We have shared the proposed specifications with our members as well as clinical directors in NWL for feedback where appropriate, as well as our summary responses to the ICB. Some of these discussions are still ongoing and as of 30 March 2026 we are still awaiting the formal outcome of the business case regarding additional funding for the new proposed cardiovascular renal-metabolic (CRM) specification. We have briefly summarised our input and ongoing concerns below.
Enhanced Services 2025/26
Access 2025/26
NWL ICB wrote to PCN CDs and managers, for onward transmission to practices, on 2nd March 2026 outlining the further funding breakdown against the main themes: Accessibility, Continuity and Digital and Engagement alongside revised submission deadlines.
The intention in introducing this was to support PCNs and recognising, although some may not have achieved all elements of the specification, practices have put effort in and should be rewarded accordingly.
Diabetes level 1 2025/26
LMC representatives raised ongoing concerns regarding the ambitious targets for HbA1c in newly diagnosed which practices were struggling to achieve despite significant efforts and improvement in patient outcomes. Following ongoing LMC representation, clinical leads made a successful case to PCEG which was approved. PCNs should have now received communications confirming the lowering of thresholds and full payment if they achieve at least 3% improvement during the year. This means that most PCNs will receive full payment for this indicator.
Non-diabetic hyperglycaemia 2025/26
While practice achievement for indicators has been high for most PCNs, some have reported challenges with hitting the target due to issues with referring to the provider, mostly in the borough of Brent. The ICB have advised that practices detail any challenges despite their best efforts to hit targets as part of the appeals process so that this can be taken into consideration.
Warfarin 2025/26
The LMCs provided overwhelming evidence from PCNs that the service was assessed as financially unviable in every borough and required a funding review. The ICB expressed awareness and understanding indicating it would raise with ICB Executives. ICB colleagues stressed it could not raise the overall single offer budget. LMCs offered solutions to address the issue including potential utilisation of underspends within budgets. This was not advanced, LMC Chairs and PCN CDs will be writing to pursue financial support for 2025/26.
Enhanced Services 2026/27
Indicative activity plans (IAP)
The ICB will be reviewing 3 years’ historical data sharing achievements and forecasts with PCNs/practices. This approach was welcomed by the LMCs.
Inflationary uplift
2025/26 was the first year that the ICB provided an inflationary uplift to single offer services, applied in-year through two staged contract variations. The LMCs have requested that the 2026/27 single offer budget also be increased in line with the GP national contract uplift. The ICB has agreed and is awaiting national confirmation of the amount before it can proceed. It has also confirmed that any increase in-year would be backdated to the start of the financial year.
Warfarin 2026/27
LMCs suggestions on how to better fund the service have not been advanced, however the ICB has agreed to keep under review as a live issue. The LMCs will continue to lobby the ICB, repeating its request for increased investment for 2026/27.
Medicines optimisation 2026/27
The LMCs asked for a reconciliation for 2025/26; this was refused by the ICB. The 2026/27 specification is more operationally complex and workload-intensive than 2025/26, with the funding remaining unchanged at £1.02 per weighted patient.
This creates a mismatch between delivery expectations, clinical risk, and remuneration.
The LMCs have:
- Requested an uplift in payment or reduction in delivery requirements.
- Requested alignment of workload with funding or consider streamlining the indicators.
- Questioned the suitability of the quetiapine switch; we believe this is purely financial and holds high clinical risk. We have asked for the indicator to be removed.
- Requested explicit clinical exception clauses for switching targets.
We are awaiting a response from the ICB.
Respiratory diagnostic hubs 2026/27
The ICB is proposing a reduction in the tariff from £84.04 to £80.05 per patient, to pay acute trust staff directly on behalf of PCNs for the delivery of their service component (training, audit and checking of results). We have made representation regarding the cost of running this service for PCNs, as well as equipment costs and the additional reporting requirements.
Respiratory specification 2026/27
Following changes to the specification in 2025/26 based on practice feedback, we have highlighted concerns regarding proposed training requirements, target thresholds for the RESP03 indicator for newly diagnosed asthmatics as well as limitations on access to diagnostics for many patients in NWL. The ICB has addressed some of these concerns by: clarifying training and including a self-declaration; reducing the RESP03 target from 80% to 75%; including virtual group consultations, and some exception coding for inhaler use and physical activity.
However, the tariff has not been uplifted and we continue to raise the limited access to diagnostics.
Access service 2026/27
Concerns have been raised regarding proposals for GP slot utilisation by UTC in addition to the contractually required 1/3000 slots for 111 direct booking.
Further clarity is required from the ICB on how this will translate operationally for practices, specifically, how patients will be booked. The LMCs have advocated that practices should assess the most appropriate management of the booked patient following contact and subsequent triage. Patient expectations would need to be managed appropriately within UTCs. The ICB is drafting an accompanying guide for practices and will be agreeing a SOP with UEC to support UTC staff, patients and practices.
LMC members lobbied the ICB not to mandate additional slot times provision; the amended specification suggests ‘optimal’ times for practices to consider instead.
The LMCs have spotlit that the different functionality of S1 to EMIS disadvantages practices and can undermine GP-patient relationships with regards increasing NHS App usage. The ICB IT Team have approached TPP direct for solutions, as has Dr Vijayadeva in his role as NHS England Digital Transformation Lead. In the interim, it is hoped a sliding scale approach will assist.
LMC representatives’ assessment of the NWL ICB modelling for additional NHS 111/UTC provision, which forms 40% of the funding envelope, suggests it creates a financial inequity for some practises based on practice registered list size. LMC modelling has been shared with the ICB.
The ICB has responded that ‘Using different list sizes for national GMS and local NWL Access spec requirements would ..be difficult to operationalise, as it is not practical to expect PCNs and practices to apply one patient list for (national) contractual compliance and another for local delivery.’
Child health hubs 2026/27
This is a new service proposal as part of the single offer for 2026/27. While comments have mostly been positive to support funding of multidisciplinary working, we have fed back comments received regarding funding available, reporting requirements, premises, training requirements and clinical responsibility which the ICB have responded to.
Cardiovascular renal-metabolic (CRM) service proposals 2026/27
Since the initial release of the first draft of the CRM service proposal on 21 December 2025, LMC representatives have been engaged in discussions with ICB leads regarding the proposed specification which replaces a number of clinical specifications currently included as part of the NWL single offer for 2025/26. Much of the proposed likely additional workload this specification generates would be funded through an additional investment of c£6.7m which is still awaiting approval of an ICB business case.
We formally wrote to the ICB on 9 March 2026 outlining key ongoing concerns relating to a number of areas, including but not limited to:
- Workforce implications and workload requirements, including absence of modelling on the impact on number of appointments required to deliver the model and the workforce to deliver it.
- Practice ability to deliver the outcome measures in the timescales, including case finding, call and recall and motivational interviewing interventions.
- The impact of this workload on practices’ ability to maintain reasonable access for other conditions including suspected cancer, acute illness and other long term conditions which has not yet been modelled through an impact assessment.
- Training requirements including the time commitment and minimum mandated staff attendance.
- Concerns about SMS spends for patient engagement and completion of questionnaires impacting on practice financial
- Potential scheme failure if imposed as presented leading to practice non-engagement, and potential significant financial loss to practices as compared to previous levels of achievement for historical services.
We have expressed members’ concerns regarding practice readiness for full implementation on 1 April 2026 and discussions have been ongoing in relation to a component of income guarantee for practices to take in to account the fact that this is a new service proposal. We are currently awaiting an updated version of the specification including possible amendment of target thresholds and clarification regarding possible income guarantees for practices. As this is a new and complex service, with new ways of working, we have requested and it has been agreed that there will be quarterly reviews with the LMCs.
Your representatives
Members of the NWL LMCs Task and Finish Group
- Siobhan Browne, Practice Manager Representative, Kensington, Chelsea and Westminster LMC
- Kathryn Charles, Practice Manager Representative, Ealing, Hammersmith and Hounslow LMC
- Dr Kyla Cranmer, Chair, Hammersmith and Fulham LMC
- Dr Chaand Nagpaul, Chair, Harrow LMC and NWL LMCs Strategic Leadership Network (SLN)
- Dr Sukhpal Shergill, Chair, Ealing LMC, Vice Chair, Ealing, Hammersmith and Hounslow LMC
- Dr Paul Skinner, Vice Chair, Hammersmith and Fulham LMC
- Dr Meena Thakur, Vice Chair, Harrow LMC
Londonwide LMCs Directors
- Dr Hannah Theodorou, Medical Director, NWL LMCs
- Jamie Wright, Director Primary Care, NCL and NWL LMCs
- Dr Asiya Yunus, Medical Director, NWL and SWL LMCs