist oversight. Londonwide LMCs has issued an analysis titled “Focus on the NEL ADHD LIS Specifications”, emailed to practices on 22nd May 2026.
The new ADHD specification expects practices to create registers, operate call-recall systems, provide repeat prescribing, undertake annual HCA and GP reviews, and take on medicolegal responsibility for patients on ADHD medication. LMCs have highlighted that there is no funding for backfill to attend staff training, register set-up, call-recall, or repeat prescribing activity. The proposed payment is £63 in year one, falling to £26 in year two, with no inflationary uplift.
LMCs have also raised clinical safety concerns, including that NICE guidance recommends at least six-monthly physical monitoring, and a shared care approach. Practices should carefully consider whether the funding reflects the workload involved in delivering this service, whether they have capacity and trained staff able to deliver the service, and whether they are prepared to take on the clinical risk. LMCs will keep pressing the ICB for a safe, properly funded shared care model for adult ADHD.
LTC PC QOF LES 2026/27 and beyond
NEL LMCs have written to the ICB regarding the development of the LTC PC QOF LES for 2026/27 and beyond. LMCs support the principle of levelling up LTC provision across NEL but have raised concerns that the framework must not expand beyond the existing successful Tower Hamlets model, without additional funding, workload assessment, clinical agreement and a clear decision-making process.
Concerns include the significant number of proposed KPIs, the risk that monitoring indicators later become payment-linked, and the potential absorption of previously separate activity-based schemes, such as DOAC follow-up, ECGs and diabetes injectable/insulin initiation work, without proper resource. We have iterated the importance of the scheme being achievable and realistic within the staffing, funding and resource constraints, within which we are operating.
LMCs have asked to meet senior members of the ICB to agree clear principles for future changes, activity-based payments and genuine levelling up without unfunded workload. We will keep practices up to date as discussions progress.
Weight management, GLP-1 prescribing and QOF
NEL LMCs are concerned about the developing position on weight management, GLP-1 prescribing and QOF. Practices may see QOF indicators linked to obesity and prescribing, but QOF is a voluntary incentive scheme and does not itself fund the clinical workload required to deliver a safe prescribing pathway.
The issue is broader than issuing a prescription. Safe weight management prescribing may require eligibility checks, monitoring, dose escalation, side-effect management, ongoing review and appropriate wraparound care. There is also concern that secondary care may recommend medication and ask GPs to “do the necessary”, even where patients do not meet primary care criteria or where no local commissioned support exists.
The LMC position is that prescribing expectations must be matched by clear pathways and funding. LMCs will seek clarification from the ICB on commissioned weight management services, wraparound care, practice obligations and safe claiming arrangements. It should be noted that unfortunately, the NEL clinical policy on obesity management for adults was published without engagement with the LMC. Going forward, we have requested that the ICB share with the LMC resource pack and FAQ they are developing, for LMC input, before these documents are shared with practices.
At this point practices should not feel pressured to deliver a service they are not commissioned to deliver. The LMC will be publishing a response to the ICB Obesity shortly.
Local engagement
Increase in FP69 flags and patient list deductions
Some NEL practices have reported a significant increase in FP69 flags and patient deductions in recent months. Following queries raised with PCSE, NHS England has confirmed that this is likely to be linked to two main factors.
- NHS England has been piloting a new data-led approach to targeted list maintenance during 2025/26. This identifies patients who may have moved away and asks them to confirm their registered address. Many patients did not respond and were therefore flagged for FP69 review and potential deduction.
- From 1 October 2025, the GP contract changed so that the FP69 review period reduced from six months to three months. NHS England has indicated that this has also contributed to the higher level of deductions seen at the start of 2026.
NEL LMCs have concerns around the additional administrative pressure for practices, as well as the loss of income due to potential inappropriate removals of patients from lists, particularly in areas of deprivation or areas with highly transient communities.
The LMC is keenly aware that NEL has the most ethnically diverse patient population in London, particularly the boroughs of Redbridge, Newham and Tower Hamlets.
We recognise that in some of our communities, patients may spend several months each year living abroad and hence may not use NHS and GP services regularly throughout the calendar year. Removal and re-registration can lead to treatment gaps and loss of follow up.
Practices concerned about the impact on workload, staffing or service stability should raise this with the local commissioners and also inform the LMCs. As the policy is set nationally, any formal complaint or further challenge would need to be directed to NHS England.
Missed or Delayed Waste Collection Service: Escalation route for practices
NEL LMCs are aware that there have been significant issues with missed or delayed waste collections in recent weeks. We have escalated to the ICB and we have also spoken with Anenta, the managing agent for the waste collection service, regarding reported collection backlogs. Anenta has advised that additional capacity is being put in place where needed while the backlog is resolved.
A dedicated escalation form has been set up for practices to report issues directly.
Practices should use the form to provide details of any missed or delayed collections. Practices that are open on Saturdays should include this in the narrative section of the form, as Saturday collections can be arranged where required. Practice managers may wish to keep this link available for prompt escalation of any ongoing waste collection issues.
MSK single point of access, MRI access and self-referral pathways
NEL LMCs met with NEL ICB to continue the engagement with the MSK transformation programme, including the rollout of single point of access models across boroughs. The key concern is that pathways must improve access, not create additional barriers for patients or extra workload for practices.
LMCs have raised concerns about variation across NEL, loss of direct GP access to MRI, rigid referral forms, and patients being sent back to GPs despite already having specialist input. Practices have also highlighted problems with GetUBetter, particularly where patients are asked to use the app before referral and then again while waiting for physiotherapy. The LMC position is that MSK pathways must be clinically flexible, support appropriate self-referral, provide clear escalation routes, and avoid unnecessary repeat GP contacts.
NEL LMCs will continue to feed into pathway testing and the developing NEL community MSK service specification, pressing for consistent self-referral, clear communication with patients and referrers, and different options appraisals where systems are not working. If you have any concerns about the MSK pathway please contact your LMC rep.
Levemir discontinuation
NEL LMCs have discussed the implications of Levemir discontinuation and the expected need for patients to be reviewed and switched to alternative insulin. This is likely to create additional workload for practices, particularly where patients are complex, housebound, frail or under shared care with specialist diabetes services.
The LMCs’ view is that the system must be clear about responsibility and resource. Practices should not be left to manage large-scale medicine switches without adequate support, specialist advice, patient communication resources and clarity on which patients should be managed by diabetes specialist teams.
This is both a workload and patient-safety issue, especially where insulin changes require careful counselling, dose adjustment and follow-up. LMCs will continue to seek clarification from the ICB and medicines optimisation teams on the local plan, including searches, patient communication, specialist support and expectations of practices.
Clinically urgent same day access
The ICB is undertaking work on clinically urgent same day access, linked to the national ambition for 90% of clinically urgent need to be managed on the same day. As part of this work, the ICB has identified 25 outlier practices where GPAD data shows no patients coded in this category.
The current assessment is that this appears to be primarily a coding and recording issue, rather than evidence of insufficient clinical capacity. GPIT facilitators have either contacted, or are in the process of contacting, affected practices to provide template training and support, and to help identify and resolve local issues. The impact of this intervention will not be clear until the next GPAD data is released at the end of June.
LMCs will continue to monitor this work closely, including whether the data accurately reflects practice activity, whether coding expectations are clear and practical, and whether any conclusions drawn from GPAD are proportionate and factual. In the meantime, practices could take up the offer of support from the ICB and the GPIT facilitators, should they have any concerns about the coding of these appointments.
NEL ICB Medium Term Plan submission
NEL ICB has submitted its Primary Care Medium Term Plan, setting out proposed priorities for the next 3–5 years, with a focus on 2026/27. Ahead of submission, local engagement was undertaken with a wide range of stakeholder, including Londonwide LMCs and BDH LMCs.
The plan covers several areas directly relevant to general practice, including front door access, Same Day Access development, digital access and triage, appointment recording through GPAD, population health management, and improving the primary–secondary care interface. Wider transformation includes neighbourhood working, estates strategy, patient engagement and closer integration with community pharmacy. There is also a strong focus on workforce and clinical capacity, including GP trainee growth, ARRS recruitment, workforce data quality and development of a system-wide primary care workforce strategy. Digital priorities include NHS App uptake and safe use of AI ambient voice technology.
NEL LMCs will continue to engage with the ICB to ensure proposals are deliverable, properly resourced, and do not create inappropriate workload transfer into general practice.
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.
Tell us about your practice’s purchasing needs and win a £20 gift voucher
Our new survey on what you buy, and why you buy it, will help us improve our offer of goods, services and training. Five respondents will also win a £20 gift voucher. The survey covers several areas, you only need to fill out the ones relevant to you – we know how busy everyone working in general practice is!
- 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!