Dear colleague,
Chair’s introduction
It has been a very hot summer, and unsurprisingly, this month’s newsletter reports on a number of very hot issues in North East London.
There are immediate actions for practices, including the need to review FP69 deductions carefully. We also provide updates on areas where LMCs continue to challenge the ICB on behalf of practices, including the LTC PCQOF and PCIT transition, housebound flu and childhood immunisation schemes, and the proposed Antipsychotic SMI Depot LIS.
Several items also look ahead to major system changes including Same Day Access, neighbourhood integrators and to the development of a NEL interface consensus document which all have the potential to impact workload, funding, clinical responsibility and how general practice is represented in wider system decision-making.
NEL LMCs’ position remains clear: changes affecting practices must be safe, deliverable, properly resourced and developed with meaningful general practice involvement from the outset. Please continue to share local examples, concerns and queries with your LMC representatives, as these remain essential in helping us challenge risks and represent practices effectively.
Dr Kate Nicholson
Vice Chair
Tower Hamlets LMC
Spotlight on guidance
Seasonal flu campaign 2026/27
There has been continued confusion around who can and cannot consent for a vaccine – this can only be done by registered healthcare professionals, which does not include HCAs. Please read the Londonwide LMCs guidance on this for the 2026/27 season, including details about VGDs, PGDs and consent.
Commissioning updates
LTC Proactive Care QOF
NEL LMCs continue to press the ICB for income protection for the 2026/27 LTC PCQOF scheme, given the delays in implementation, the time required to affect positive changes to clinical outcomes and the ongoing transition from CEG to PCIT.
This matters because practices and PCNs are being asked to deliver against a scheme where key operational dependencies have not been fully in place, including agreed templates, searches, targets, training, call/recall processes and reporting arrangements. Practices should not be financially penalised for delays or technical gaps outside their control. Londonwide LMCs position is that expectations for General Practice achievement in this first year of the scheme must be proportionate, pragmatic and fair. Where practices have undertaken work in good faith, there should be protection from unfair clawbacks.
PCIT templates and searches
Practices have raised concerns about PCIT implementation, including missing or inadequate templates, coding issues, uncertainty about which tools should be used, and anxiety that practices could be penalised against requirements when the necessary tools are not yet fully available.
The ICB confirmed that PCIT will not simply reproduce CEG templates, because they want to quality assure the templates against the actual service specifications and ensure coding and reporting are reliable. Additional resource has been provided to accelerate this.
LMCs have also raised the wider QOF risk if PCIT does not provide templates and searches equivalent to those previously available through CEG. Practices need clarity on what PCIT will provide for QOF, local enhanced services and PCN-level delivery. Londonwide LMCs requested a timeline/prioritisation plan for outstanding PCIT work. We will clarify the PCIT offer for QOF templates and searches and continue pressing the ICB and PCIT on implementation issues. If you have any issues that you feel have not been fully addressed through your direct initial queries to PCIT, please kindly inform your local LMC reps, so that the issues can be escalated on your behalf.
The ICB has confirmed that they are also working to identify a funding source for the PCN hub templates and they are seeking approval for a model whereby PCNs initially pay the charge and could subsequently be reimbursed.
Housebound flu and childhood immunisation engagement schemes
Londonwide LMCs has received two draft specifications for a NEL-wide housebound flu scheme and a PCN childhood immunisation engagement scheme. We have reviewed these specifications and provided comments to the ICB. We will keep practices up to date on progress for these schemes.
Mental Health / Antipsychotic SMI Depot LIS
Londonwide LMCs, alongside BDH LMC representatives, has been negotiating the NEL-wide Antipsychotic SMI Depot LIS and associated shared care arrangements with the ICB for over eight months.
While we recognise the complexity of developing a single NEL approach, and welcome investment in general practice, significant clinical and operational issues remain unresolved. These include: the need for additional CMHT liaison nurse support, particularly in Outer NEL where practices may be administering depot medication for the first time; a consistent mechanism for timely specialist advice and escalation; clarity on Mental Health MDT provision and consultant psychiatrist capacity; safe arrangements for clinically complex patients; and appropriate GP and allied health professionals clinical training.
The LMCs view is that these issues are fundamental to safe shared care. Shared care remains voluntary and non-core for General Practice, and practices must be satisfied that capacity, competency, clinical governance and continuing specialist support are in place before accepting responsibility for individual patients.
Londonwide LMCs has asked the ICB to pause implementation of the SMI depot LIS until the outstanding issues are resolved or appropriate mitigations are agreed.
FP69 list cleansing and patient deductions
Practices continue to raise concerns about FP69 list-cleansing and patient deductions. We are aware that practices report significant reductions in list size and often have to reinstate several patients after checking.
List deductions can create both financial and patient safety risks. We are aware that around 15,000 patients had been deducted from NEL practice lists between April and June 2026. In the long-term, practices are looking at losing around £200 per patient when taking into account funding made available through QOF, DES, LES, etc on a per-patient basis in addition to global sum. This could represent approximately £3m disinvestment from general practice in one quarter. There is also a risk that vulnerable patients are removed despite remaining resident or still needing continuity of care.
NEL LMCs’ view is that practices should not be left to manage the consequences of large-scale list-cleansing without transparency on the process. Any process must be accurate, proportionate and sensitive to deprivation, mobility, language barriers and safeguarding risk. Practices should check deductions carefully, reinstate patients where appropriate and share examples of problematic deductions with their LMCs.
Londonwide LMCs are engaging with NHSE on a regional level to express our concerns that the impact of this disinvestment risks destabilising individual practices and also General Practice as a whole. We are also aware that similar concerns have been raised by the GPC on a national level, but that NHSE have still pushed ahead regardless.
Londonwide LMCs’ FP69 guidance
Obesity, QOF and Tirzepatide
The NEL ICB Medicines Optimisation Team has recently circulated advice on the management of obesity and the use of tirzepatide in general practice.
We are concerned that this communication is misleading, as it appears to suggest that an obesity management service has now been commissioned from general practice through QOF. This is not the case. We have previously published a briefing for North East London setting out the LMC’s interpretation of the contractual position, together with an assessment of the financial implications.
We have contacted the Medicines Optimisation Team and expressed our concerns.
At present, no obesity management service has been commissioned from general practice. Practices may, of course, choose to undertake this work without additional commissioned funding, in the expectation that the first-year QOF income will cover the associated costs. However, we strongly recommend that practices read our briefing before making that decision, as doing so may have important longer-term contractual and financial implications.
Obesity, QOF and Personal Care Adjustments (PCAs)
A further issue has been raised nationally concerning whether a PCA may be applied to OB005 where no appropriate service has been commissioned. The Business Rules for this QOF domain appear to provide for such a PCA. However, there is a significant difference between the interpretation adopted by the LMC and GPC, and that of NHS England. NHS England has published an FAQ addressing the issue, but its wording is unfortunately unclear and appears internally inconsistent. We are therefore awaiting definitive clarification.
Where we are with DOACs
The position regarding DOACs remains unresolved. The LMC’s view is clear and unchanged: neither the initiation nor the ongoing monitoring of DOACs forms part of core GMS. We have previously produced a North East London position statement for practices and commissioners setting out our position.
NEL ICB has advised us that the matter will now be determined at London regional level rather than by the ICB. The LMC will be meeting regional colleagues shortly in an effort to resolve the current impasse.
Pending the outcome of those discussions, we are not currently advising practices to initiate the transfer of patients back to hospital-based anticoagulation services. However, practices should be clear that general practice is continuing to provide this service temporarily and under protest, in the absence of an appropriately commissioned service. The LMC reserves the right to advise practices to return this work to secondary care if that becomes necessary to protect general practice’s capacity to deliver safely the services it is commissioned to provide.
Local engagement
Same Day Access engagement
The ICB has confirmed that the new Same Day Access specification is expected to go live from 1 October 2026 and move into the NEL Network Contract framework. The initial specification is likely to involve limited operational change, but the ICB sees this as the starting point for wider redesign over the 3.5-year contract period.
The longer-term aim is to position SDA more clearly within the urgent and emergency care system, including links with 111, UTCs and the UEC single point of access. LMCs were clear that if activity shifts from urgent care into general practice, the associated resource must also shift.
NEL LMCs raised concerns about inconsistent opening hours across NEL, limited communication with PCNs ahead of implementation, a lack of tariff uplift over the years, uncertainty around interoperability funding and the need for fair KPIs. The specification must also remain flexible enough to align with neighbourhood working and any future PCN DES changes.
The ICB has agreed to engage with providers, Places and LMCs during the first six months and to review the model iteratively.
Levemir switching
NEL LMCs have written to the ICB regarding the increasingly urgent position for patients prescribed Levemir. Approximately 1,600 patients across NEL remained on Levemir in July 2026, predominantly in Outer NEL, and pharmacies are already reporting intermittent supply problems.
The LMCs are extremely concerned about the risk of gaps in insulin provision, which could lead to significant patient harm. While some PCNs have accepted the third-party Levemir switching support offer, this does not cover all affected patients. At the current rate of switching, completion would not be expected until around October 2027.
The LMC position is that general practice may be well placed to undertake much of this work, but only with appropriate training and funding. Practices cannot safely absorb this additional clinical workload without resources, particularly when the ICB is considering funding additional capacity in secondary and community services.
NEL LMCs have asked the ICB to provide clear referral and signposting arrangements for practices and pharmacies, and to ensure pharmacies direct patients into any commissioned pathway rather than routinely back to general practice.
NEL integrators and neighbourhood working
Londonwide LMCs have written to the ICB seeking urgent clarification on the proposed neighbourhood integrator function, following the request for each Place to identify potential integrator organisations by mid-August.
The LMCs recognise the importance of neighbourhood working and welcome the principle that primary care should be a critical partner. However, if general practice is to be a genuine and equal partner, it must be involved in shaping arrangements from the outset, not consulted after potential models or organisations have already been identified. LMCs are the elected representatives of general practice and should be involved alongside PCNs, federations and other primary care partners.
The LMCs has asked for clarity on the Place shortlisting process, the functions and resources expected to transfer to an integrator, and the decision-making and sign-off process after shortlisting; we also asked how this work aligns with the emerging national SNP and MNP contracting models.
The LMC view is that the process must be inclusive, transparent and fair, with meaningful general practice involvement before any integrator or host arrangements are concluded. Londonwide LMCs has requested an urgent discussion with the ICB.
NEL Primary and Secondary care interface consensus
NEL LMCs are progressing a draft NEL LMCs interface consensus document to support practices in understanding and challenging inappropriate workload transfer between primary, community, mental health and secondary care services. This is expected to be ready by the end of September 2026.
NEL ICN remains without a shared system-wide interface document, despite recurring issues such as inappropriate requests for investigations, prescribing, onward referrals, fit notes, follow-up and administrative work being passed back to general practice. Several providers have their own documents, but these are often secondary-care led and have not necessarily been agreed with LMCs.
The LMC view is that practices need a clear, accessible and agreed framework that can be used when interface disputes arise. The document will draw on existing London examples, particularly the North Central London document, but will also reflect NEL-specific issues, including A&G, GP quality alerts and the NEL interface prescribing policy.
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 a number planned in every 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.
Well done to the prize draw winners from 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. The randomly selected winners of the gift vouchers were:
- Trudy Do, Havergal Surgery
- Karen Tobin, The Bromley Common Practice
- Anca Radulescu, St. Margarets Medical Practice
- Marian Negoita, Amersham Vale Practice
- Aparna Pal, Jubilee Garden Medical Centre
Our Buying Group suppliers are:
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- 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!