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NWL LMC newsletter – Late July 2025

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Covering: LMC elections, Londonwide LMCs stocktake, fit notes, proposal to merge NCL and NWL ICBs and more.

Dear colleague,

North West London LMCs newsletter – Late July 2025

LMC elections
Thank you to everyone who stood and voted in the recent LMC elections. Your LMC members for 2025-28 can be found here. The new members officially take up their posts on 1 September, so until then your existing LMC teams remain in place.

Londonwide Local Medical Committees – Constituent Survey
We have instigated an organisational stocktake and are seeking feedback from you and your practice teams to better understand your needs and priorities for our services going forwards.

The survey will remain open until 15 August 2025.

All responses will be anonymous unless you choose to actively identify yourself within your free text response/s. Thank you for taking the time to contribute to this survey. A short summary of our role and how we support practices is available if it would assist you in responding.

Londonwide Guidance in focus – GP Support’s guidance on core opening hours

Fit Notes – policy changes and consultant’s responsibility to provide sickness certification for patients under their care
Your LMC is assisting in a workstream with the ICB and acute provider collaborative so that Trusts are issuing fit notes in line with their contract, to avoid patients using appointments unnecessarily to request sick notes/ongoing sick notes that should have been provided by their hospital consultants.

The National Fit Note Guidance includes that: in 2022, Department for Work and Pensions (DWP) implemented two significant changes to the fit note.

  1. A new version of the fit note was introduced to replace the signature in ink with the name and profession of the issuer, which means that patients can receive their fit note through digital channels (where the local IT system support this). The LMC is part of a workstream working towards making electronic fit notes available within secondary care settings from September. In the interim, patients should receive a pre-printed fit note form from their hospital doctor when discharged from hospital.
  2. DWP have also enabled nurses, occupational therapists, pharmacists, and physiotherapists, in addition to doctors, to certify fit notes. This means patients can receive a fit note from the healthcare professional treating them, for instance a physiotherapist, if it is appropriate for them to do so.

As per the NHS standard hospital contract, (SC11) this activity should be provided by secondary care:

  • ‘11.12 Where a Service User either:
    • 11.12.1 is admitted to or discharged from hospital; or
    • 11.12.2 attends an outpatient clinic or accident and emergency department, the Provider must, where appropriate under and in accordance with Fit Note Guidance, issue free of charge to the Service User or their Carer or Legal Guardian any necessary medical certificate to prove the Service User’s fitness or otherwise to work, covering the period until the date by which it is anticipated that the Service User will have recovered or by which it will be appropriate for a further clinical review to be carried out.’

The role of hospital doctors in issuing the Statement of Fitness for Work
Hospital doctors may need to provide all certification for social security and Statutory Sick Pay purposes for patients who are either incapable of work or who may be fit for work with support from their employer. The duty to provide a Med 3 rests with the doctor who at the time has clinical responsibility for the patient.

Hospital out-patients
For an out-patient this will generally be the hospital doctor, except where the GP retains responsibility, for example where the patient has been referred to a hospital for an opinion or advice on their health condition. In cases where the patient’s GP has not taken over responsibility for the incapacitating condition the treating clinician should issue any subsequent Statements for an appropriate forward period.

Hospital in-patients
Form Med 10 should continue to be issued to cover any period that a patient is in hospital. On discharge from hospital the doctor who has clinical responsibility for the patient should provide them, if appropriate, with a Med 3 to cover a forward period. This is to avoid unnecessary referrals to GPs solely for the purpose of sickness certification.

This month, your LMC has been discussing the following

Proposal to merge NCL and NWL ICBs
Following NHSE’s requirement for ICBs to cut running costs by 50%, NCL and NWL ICBs have drawn up a proposal to fully merge into a single organisation by 1 April 2026.  Further detail about the ICB’s case for change can be found here. The proposals were approved at the ICB Board meetings that took place on 22 and 23 July, they will now follow a timetable between July and December to work through the approval and diligence processes needed to form the new organisation.

A programme team will be formed by the two ICBs to plan for the transition of resources.  One of the key issues on our radar for NWL will be to monitor financial plans, particularly as the case for change paper includes a risk that the combined organisation could receive less funding if it moves to fair shares when combined. However, we understand that discussions are underway with the national team.  The NCL and NWL LMC sector teams will work closely together to monitor the development of the merger and we will keep you informed.

Primary Care Provider Collaborative (PCPC) Development
Your LMC has started attending the working groups in its role as the independent voice of GPs, recognised in statute and enshrined in legislation.

The LMC has reiterated the importance of “form following function”. Presently, we do not have clarity regarding all of the ICB functions that would be devolved to the PCPC, nor detailed financial costs of carrying out these roles. We have requested worked examples/scenarios to help the working group understand how the ICB envisages the process of functions being transferred via the PCPC including associated budgets and workforce details.   We have also requested confirmation that the future operating costs of the PCPC are not met with contributions from constituent members and by extension General Practice. We will keep you updated on progress and also welcome your feedback so that we can influence the development in a way that supports GP practices.

NWL ICB Enhanced Services Single Offer
2024/25

  • Year end reconciliation – the borough teams and ICB finance leads anticipate resolving queries by w/b 28th July, with payments to be made in the early August payment run.

2025/26

  • Draft clinical audit templates – clinical audits are a contractual requirement of PCNs, to support continuous learning, service improvement, and to demonstrate value for money (vfm). This is the first year that the ICB has formally requested audits of all PCNs; the LMC has raised CD concerns about their practicality and usability and submitted suggestions for making them more robust and user-friendly. An ICB response is awaited.
  • Warfarin service funding and methodology – the LMC has been raising concerns over the affordability of the service and will be holding a dedicated meeting with the ICB.
  • Wound care and community services – the LMC has raised community rejections of referrals for temporarily housebound patients that are not covered by the GP enhanced service. The ICB will be discussing this with the community service providers.
  • Inclisiran enhanced service request – the LMC has raised the additional workload including counselling needed, which should be supported by an enhanced service.
  • Diabetes payment discrepancies – the LMC has challenged the ICB not applying the 2.15% uplift to the NDH and Level 1 services – a formal ICB response is awaited.
  • CMDU service – this is likely to be extended after September 2025.
  • Possible future services: the ICB is exploring the provision of hypertension case finding and CRM. The LMC has yet to review formal proposals and will keep you updated.
  • It is likely that 26/27 services will be more outcome-based; the LMC has shared a research paper to support an approach that avoids unintentionally increasing health inequalities.

Protected Learning Time (PLT)
Your LMC has raised the need for a policy to be launched with worked scenarios and FAQs. We are aware that NCL practices are resourced to provide reports to the ICB of education undertaken for accountability/transparency and to demonstrate value for money (vfm). We have asked the ICB to investigate using resources such as Service Development Funding (SDF) to support this. We will keep you updated.

NWL (Imperial) Path Lab issues
LMC leads continue to raise:

  • Unreliability of results, undermining patient care and safety.
  • Poor communication.
  • Need for quality assurance and monitoring mechanisms at the lab.
  • Need for external monitoring including a user group with LMC involvement.
  • GP compensation for the earlier uACR error-related work.

The ICB is meeting internally to consider the LMC evidence sent in and is discussing the need for external quality assurance. We will keep you updated.

Primary Secondary Care Interface
Trust contact details on correspondence: both the ICB and LMC have carried out audits and the LMC has raised the need for this in London North West UHT correspondence in particular to avoid patients wasting GP appointments on hospital queries.

Update on Trust-GP liaison systems: Hillingdon Hospital has appointed a Primary Care Liaison Officer (PCLO) to take GP/primary care queries, please see updated details below:

LNWH GP liaison team is designated solely for GP-related issues, queries, or feedback, as they are unable to assist patients directly. Please direct patients to PALS https://www.lnwh.nhs.uk/pals/ or their Patient Access Centre at 0208 235 4200, where the teams are fully equipped to provide guidance to patients.

Best wishes,
North West London LMC Chairs

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