Dear colleague,
Chair’s introduction
Dr Asad Ashraf, Chair, Waltham Forest LMC
Welcome to this month’s newsletter. On 24 February 2026, all Londonwide LMC Chairs and Vice Chairs met with the ICB’s senior primary care leadership team to discuss some of the most pressing issues facing general practice in NEL. The agenda covered the ICB consultation and restructure, including the likely impact on clinical leadership; DOAC and warfarin arrangements with the new community providers; the enhanced services review, including a new long-term conditions scheme rolled out across NEL; and the latest neighbourhood update. We also raised additional concerns, including the Trusts’ response times for Advice and Guidance. You will find updates on these issues throughout this newsletter.
There is a huge amount happening across the system, and it is increasingly clear that the scale of ICB cuts will have a significant impact on how primary care is supported — and how clinical leadership operates going forward. At the same time, the new core contract changes have been announced for 2026/27 and have sparked several concerns on the impact they will have on general practice.
At a time like this, it is vital that general practice speaks with a strong, collective voice. The role of the LMC is more important than ever: we are here to protect General Practice. Enjoy reading the Newsletter!
Spotlight on policies and guidance
Changes to the GP contract for 2026/27
Practices will have received a letter from NHS England and DHSC with details of the final contractual arrangements for 2026/27 following the conclusion of the national consultation. Londonwide LMCs have circulated an initial analysis of the contract highlighting what we currently know, and the potential impact of these changes on practices based on the information currently available. Specific details of the contract will only be known when further information is released by DHSC/NHSE and we caution that whilst several contract analyses have been circulated online/ via social media, the paucity of detailed information available means we are unable to comment on their accuracy. A comprehensive and detailed analysis of the contract is not currently possible without further information.
GPC England have run a series of three initial webinars explaining the contract changes. BMA members can expect to hear directly from them about further updates, we and Londonwide LMCs will aim to share these updates as we receive them.
NHS England are also running webinars, their next one is on Thursday 7 May, 5:00-6:00pm.
QOF QI indicators – requests for manual submissions of retired indicators
Practices have queried why manual submissions are still needed for retired QOF QI indicators. Although these indicators no longer attract payment, CQRS has not been updated to automate the adjustment for 2025/26. Practices must therefore complete a manual entry so CQRS can calculate year-end QOF payments correctly. If this is not done before year end, the system may be unable to process payment. Practices can complete this at any time up to 31 March.
BMA Regulation 17 Guidance: What is ‘Core’ General Practice?
Practices have been asking about unfunded work and whether ICBs can require services to continue where they are no longer operationally sustainable. This often comes down to whether a service counts as part of ‘core’ general practice under the GMS contract. To clarify matters, in 2025 GPC England published guidance on Regulation 17 after taking legal advice. The key message is that ICBs cannot simply decide that a service must be delivered in-house by unilaterally declaring it part of “essential services”. Beyond core consultation, diagnosis and a limited number of specified services, practices may decide whether further treatment or investigation is provided in-house or by referral to another provider. The GPC/BMA’s guidance on Regulation 17 is worth a read: Regulation 17 Guidance.
Commissioning updates
Enhanced services review
NEL LTC Proactive Care Quality and Outcome Framework (PCQOF)
We attended the first two NEL LTC PCQOF working groups, the proposed new framework for managing LTC in General Practice. This model uses a “Year of Care” approach to turn routine reviews into collaborative, person‑centred care plans that empower self‑management with personalised goals and coordinated support.
The LMC raised concerns around this approach, considering the significant variation in the current starting positions of each borough, including the differences between the historic investment in General Practice. We strongly recommended that variations between local populations are considered –particularly with regards to deprivation, language, health education and literacy – in the development and implementation of this model, to avoid exacerbating existing health inequalities. Londonwide LMC has also provided extensive comments and raised several concerns regarding the proposed LTC clinical indicators. Negotiations regarding the indicators currently continue.
An implementation year (Year 0) will require clear timescales, funding confirmation, clinical education for General Practice and wider patient education to support mobilisation. We also flagged that a single year is likely too short for workforce planning, recruitment, training and embedding—requesting an end-of-Year-0 review point. We will continue to update practices as discussions progress.
NEL Supplementary Care Home Service
The ICB has shared with the LMCs a new proposal for the 2026/27 Supplementary Care Home Service specification (which is additional to the PCN DES). The most significant change from the previous contract is the proposal of a change in the funding model from a bed-base flat rate (100%), to a split funding model of beds (50%) and KPI performance (50%). Hence only half of the tariff is now guaranteed, whilst the remaining half is dependent on the practice achieving multiple KPIs, with most indicators operating on an “all-or-nothing” basis. Failure to meet targets (typically 85–90%) will result in nil payment for that indicator.
We have challenged this model as it seems too “punitive” and, based on current performance, most of the KPIs and targets seem unachievable, which can lead to the financial destabilisation of General Practice. Some indicators rely on wider system behaviours (e.g. care home calls to NHS111 and LAS), linking funding to factors outside practices control. There has also been no overall tariff uplift, despite rising staffing and delivery costs. While some amendments have been made, the core funding model remains unchanged despite extensive LMC pushback.
We have raised these concerns several times in the last 12 months. Londonwide LMCs and BDH LMCs have also jointly written to the ICB formally stating that we do not support these changes. It will be up to practices to carefully consider all the requirements in the specification and associated KPIs and targets; and whether the income from the new payment model is enough to cover the costs of delivering the service.
New NEL community anticoagulation services – update
The Community Anticoagulation Service has been recommissioned across NEL. A key aim is to standardise warfarin management and support appropriate switching to DOACs — but there remains uncertainty about who is responsible (and funded) for the workload associated with the prescribing of Warfarin and ongoing DOAC monitoring.
Ongoing DOAC prescribing/monitoring (and the “checks” needed when issuing repeat anticoagulants, including Warfarin) is not resourced via any local enhanced service in NEL, creating unfunded workload shift to general practice. Critically, where the practice is the prescriber, the medico-legal responsibility remains with the prescriber to assure monitoring is safe and effective, even if monitoring activity sits elsewhere — creating a commissioning gap and potentially increasing prescribing risk, when services are split.
The ICB has confirmed that they are looking to implement interim arrangements across NEL to temporarily fill this commissioning gaps, whilst a longer-term solution is developed. Details of these arrangements however are still in development and we are meeting regularly with the ICB to monitor progress.
PCN CAIP claims
ICB has asked us to remind PCNs to try and submit their CAIP claims for 2025/26 in plenty of time before the deadline of 31 March, due to the staff restructure, as they want to ensure these claims get processed without any delays. Completed domain templates should be sent to the Primary Care Place Team at
PCNs can also contact your Place Team should you have any queries about your submission.
Local engagement
Quality Alerts
LMCs received an update on the NEL quality alerts process and reviewed the emerging reports and response timescales. We’ve pressed for fuller data, a clearer narrative and explicit learning points, and for clear ownership/accountability, so Trust actions are delivered consistently. We also asked for a defined escalation route, when practices don’t receive timely responses (particularly urgent alerts) and stronger comms to practices, to build confidence in the process. With the ICB quality team expected to reduce significantly, we flagged risks to capacity, continuity and asked how alerts will be managed going forward. We also pushed for community and independent providers to be included as the system develops; LMCs offered to support further design discussions.
Please visit this site for more information Quality Alerts – North East London
Blue Badge requests
We have written to all North East London Local Authorities about increasing requests to GP practices for information to support Blue Badge applications. Practices report being asked by patients and/or local authorities to assess mobility or comment on eligibility—work that national guidance says sits with local authorities, supported by appropriately appointed expert assessors. Under Department for Transport guidance, the GP role is limited to confirming factual clinical information (where appropriate) and providing insight from the medical record into reported walking difficulties. Practices are reminded that Blue Badge reports/opinions are not part of core NHS contractual services: practices may charge a reasonable fee (agreed in advance) or decline requests where capacity or clinical knowledge is insufficient.
Schools’ requests from GPs
Londonwide LMCs have written to Local Authorities in City and Hackney, Tower Hamlets, Newham, Redbridge and Waltham Forest, to remind schools across North East London that GP practices do not provide sick notes or letters explaining school absence, or proof of GP appointments. Requests for this information create unnecessary administrative work, fall outside NHS contractual requirements, and can cause frustration for patients and practices when refused. The LMCs also remind schools that GPs are not required to issue prescriptions for medicines that can be bought over the counter. Please find guidance at these links: Londonwide LMCs, DfE (see paras 365-366), NHS England.
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.
Your Londonwide Team at the London General Practice Awards 2026
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.
Your Londonwide Team for North East London was also in attendance, supporting the event and celebrating the successes of our GP colleagues. Please do get in touch should you have any queries or if you want to raise any issues. Details here.
From left to right (Studio Ghibli version), Ian Williamson (Committee Liaison Executive), Dr Tamara Hibbert (Chair of Newham LMC), Dr Emma Radcliffe (Chair of Tower Hamlets LMC), Dr Shabnam Quraishi (Associate Medical Director, LLMCs), Daniele Serdoz (Assistant Director of Primary care, LLMCs) and Dr Darren Tymens (Deputy Medical Director, LLMCs).
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