Newham LMC newsletter – July 2025

Dear colleague,

Newham LMC newsletter – July 2025

Here is an update on the work of Newham LMC.

Midwifery medications
Led by LMC member Dr Laura Scott, a group of practices gave notice that they were no longer accepting requests from midwifery services to prescribe medications. We were advised that the Newham University Hospital midwifery team said requests for urgent/initial medications could be sent back to the originating midwife or obstetrician, and to email bartshealth.nuhantenatalresultstoaction@nhs.net if this was not actioned. NUH also organised training and communications for community midwifery teams.

Withdrawing unfunded work
Given financial and workload pressures, practices may be considering giving notice to other elements of unfunded, non-contractual work that they may have been providing to cover commissioning gaps. The midwifery example shows that this approach can work, and provided a base on which Londonwide LMCs has created a letter template which can be used for this purpose.

We strongly encourage co-ordinated responses to issues – if you are considering using the template, please contact the LMC to discuss ideas and shared learning, or come to the Unified Voice drop-in meeting to discuss the issue.

The BMA also provides template letters for similar purposes, which can be accessed here.

The LMC is also working on MRSA prescribing for outpatients. If there are other areas of unfunded work that the LMC should address, please let an LMC rep know, or come to the Unified Voice drop-in meeting.

LIS negotiations
The LMC has had intensive discussions with the ICB over Local Incentive Schemes for both 2024-25 and for 2025-26. A number have improvements have been secured including:

• Practices should now have received a copy of the retrospective Network Contract variation for 2024-25 for SNS and incorporated SNSs.
• In the 2024-25 Long-Term Conditions spec, clearer targets, some targets removed including providing insulin initiation.
• For ECGs, payments for Q1 2025-26 will be honoured as commissioning arrangements are still being clarified.
• In the 2025-26 phlebotomy spec, practices not to be penalised for delays by other community providers.
• SNS payments to be streamlined for 2025-26.
• In the Mental Health LIS for 2025-26, removal of the ADHD element but retention of Anxiety and Depression, and (with improvements including automatic/easier payment) Supported Transfer of Care.

The LMC has advocated for practice-level targets, to avoid practices being penalised for non-achievement by other practices in their PCN. The ICB has held to PCN targets but has agreed to an appeal mechanism for achieving practices.

We are still discussing the wound care spec, including the ICB’s proposal to withdraw payments for referral and admin, and difficulties referring patients to dressing clinics. We welcome practices sharing examples via email or at the Unified Voice drop-in so that we can share with the ICB. Practices may wish to create a separate appointment list for wound care, if it would be easier to audit.

The Care Homes contract is being reviewed but meanwhile is to be rolled over for at least 6 months.

CYP Imms Co-ordinator
The LMC is working to encourage and support the ICB to get in place a Children and Young People Immunisations Co-ordinator role that works, and to communicate with practices about it. We understand there is funding for the role for 2025-26. The ICB has agreed to remove reference to the role from the Childhood Immunisation service specification until staff are in post. There will not be payments linked to the referrals to the childhood imms coordinators in 2025-26.

Community drug charts (MAR charts)
Dialogue remains ongoing about arrangements for community drug charts (Medicines Authorisation Records or MAR charts), and currently GPs are requested to continue doing charts for palliative care / end of Life patients only, while options are explored.

By way of background, BMA and legal guidance is that there is no need for a GP to complete a MAR chart as a prescription is all that is legally required for a nurse or other community worker to administer medication. MAR charts are a record of administration and not an authority to administer medication.

The prescription (FP10) serves as the necessary authorisation, and the GP is not obliged to provide an additional authorisation document. Following requests from GPs, NE London LMCs wrote to the Chair and Chief Nurses of ELFT and NELFT giving 90 days’ notice from 4 April 2025 that GPs will no longer be providing medicine authorisation charts for district nurses. This position subsequently changed to continuing palliative and EOL MAR charts while discussions with the trusts continue.

Omnes
The LMC has raised issues with Omnes about their reporting – Omnes has agreed to offer additional training to staff, review its auditing practices and rectify issues with the referral form.

Weight loss medications
You may be getting patients asking for obesity injections such as Wegovy and Mounjaro. Prescribing weight loss injections should form part of a Tier 3 service, which is not currently commissioned by NEL ICB. Nationally, funding has been made available to prescribe tirzepatide (Mounjaro) for some patients but there are very strict eligibility criteria and a lack of support to assist patients with their weight loss. Londonwide LMCs has pressed for NEL ICB to commission a Tier 3 weight loss service for some time and, until there is a service, to provide patient-facing information so that GPs do not have to field all the enquiries about GLP-1 agonists. This has not been forthcoming despite our efforts, so we have formally written to the CMO of NEL ICB and included within this letter a statement that practices may wish to add to their website.

NEL LMCs position statement on unfunded projects and pilots
NEL LMCs are increasingly concerned about a number of unfunded projects and pilots being implement by system partners without proper engagement with LMCs. As such there is insufficient consideration of their impact on practice workload, and inadequate resources to support delivery. Recent examples include NEL Cancer Alliance projects such as lung and liver health checks and pancreatic cancer case finding. While we recognise that each one is a potentially important initiative aimed at improving patient care, particularly cancer care, it is the cumulative effect of introducing multiple projects without the necessary resources, that places unsustainable pressure on already overstretched practices.

We strongly advise that practices do not engage with projects or pilots that lack clear and adequate resourcing for general practice. If approached about participation in a new projects, practices should contact the LMC for advice before committing. We continue to engage with the ICB and system partners, including the Cancer Alliance, to ensure that future initiatives include appropriate resourcing for general practice and that LMCs are involved at the earliest stages of development.

Care Homes spec
The LMC has seen a new proposal for the Care Homes locally commissioned service and has considerable concerns, including:

• A reduction in the tariff per care home bed compared to the value in the current specification.
• The shift in the payment model, which will see 50% of the payment dependent on achievement of 7 KPIs, which all have unrealistic targets.
• The significant workload involved in delivering all elements of the specification.
• The lack of acknowledgement of the level of resources involved in delivering this service especially in home where there is a high turnaround of residents.

We have provided detailed feedback to the ICB and raised our concerns around the sustainability of this service in the current proposal. As currently structured, the LMC cannot recommend implementation of this specification. We are meeting with the ICB regularly to have further discussions.

For 2025-26, the Care Home spec is being continued from 2024-25 as is. Practices should have received revised contracts.

Digital facilitation
There is a NEL ICB digital team, who support practices with engaging patients digitally – they can support practices in their work on channels such as the NHS app, and may potentially be able to attend a meeting with the practice PPG. Practices can contact Newham senior facilitator Clive Sutherland, or team lead Chito Nwulu.

London Ambulance Service procedures
LAS have developed a decision-making tool for LAS staff to observe which clearly articulates the circumstances when crews should contact GP practices. These are agreed for the following situations:

• End of life care.
• Information sharing regarding/surrounding a safeguarding referral.
• Expected death.
• GP admission request where on arrival of the LAS crew the patient is refusing conveyance which the patient’s GP has arranged.

For all other situations there are other processes for ambulance crews to follow including accessing internal LAS clinical support and advice. Incidental findings will be shared with details of the London Care Record or via an electronic form – patients will be advised by the LAS crew to contact the GP for a routine follow up.

Prescribing Efficiency Scheme (PES)
Following discussions with NE London LMCs, the ICB has made several improvements to the PES that it was proposing:

• Removal of PCN level target, Full payment of £450/1000 patients paid to practices for practice level achievement, as PES is Practice level work.
• Sliding scale payment has been confirmed (% achievement from baseline = % payment towards target).
• Alternative practice improvement targets added, in view of the significant intra-borough variation which would otherwise potentially have disadvantaged some practices.
• Reduction in overall number of workstreams from 8 workstreams down to 5.
• DOAC indicator has been amended, so that it is now for new initiations only.

However, despite LMCs’ requests, there is still no exception coding for PES. We recommend practices to keep records for clinical reasons for exclusions to indicators/areas of work and then present these records to the ICB medicines optimisation team at the end of the scheme, to raise challenges, if needed, where failure to achieve targets has been due to warranted clinical reasons. The ICB team has assured LMCs that “there will be a transparent process for managing such cases”.

Overall, the LMC advises individual practices look at their current achievement for each of the PES areas and the individual indicators within each area, to assess the workload required to meet the targets and then determine whether these targets are achievable in the funding envelope offered.

For further LMC feedback and recommendations regarding PES please see the link here.

Prescribing Quality Scheme (PQS)
Similarly to the PES, LMCs secured some improvements to this scheme:

• Requirement to attend only one meeting, rather that the proposed five.
• Recalibration of the thresholds for achievement of the reduced antimicrobial lengths in line with local performance, which has resulted in a number of lower targets.
• Alternative practice level targets for reduced antimicrobial lengths (antimicrobial stewardship).
• Increased number of points allocated to C1 (Medicines Optimisation in Type 2 Diabetes with Chronic Kidney Disease).
• Increased number of points allocated to C2 (Problematic polypharmacy/ SMR).

Remaining concerns include:

• There remains a significant workload for C1 Medicines Optimisation in Type 2 Diabetes with Chronic Kidney Disease, within a limited funding envelope.
• There remains a significant workload for C2 Problematic polypharmacy/ SMR, within a limited funding envelope.
• Practices should be mindful that despite LMC’s requests, there is no exception coding for PQS, hence practices should keep records for clinical reasons for exclusions to indicators/areas of work and present these records to the ICB MOT at the end of the scheme, to raise challenges if needed, where failure to achieve targets has been due to warranted clinical reasons.

The LMC requested that the ICB send practices dashboards showing their current achievement against each indicator and, in the case of SMR, the target number of reviews to be completed. Practices should look at their achievement for each indicator to determine whether the targets are achievable and worth the workload, in the funding envelope offered.

London General Practice Awards
The 2025 London General Practice Awards were celebrated in the Houses of Parliament on 6 February. Newham was represented on the podium, with Star Lane Medical Centre commended in the Safety Award category. The full roster of winners and commended nominations, with photos and report, is available here.

Freedom to Speak Up Guardian
The Guardian Service provides a safe, confidential route for general practice staff to raise concerns. It is 24/7, confidential, and independent. The emphasis is on de-escalating situations, transparency, and appropriate escalation pathways where needed. There is further information at Freedom to Speak Up – North East London.

Practices are advised to update their whistleblowing policies with the Guardian contact details – 0333 733 6551 and contact@theguardianservice.co.uk.

LMC elections
Thank you to everyone who nominated themselves for Newham LMC and those who encouraged colleagues to do so. LMC election nominations closed at 5:00pm on Tuesday 3 June. The new committees will have their first meetings starting from September, following the completion of the full elections process across London. Until then your existing LMC representatives will continue to support you as usual.

Voting for members of Newham LMC opened on Monday 23 June and GPs practicing in the area should have received a ballot from Civica Election Services via email. You have until 12pm on Tuesday 22 July to vote, so please do so. When you go to vote each candidate will have had the opportunity to provide a summary of why they think they would make a good LMC member.

There is general information about the LMC elections here. Queries, including if you have not received a voting email (having first checked your spam/junk folder for an email from Civica) can be directed to lmc-elections@lmc.org.uk.

LMC information
You can find information about LMC members, contact channels, meeting dates and so on at our web page.

Raise your issues
We continue to encourage practices or individual GPs to raise any concerns or difficulties they are facing. This can be done by approaching one of the reps or attending the monthly drop in UV meeting open to all

Best wishes,

Newham LMC