Dear Colleague,
Introduction from Dr Darren Tymens, Londonwide LMCs Medical Director for North East London
2025 has been a challenging year for the health service, and for general practice in particular. We have seen NHS England abolished, ICBs brutally downsized, a contract agreement that forces implementation of online consultations throughout core hours despite risks to patient safety, and new London and national Ten-Year Plans. In NEL we have felt the impact of all of these things, and Londonwide LMCs teams working in NEL and its committees, led by a hard-working and committed group of Chairs and Vice Chairs, have worked diligently to mitigate the worst aspects whilst also trying to help general practice (in all its forms) prepare to make the most of any opportunities.
General practice itself remains surprisingly resilient and robust. We have been around in one form or another for at least 2500 years, since Hippocrates finished his first clinic, almost certainly an hour late. As we head into the Christmas period: for those taking time off, please enjoy a very well-earned break; for those continuing to work, please remember how vital your contribution is, and how deeply valued you are by the communities you serve – even if not everyone always remembers to say so. To quote Sir William Osler, often considered the father of modern medicine: ‘Nothing will sustain you more potently than the power to recognize the true worth of your work.’
Below is the LMC December newsletter, summarising in more detail the issues currently affecting NEL. On behalf of the NEL Londonwide LMC team – take care of yourselves, and please also take care of each other. And if there is anything you think that NEL Londonwide LMCs can help you with – large or small, personal or contractual – please let us know.
Spotlight on policies and guidance
There are some important steps for practices to take over Christmas and New Year to ensure contractual compliance. Please read Londonwide LMCs’ latest guidance.
There are some important updates on the seasonal flu campaign 2025/26 and other immunisation changes.
Enhanced services review
We have strong representation of LMC leads on new task and finish groups established for the NEL review of enhances service. We will provide more details as the review progresses.
Phlebotomy
Two rounds of LMC feedback provided on the draft spec. There is a need to review the current tariff to reflect inflationary costs. We strongly objected to the proposal of not having a domiciliary service tariff and the impact this will have on patient care and LTC management, especially in view of the current waiting times for domiciliary phlebotomy provided by community services.
Mental health
Initial discussion on proposals for a scheme covering ADHD and a scheme on SMIs and depot. There are LMC representatives on the two working groups, who will provide feedback on the ADHD specification as well as feed into the development of the SMI and depot specification.
Simple wound care
Feedback provided on the draft specification. We have highlighted concerns on the viability of the service unless the tariff reflects the true costs of delivering the service, including consumables; and recommended that the proposal to extend the service to include weekend provision is reconsidered by the ICB.
Contracting and procurement
We have expressed concerns on the proposals to open a few of the services to the market, as we know they are best delivered in general practice. We are working with the ICB to mitigate this and have asked the ICB for more information on the process.
Other commissioning activity
NEL Community Anticoagulation service
We raised concerns with the ICB about the new Community Anticoagulation Service, particularly the limited communication with practices about providers, locations and expected scope of care. We also challenged a gap in the commissioned model around ongoing DOAC monitoring, which is not contractual for GPs and currently has no LES or funding attached in NEL. Practices may need to consider whether to continue this unfunded work unless an appropriate LES is introduced, noting that other ICBs are already remunerating GPs for DOAC monitoring. We have asked the Medicines Optimisation team to continue working with us to clarify responsibilities and funding before the new service goes live, to minimise risk and avoid unintended adverse impact on patients, due to commissioning gaps.
Core contract compliance
Practices need to ensure they are compliant with the new core contract requirements around online consultations throughout core hours; if you are struggling to maintain this, please contact the ICB for support. We know this is challenging for many practices, but if you are having difficulties it is better to be in dialogue with commissioners about what they are.
Practices should also ensure the “You and Your General Practice” information is clearly available on their website – recent checks by the ICB found that around 22% of practices did not appear to have this in place. The ICB will shortly be contacting practices that may not be fully compliant to offer support and clarify any issues. If you would like to discuss this, please get in touch with your local LMC or the NEL sector team at Londonwide LMCs.
Primary – secondary care interface
Your LMC reps have completed a new NEL-wide self-assessment of the primary-secondary care interface for each Trust, reviewing progress on onward referrals, fit notes, discharge summaries, advice and guidance, call and recall, clear points of contact and interface meetings.
The results show significant variation between Trusts – with some evidence of improvement in areas such as clearer GP action lists on discharge letters and onward referral processes, but also persistent gaps including weak call/recall systems, inconsistent fit note provision and poor contact routes into hospital teams. This structured feedback will be used to strengthen our representation at NEL and regional level, press for clear accountability from Trusts and the ICB, and challenge any ongoing transfer of hospital work into general practice.
Local engagement
Engagement with the NEL training hub
This month we reset our engagement cycle with the NEL Training Hub, focusing on apprenticeships and wider workforce development. We discussed an “Apprentice First” approach to vacancies, tackling stigma and encouraging practices to see apprenticeships as a high-quality route into both clinical and non-clinical roles. There has been growth in non-clinical apprenticeships, supported by tailored programmes and a managed apprenticeship service to reduce the admin burden on practices.
The Training Hub also outlined current and emerging offers across three priority areas: leadership (including a GP Practice Operations Manager programme), community and prevention (Community Health and Wellbeing Worker roles), and digital (integrated learning with potential short courses to follow). The borough level training hub clinical leads will be invited to the borough LMCs to discuss local training needs analyses.
Oliver McGowan Training
We met with the ICB and Training Hubs to discuss the rollout of Oliver McGowan training in NEL. We raised practices’ concerns about the limited access to Tier 2 face-to-face sessions, capacity to release staff for whole day training sessions, training locations, and how training can be evidenced for the purpose of satisfying CQC requirements.
Practices should visit the Training Hub website for signing up to the training. Further training dates will be released for February onwards.
We challenged the concentration of Tier 2 sessions at Homerton, highlighting the risk of inequalities, and pressed for a fairer spread across all boroughs and GP-accessible venues. We also asked for a process whereby practices who cannot secure a place in this round of training can request a written letter from the ICB confirming that training is underway. We will continue to monitor delivery, including the new external provider to ensure the programme is equitable across all NEL.
NEL racism in general practice listening events
The ICB is hosting listening events across NEL boroughs to inform the development of a stronger, system-wide response to racist abuse towards primary care staff. The need to update the zero-tolerance information on the ICB website was reiterated and provide clear, consistent messaging and posters for practices, including localised resources.
We called for psychological and wellbeing support for affected staff, anti-racist training, and practical toolkits to help teams respond to both overt and subtle racism, including vexatious complaints and requests not to see BAME staff. The importance of 100% formal reporting of incidents, shared learning (not just practice-level SEAs) was highlighted, and clear policies and thresholds for action against abusive patients, aligned across NEL. The LMC will continue to engage with the ICB to support the development of this area of work.
Londonwide LMCs Buying Group
Londonwide LMCs has refreshed and relaunched its Buying Group. This provides practices and staff access to enhanced deals on quality-assessed suppliers for a range of products, services and other opportunities.
New products and services include offers on staff wellbeing, call and recall, and practice supplies; the expanded existing range includes insurance, cloud telephony and online training/support. Please take a look – are there any other services you would like to see listed? Fill in the feedback form and let us know your thoughts.
The Londonwide LMC NEL Sector Team
You can find the details of your LMC Chairs across NEL here.
Best wishes,
Londonwide LMCs