NWL LMCs newsletter – December 2024

NWL ICB access plans

Progress in developing an Access Specification has been slow since the agreement to keep access out of the 24/25 NWL Single Offer. This was in part explained by the general election, changes in ICB organisation structures and failure to get agreement on the content of a stand-alone scheme which has subsequently been offered in 2 parts. We are in agreement with the ICB to keep these monies in General Practice and supported the concept of PCNs putting forward their solutions to improving access.

Unfortunately, the mechanism to ensure this investment is realised has not been helped by a lack of clarity of activity, sustainability and value for money when submitting business cases. Sharing feedback with PCNs as to what is a good scheme, and the marking criteria has not happened until this week. Our concern is PCNs will expend forlorn effort in writing business cases only for these to be turned down due to the ambiguous nature of assessment; especially relevant is the desire for these monies to be unrealistically spent in year. However, we are reassured that the ICB is looking to provide feedback to approve as many business cases as possible. We look forward to January when planned meetings to discuss specification for 25/26 will be shared.

Managing the primary-secondary care interface FAQs

1. What can I expect from my hospital trust?
   The NHS standard contract, introduced in 2017, outlines key responsibilities for Trusts in relation to the primary-secondary care interface, as summarised in the following report: ICB leads recognise the importance of the involvement of LMC leads in the workstreams planned for 2025. You can read more here.
2. This is not what my practice and patients are experiencing – what is my LMC doing to help?
   At a NWL wide level LMC leads are meeting with the ICB and acute provider collaborative leads to discuss how to implement solutions around four key areas, identified as priorities by NHS England in the Primary Care Access Recovery Plan published May 2023:
   • Onward referrals
   • Complete care (fit notes and discharge letters)
   • Call and recall
   • Clear points of contact for clinicians

   At a borough level, LMC leads attend Trust-GP forums to escalate and resolve problems with local Trust leads directly.

3. How can I pushback on un-resourced work transfer from secondary care to my practice?
   Londonwide LMCs has created template letters to help practices pushback. These can be uploaded to your clinical system for ease of use by practices. More information can be found here and a copy of the template letter here. Practices and PCN CDs are encouraged to report any interface issues they are experiencing with local Trusts to the applicable Primary Care Liaison Officer (PCLO), copying in the relevant Trust Senior Responsible Officer (SRO). LMC leads should be provided with anonymised examples for awareness, especially when escalation is needed. Please see the appendix for full contact details.
4. I waste a lot of appointments dealing with patient queries and problems the Hospital should be dealing with – how can I stop this?
   As well as monitoring and resolving GP concerns raised, your Trust Primary Care Liaison Officer (PCLO) and Senior Responsible Officer (SRO) will be monitoring issues, queries and complaints sent in by patients to PALS. Practices are encouraged to use your PPGs and patient forums to raise awareness of Trust responsibilities and encourage patients to send their concerns, queries and complaints to Trust PALS. Please see the appendix for full contact details.

GP Pathfinders Update Communications
The responsibility for providing other ICBs and practices update communications sits with NWL ICB.

NWL LMCs concerns re Adult ADHD services
NWL LMCs had no involvement in the process for Harrow Health to take Adult ADHD services. We met with Harrow Health on 6th August and ICB on 12 September; we are still chasing the ICB for a response to our concerns about the pathway, following their recent cancellation of a further meeting to resolve the issues below.

We understand the pathway is for general practice to take on Shared Care and Annual Reviews. Both elements create clinical safety concerns and clinical liability risks for GPs. The four main concerns we concluded as: patient safety; Shared Care; Annual Reviews, and remuneration needed for prescribing.

We are aware of examples where there is no Shared Care agreement, or where Shared Care is not Shared Care due to patients being discharged, with the ask for GPs to prescribe medication. Please be aware of this pattern, and exercise judgement when deciding whether recommendations from other providers fall within your remit and within your competence. More guidance on Shared Care pathways can be found here.

Best wishes,

North West London LMC Chairs

Appendix

1. Hospital Trust contractual obligations:

The ICB is working with Trusts and the LMC to achieve 4 priorities: • onward referrals • complete care (fit notes and discharge letters) • call and recall • clear points of contact

2 Hospital Trust contact details for Practices and PCN CDs to report issues

Please report to the Trust Primary Care Liaison Officer (PCLO), copying in the relevant Trust Senior Responsible Officer (SRO). You may also send a redacted copy to your LMC lead if you want this escalated.

3 Trust PALS contact details for your patients to send in their concerns, queries and complaints