North West London LMCs newsletter – late March 2025
Londonwide LMCs guidance in focus: safe working including Shared Care
Shared Care and ADHD
We continue to receive concerns regarding shared care arrangement requests, in particular for ADHD. Please note shared care arrangements are voluntary.
We understand the pathway is for general practice to take on Shared Care and annual reviews for ADHD. Both elements place clinical safety concerns and clinical liability risks for GPs.
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 including a template letter can be found here.
Safe working
We appreciate this is a very challenging time for general practice and we want you to know that the LMC are here to support you should you need us. Please look after yourselves, your staff and your patients by always working safely and within your capacity. Londonwide LMCs’ safe working pack is full of advice and resources to help you to do this, and none breaches your contract.
Enhanced Services
Contract Variation 2025/26
PCNs will have, or will shortly receive, from the ICB, 2025/26 single offer contract variation for signature. The LMC shared earlier specification drafts with CDs for feedback to ensure borough issues were captured and asked for 2024/25 lessons learned to be incorporated. Concerns raised and outcomes are below:
- Inflationary uplift – there has been a net uplift of 2.15% across all tariffs.
- Underperforming 2024/25 services – we raised: low demand, training needs, staff turnover and pricing. A small training budget has been included in some services to mitigate.
- Diabetes – we raised timelines, targets, frailty and patient safety. Funding has been shifted to level 1 and the timeline for achievement has been reduced from newly diagnosed in the past 6 years to in the past 2 years. The LMC will be meeting with the ICB diabetes lead in May to discuss issues such as deprivation and specialist practices.
- Respiratory specifications for 2025/26 are simpler, but concerns were raised re thresholds and equipment costs for FeNO. There has been no commitment to moving to full FeNO funding, although this may be considered in the future. Support for respiratory champions will be explored later in the year.
- Medicines Optimisation Enhanced Service (MOES) – we raised deprivation, too many targets and issues out of practice control; we welcome the addition of a part 2 to provide an opportunity to achieve unallocated funds and improve safety.
The LMC has requested a learning event for practices and PCNs to share challenges, successes and lessons learned to inform commissioning decisions.
2024/25 Year end reconciliation
The ICB will be writing out week beginning 31 March 2025 with the process and key dates including for appeals. We have reminded the ICB that this should include a mechanism to recognise the impact of the NWL Imperial Path Lab error.
NWL ICB access 2024/25
Phase 1
The LMC understands from the ICB that they expect all the 50p/head for Phase 1 (£1.3 million) will be paid out by the end of the financial year. This funding was supposed to be released by the ICB on receiving a signed contract. The LMC pursued this when it did not happen and was advised this was due to ICB capacity constraints. The LMC continues to support those PCNs that are still awaiting payment.
Phase 2
In addition to meeting with and writing to ICB leads, LMC Chairs contacted local Councillors and patient representatives in advance of the North West London Joint Health Overview and Scrutiny Committee – 13 March 2025 to obtain reassurance from Rob Hurd that the Phase 2 access funding be kept in General Practice rather than lost to the ICB deficit. Rob Hurd’s ICB report was taken first as he had to go to an urgent meeting following the HSJ announcements that ICBs had to make 50% cuts by December and NHSE will be abolished and merged with DHSC. Natalia Perez, Hammersmith & Fulham Councillor, quoted LMC concerns re access, in particular re phase 2, that a portion of the £6.6M may return to the ICB; could Rob Hurd confirm the full £6.6M would stay in General Practice for 2024/25. Rob Hurd advised that all but 6 PCNs had been supported and £4.7M would be spent on access by 31 March 2025. The ICB could not carry funds into 2025/26 therefore the remainder would be spent on services in year and not lost to patients. The LMC has since obtained confirmation from the ICB that the remaining funding will be used for primary or community care programmes: it will not be used to offset ICB or acute deficits.
We are aware that a few PCNs have chosen not to take their proposal forward. The ICB had proposed setting up a support framework for PCNs that have either not been successful or have not applied for Phase 2, in order to assist all PCNs to be able to participate in the 2025/26 service. LMC leads followed up on this commitment as a possible use of any underspend. In light of the time needed to set this up and for PCNs to apply and achieve, this will not be resourced in the remainder of 2024/25, but the ICB has given the LMC a commitment to provide this targeted support in early 2025/26.
In summary, although the 2024/25 year has been extremely challenging, PCNs have cumulatively achieved the highest amount ever of patient engagement in North West London and just over 80% of funds have been used to improve patient access to General Practice services.
NWL ICB Access 2025/26
Although the timeline for developing the Access 2025/26 specification has been tight, with weekly meetings and virtual consultation in between, the process has been managed professionally, with active listening, a clear project timeline, thoughtful chairing, and responsiveness to LMC suggestions and contributions. The KPIs seem achievable, and discussions are ongoing to ensure the template proposal is not onerous and any data created can be meaningfully used to improve patient care.
The LMC has highlighted to the ICB the effectiveness of this approach and suggested it could serve as a template for future discussions in other task and finish groups. The ICB has agreed to identify learning that can be used for future ways of working.
Integrated Neighbourhood Teams (INT)
Each borough is developing a different model for integrated working, which is a priority in the Ten year Plan – your LMC is monitoring developments across north west London at its liaison meetings with borough teams.
Community Services Review
The LMC has been made aware that the three community trust providers are reviewing and possibly standardising their services. Although these are not provided by General Practice, they may have impacts on your work and there is potential to create service gaps. We have raised this with the ICB, who have confirmed that this should not result in additional (unfunded) work in General Practice, and we are keeping a watching brief.
Managing the Primary-Secondary Care Interface
The ICB is working with Trusts and the LMCs to improve 4 priority areas:
- Onward referrals.
- Complete care (fit notes and discharge letters).
- Call and recall.
- Clear points of contact.
Eight supporting workstreams have been set up with LMC representation to achieve tangible outcomes. Current areas of focus:
- Onward/consultant to consultant (C2C) referrals: comprehensive guidance has been agreed and is being cascaded across Trusts; we have asked for this to be cascaded to General Practice as well.
- (Electronic) Fit notes: a task and finish group has started meeting and we have requested an interim mechanism and guidance for Trusts such as paper fit notes.
- Primary Care Liaison Officer: we continue to pursue how the role at Hillingdon Hospital will be filled to monitor the interface problems GPs and their teams face.
GP Pathfinders
The implementation and communication of the GP Pathfinders’ investigation is the responsibility of the ICB as commissioner. We understand that a comms message to practices is being prepared on the outcomes of the investigation so far, changes in the registration of new patients, as well as an update on commissioners’ plans for redistribution of capitation funds to those practices who have had patients deregister with them as a result of this incident. However, we have not had confirmation from the ICB whether this message has been sent out yet.
NWL Pathology Service: Imperial uACR Lab Error
The LMCs have asked the ICB to keep practices updated on progress and has requested a report including learning on how to prevent and manage future problems. The LMCs have asked IHT how it intends to compensate affected GP practices, to fully recognise the inappropriate workload created by IHT issues. This approach by the LMCs is supported by the ICB. We await the IHT response.