North West London LMCs newsletter – March 2025
Londonwide LMCs guidance in focus
- Shared Care and ADHD
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. - Physician associates
NWL ICB and the Training Hub recently hosted a GP webinar on physicians associates. The LMCs would like to remind you of the BMA and RCGP viewpoints on this issue. - 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.
NWL ICB access 2024/25
Phase 1
LMC leads have been contacted by PCNs who have received letters from the ICB challenging their patient/staff engagement outcomes. The LMC notes that the contractual requirements do not include KPIs for minimum number of patients in attendance at an event. The LMC encourages you to double check your achievements; you do not need to carry out additional work where the challenge is not justified; your LMC will support you.
NWL ICB hosted two events (F2F and Virtual) on Thursday 6 February for NWL residents to hear the findings of the patient surveys. Feedback from the events noted that the narrative presented by the ICB did not acknowledge the high survey returns nor the 62.9% increase in GP appointments compared to 2023 as evidenced in the ICB Presentation.
It is noteworthy that the PCN patient engagement exercise resulted in the highest ever patient survey return for the NWL ICB, driven by the practices and PCNs. This is despite the difficulties that had to be overcome such as: no support for translation services and PCNs undertaking activity on trust and carrying the costs incurred. The LMCs understand from the ICB that they expect all the 50p/head for Phase 1 (£1.3 million) will be paid out.
Phase 2
LMC leads are concerned that the process length and approach indicate it is unlikely that revised proposals can be approved, completed and resourced by year end. The ICB has offered to part fund proposals, but this may not make them viable for PCNs and we are aware that a few PCNs have chosen not to take their proposal forward for fear they may deliver at cost. The ICB has 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. The LMCs have written to request that this funding be kept in General Practice rather than lost to the ICB deficit and that learning is incorporated in the 2025/26 process.
NWL ICB Access 2025/26
Looking forward, the ICB has set up weekly meetings to develop a specification for 2025/26. Possible metrics and measures have not yet been agreed – we have asked the ICB to improve communications to ensure PCN engagement. The LMCs wish to encourage flexibility and inclusiveness in this process, learning from the 2024/25 process. ICB leads Hilary Tovey, Siobhan Herron and Julie Sands attended an LMC-hosted event for PCN CDs and LMC Chairs and Vice Chairs to give an update and field questions. The meeting acknowledged the increasing complexity of patients attending General Practice and the need to create an equitable and flexible approach to this work. This will be discussed more fully at the ICB-hosted GP webinar this week.
Enhanced Services
The LMCs have been raising 2024/25 individual service issues with the ICB and asking for lessons learned to be incorporated in the specifications for 2025/26. The LMCs will be carrying out an initial review before these are shared with PCNs at the end of March. Achievements to date are below:
- Anticoagulation – we have asked for a fairer tariff for providing this service
- No progress has been made on diabetes as the team was unable to meet with the LMC
- Respiratory specifications for 2025/26 are anticipated to be simpler, we await a draft specification
- The ICB are unable to commit to an inflationary uplift similar to surrounding ICBs. For comparison, NCL have had a 7.2% recurrent uplift on all locally commissioned services, backdated to 1 April 2024, with the exception of the recently introduced LTC LCS. These come with no additional asks of practices IE improved KPI’s.
Managing the Primary-Secondary Care Interface
The ICB is working with Trusts and the LMC to improve 4 priority areas:
- Onward referrals.
- Complete care (fit notes and discharge letters).
- Call and recall.
- Clear points of contact.
8 supporting workstreams have been set up with LMC representation to achieve tangible outcomes; an example is below.
Onward/consultant to consultant (C2C) referrals:
The LMCs met with ICB and Trust leads to discuss how the recently produced helpful Trust guidance would be cascaded and operationalised within Trusts and communicated to GPs. The LMCs commended the comprehensive guideline as a helpful step forward in reducing the inappropriate workload created in General Practice.
Primary Care Liaison Officer
We have provided input into both qualitative and quantitative measures that could be used to monitor the interface problems GPs and their teams face. The role at Hillingdon Hospital remains unfilled and the ICB have committed to help to remedy this.
The LMCs are also working on a service alert system to support you and we will keep you updated.
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.
NWL ARRS payments update
The LMCs raised issues with payments to PCNs and the ICB has reached out to those PCNs that shared their problems with the LMC. Following the restructure, the ICB has a smaller team and has reviewed its processes and outstanding 2024/25 queries. The ICB will be sending PCNs details of two payment runs in March to maximise the claims processed and expenditure made in 2024/25 along with details of a new process to improve how it deals with PCN queries. In light of its smaller team, the ICB is not able to increase its payment runs on an ongoing basis, but will be talking to other ICB teams outside London and NHSE/PCSE about the payment time lag.