North West London LMCs newsletter – April 2025
Londonwide LMCs guidance in focus
Core hours – contractual requirements and practice self-checklist
The GP Support team at Londonwide LMCs support practices who have received contract advisory notices in relation to core hours. Further information on what can happen if your practice is found to be in breach of your GMS/PMS Contract can be found at the following link.
Issues practices have been challenged by ICB’s relating to Core Hours fall into two categories:
- Having their front doors closed for any time during core hours (8.00am to 6.30pm). This tends to happen during lunch time to allow staff time to catch up with administrative work, attend training, utilise protected learning time etc, but in most cases we have seen that there is an alternative access system in place as outlined below.
- Having their telephone lines either switched over to an alternative provider such as a local Out of Hours organisation or having an internal system of a bypass number in the event of an urgent appointment request. This tends to happen first thing in the morning, for example between 8am and 8:30 or 9am, during lunchtime, or sometimes at the end of the day between 6pm and 6:30pm (these are indicative times).
Guidance on Core Hours Contractual Requirements and supporting Practice Self-check considerations can be found at the following link.
If you have been contacted by NWL ICB on issues relating to Core Hours, please contact the GP Support team for expert and confidential advice at gpsupport@lmc.org.uk.
NWL GP collective action on MAR charts
BMA and legal guidance is that there is no need for a GP to complete a community drug chart (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 obligated to provide an additional authorisation document. Following requests from GPs, NWL LMCs have written to Trust SROs, cc the ICB, giving 90 days’ notice from 17 April 2025 that GPs will no longer be providing medicine authorisation charts for district nurses.
Eating disorder pathways
LMCs have asked the ICB for a meeting to understand the commissioning arrangements for these services and clarify the expectations on GPs. We have noted that some services are requiring GPs to perform physical health monitoring tasks, such as monthly blood tests, ECGs, and observations. This is inappropriate and unfeasible due to the lack of resources and accessibility, particularly the absence of paediatric ECGs. We have shared examples, national guidance section 3.6 and coroners reports to assist and to highlight the patient safety issues. We will continue to keep you informed of any changes.
NWL ICB Enhanced Services Single Offer
2024/25
Year-end Reconciliation process – NWL ICB will be contacting PCNs outlining the process and timeline it will follow, including appeals management. The LMC reminded the ICB that it had agreed to include the impacts of the NWL Pathology Lab errors on achievement as part of the year end reconciliation process.
2025/26
As reported last month, the LMC and ICB have discussed key lessons, including the importance of early planning, sharing learning, and addressing issues proactively. To support these efforts, the ICB will utilise primary care webinars to:
- Launch this year’s services
- Gather and resolve questions and concerns
- Identify training needs
- Share best practices
- Identify quick wins
The ICB will maintain an issues log to determine whether problems are PCN-based or NWL-wide. Additionally, the LMC has requested that the ICB provide enhanced services information in a centralized location, with any changes highlighted throughout the year. The ICB is also exploring digital solutions to streamline processes. Please consider sending a practice representative to the webinars and checking the Training Hub newsletter for training opportunities. The first webinar will be held on Wednesday 30 April 1:00pm – 2:00pm. Click here to join the meeting.
The LMC continues to raise the following:
- Warfarin monitoring and funding – the ICB will review the methodology for funding the service.
- Diabetes – patient safety and deprivation index issues.
- Respiratory- learning from training.
- Medicines Optimisation Enhanced Service (MOES)- there will be quarterly monitoring/discussions.
The ICB wishes to engage with PCNs that withdrew or chose not to engage with Phase 2 of the service in 2024/25 to understand the reasons and discuss what support may be needed to assist in 2025/26. The format for these is intended to be facilitative.
Community services review
The LMC has highlighted the need for fully representative consultation to avoid unintended consequences and unrealistic expectations of General Practice to fill service gaps. The LMC has also highlighted the collective action on MAR charts (as above) which will impact on this.
Managing the primary-secondary care interface
The LMC is working with the ICB and Trusts to improve 4 priority areas:
- Onward referrals – guidance is being finalised and will be shared with general practice.
- Complete care (fit notes and discharge letters) – Trusts are identifying priority areas for issuing fit notes; acute trusts are developing a template for discharge summaries.
- Call and recall- live across all acute trusts.
- Clear points of contact – the LMC continues to pursue how the role will be filled at Hillingdon Hospital.
Eight supporting workstreams have been set up with LMC representation to achieve tangible outcomes. LMCs will be writing to Trusts this week to request their access policies following concerns over the management of DNAs and private to NHS referrals.
NWL Updated interface prescribing policy 25/26
The LMC was consulted on the policy but not all of our comments have been taken on board, specifically, under ‘Discharge arrangements’ the contractual requirements reference ‘a minimum period of 7 days’ supply’; the LMC requested amendment to ‘a minimum period of 14 days supply’ to align with other parts of the policy, in particular in monitored dosage systems in paragraph 6.1.
LMC elections – nominate yourself now
This spring is your opportunity to stand for all the LMCs which cover North West London. Please watch our short animation explaining why should you stand for your local medical committee, which is part of our regularly updated elections page. You can also share the animation and a short message via WhatsApp.
If you would like to find out more about being a member we are running two lunchtime awareness sessions on either Wednesday 7 or 21 May 2025 you can register for these via lmc-elections@lmc.org.uk.
Dr Lisa Harrod-Rothwell, CEO, Londonwide LMCs says: “If you are the type of person who likes things to change when they are broken, if you don’t accept people saying “that’s just the way it is, we have to live with it”, and you want to make a difference to your colleagues and your patients, please stand for your LMC. You can raise and resolve all sorts of issues such as interface and pathways that are impacting on your ability to do your job.”
Nomination packs were be sent out via email on Monday 28 April. If you do not receive regular emails from us, think your details need updating, or you know of any GPs who may not be receiving our updates, whether they are a partner, employed, locum, new entrant or a trainee GP, contact us on lmc-elections@lmc.org.uk.