Dear colleague,
Chair’s introduction
I am pleased to share the latest NEL newsletter. This month, Londonwide LMCs’ Chairs and Vice-Chairs met with the NEL ICB Executive Team for our quarterly liaison meeting. The discussion covered several issues directly relevant to practices, PCNs and wider primary care teams.
The ICB outlined its plans to refresh the primary care strategy, with proposed priorities including access, neighbourhood working, prevention, health inequalities and sustainable primary care. We emphasised that the strategy must not simply be aspirational; it needs clear, measurable outcomes and must recognise the impact of wider system pressures on general practice, including interface issues, delayed pathways and unfunded workload transfer.
We also raised the need for practical support on anti-racism, staff safety and Freedom to Speak Up arrangements, including de-escalation training and support for frontline staff. Other key areas discussed included neighbourhood working, Care Close to Home and the forthcoming phase two commissioning review. On DOACs, shared care, LTC PCQOF and PCIT, our message remained clear: work transferred into general practice must be supported by safe pathways, clear responsibilities, proper training, reliable data and appropriate resourcing.
Please continue to share local examples and concerns with your LMC representatives. These remain essential in helping us challenge inappropriate workload transfer and represent practices effectively.
Dr Sweta Raj
Vice Chair
City & Hackney LMC
Spotlight on guidance
GP Reimbursement scheme
NHS England provided an update on 1 October 2026 with information relating to the 2026/27 GP Contract. A significant update relates to the practice level GP Reimbursement Scheme and the details of which can be found in the October 2026 amendment to the Statement of Financial Entitlements (SFE).
Commissioning updates
Phase two local enhanced service review
NEL ICB is expected to undertake phase two of the local enhanced service review during the remainder of the financial year. NEL LMCs have had sight of the review plans and have provided extensive comments on them. Any LES review must be transparent, evidence-based and undertaken with meaningful LMC and practice engagement. Specifications must be clinically realistic, properly funded and deliverable within available capacity.
NEL LMCs have also asked the ICB to confirm the principle that the level of funding in each borough will be maintained at least at the current level and that any decommissioning of enhanced services will be undertaken with a view to reinvest the funding in general practice. The ICB confirmed that the existing principle will continue, namely that where funding is released within a borough following a service change or the decommissioning of a service, that funding will remain within the borough and be available for reinvestment in response to local needs and priorities.
This is a reassuring outcome for NEL general practice.
NEL Same Day Access specification
NEL ICB has shared the latest Same Day Access specification, with the new contract expected to run from 1 October 2026 to March 2030. The ICB described this as the first stage of a longer-term approach, with continuity of existing provision from October and the first six months used to understand local models and develop the specification further.
NEL LMCs have provided extensive feedback on the specification, raising concerns about activity levels, the lack of tariff uplift, and the requirements around opening hours, direct booking, digital interoperability and KPIs. The current tariff has not been reviewed for some time, despite rising staffing, estates and national insurance costs.
The LMCs’ view is that a multi-year contract may support stability, but only if it includes annual cost reviews and inflationary uplift. SDA must be co-designed with general practice, flexible enough to reflect local models and neighbourhood working, and should not shift additional activity into primary care without the associated resource.
Londonwide LMCs will continue to press for a clear engagement plan with PCN CDs, LMCs and the proposed clinical reference group.
NEL LTC PCQOF and PCIT
NEL LMCs continue to press the ICB for income protection for the 2026/27 LTC PCQOF scheme. The ICB has previously indicated that it may use last year’s income as the reference point, rather than providing a full 100% guarantee, and this remains an important area for clarification and negotiation.
This matters because practices and PCNs are still dealing with delayed searched and templates, uncertainty around counting and coding, lack of clarity on the specification, KPIs and targets, and lack of training for delivery of the new model.
The LMCs’ view is that practices should not be financially penalised for system delays, unclear specifications or technical issues outside their control. Year one should be treated pragmatically, with a clear focus on mobilisation and planning for 2027-28.
Londonwide LMCs will continue to engage with the ICB to seek clarity on implementation requirements. Practices should keep evidence of delivery and raise any template, coding or reporting concerns directly with PCIT and the ICB, copying their local LMC in the communications.
Levemir switching
Londonwide LMCs previously submitted a high-level proposal for a funded PCN-level LES to support the accelerated switching of patients currently prescribed Levemir to an alternative insulin. The proposal included a mobilisation payment for training, register set-up and preparation, plus a tariff per patient switched to cover clinical consultation and follow-up.
The ICB has confirmed that it is unable to proceed with the proposal. The reasons given are the level of investment required, the time needed to develop and approve a business case, and the lead-in time required to develop and deliver the education and training needed for GPs to undertake the work safely. The ICB has also referenced the national requirement to complete switching by the end of November.
The LMC view remains that insulin switching is clinically significant work and must be delivered through a safe, resourced and clearly communicated pathway. If general practice is not being commissioned to undertake this work, practices should not be expected to absorb it without funding, training and appropriate support. And an alternative pathway should be in place to support this work.
Londonwide LMCs continues to seek clarity on the commissioned pathway and escalation arrangements for patients requiring urgent support.
NEL Housebound Winter Checks
NEL ICB has shared the final specification for the NEL Housebound Check and Winter Vaccination Support service, running from September 2026 to March 2027 alongside the national Covid and flu enhanced services.
Following LMC feedback, the final specification includes some practical improvements. The scheme end date has been corrected to 31 March 2027. LMCs have also asked the ICB to confirm which accredited dementia screening tools are accepted by dementia services in NEL, so practices can use a validated tool appropriate to the patient and local referral pathway. The ICB confirmed that when using cognitive testing, validated brief structured cognitive tests can be used, some of which are relatively quick to perform, such as: the 10-point cognitive screener (10-CS), the 6-item cognitive impairment test (6CIT), the 6-item screener, the Memory Impairment Screen (MIS), the Mini-Cog, Test Your Memory (TYM).
The main concern remains funding. The scheme pays £17 per patient for the additional housebound check. When combined with the relevant flu/Covid item of service payment, the total payment is approximately £35.76 per patient, broadly equivalent to around 40 minutes of practice nurse time. Practices will need to consider whether this covers travel, assessment, vaccination, cognitive screening, documentation and administration.
The specification still provides only one £17 payment, even where more than one visit is needed. Practices should review the specification carefully and satisfy themselves that the funding is sufficient to fund their delivery model before signing up.
GP ADHD LES service specification
Londonwide LMCs have had sight of NEL ICB’s FAQ on the new GP ADHD LES. Practices were asked to sign up to the LES by 9 October 2026. NEL LMCs position on this specification remains largely unchanged from previous communications.
LMC representatives have been engaged throughout the development of the pathway and LES. Feedback received from LMC colleagues has been extensive. However, the final version of the specification has not addressed all the serious concerns raised and therefore Londonwide LMCs are not able to endorse this specification.
The key concerns are that the proposed pathway does not appear to be NICE compliant, that it represents transfer of care rather than genuine, shared care, and that the proposed annual tariff is insufficient when clinical workload, training, call-recall, prescribing responsibility and risk are considered.
There are also concerns that Right to Choose providers have not yet been validated or accredited by the ICB, meaning the risk associated with transfer of care from an RTC provider remains firmly with the GP, who accepts the diagnosis from unaccredited private providers. Further assurance is also needed on the proposed Advice and Guidance Plus offer at NELFT and ELFT and on support for patients who are triaged as not requiring treatment.
The LMC view is that practices should think carefully before accepting any scheme that transfers specialist prescribing and monitoring responsibilities without adequate funding, safeguards and continuing specialist support. Practices should consider these risks before making any decision to sign up.
Local engagement
NEL ICB Clinical Director roles out for advert
The job adverts for the three remaining NEL ICB Clinical Director roles are now out, including the Clinical Director of Primary Care. Click on the links below if you are interested in applying for any of these roles:
- Clinical Director of Primary Care — closing 9 November
- Clinical Director for Population Health — closing 8 November
- Clinical Director of Proactive (Urgent and Emergency Care) — closing 8 November
Primary and secondary care interface consensus document
NEL LMCs continue to progress the implementation of the Londonwide interface consensus document as a framework to support practices in challenging inappropriate workload transfer between primary, community, mental health and secondary care services.
LMC representatives attended the recent Barts interface workshop and presented the Londonwide LMCs consensus document. This led to positive engagement from senior Barts colleagues and agreement to develop a co-produced Barts-wide interface document by December 2026, with socialisation and implementation between then and March 2027.
The workshop also identified further priorities, including electronic consultant-to-consultant referrals, including two-week-wait referrals, a clearer directory of services, a “you said, we did” newsletter for GPs, more GP involvement in education and research, and further consideration of a GP liaison officer role.
NEL LMCs view remains that a NEL-wide interface solution is needed. However, progress with Barts is a positive step and may provide a model that can be rolled out more widely. Further conversations are planned with the Homerton and BHRUT over the next few weeks.
MRSA decolonisation following secondary care screening
Practices have raised concerns about being asked to arrange and prescribe MRSA decolonisation after positive screening results from secondary care, including a recent maternity case at Whipps Cross.
Londonwide LMCs has reviewed the relevant Barts Health MRSA policy and noted that the responsibilities for decolonisation appear to sit with the hospital team, including pre-assessment clinic staff for elective patients. The policy refers to GPs being informed of positive results, but it is unclear in what circumstances prescribing decolonisation becomes a GP responsibility. NEL primary care antimicrobial guidance also does not establish a blanket expectation that general practice should initiate decolonisation following hospital screening.
NEL LMCs view is that the clinical team requesting an investigation should remain responsible for reviewing and acting on the result, including ensuring the patient receives necessary treatment. An internal Trust policy cannot unilaterally create a contractual responsibility for general practice or transfer work into primary care.
Where the system wishes general practice to undertake this work, this must be developed as an agreed interface pathway, with LMC involvement, clear responsibilities, appropriate communication and consideration of workload and resource implications. Londonwide LMCs has written to the ICB about this and is awaiting a formal ICB response.
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. 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.
Also, lookout for LMC-led GP events in your area, we have events planned in every NEL borough throughout October and November 2026.
Please 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.
Get new deals with the Londonwide LMCs Buying Group
Our Buying Group suppliers not only offer great deals to practices looking to switch, they also aim to offer the best value to existing customers in the Londonwide LMCs area, including explaining new products and features as they get rolled out.
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- 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.
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