Chair’s introduction
Hope you have all managed to have a short holiday away from work over summer to refuel your Wellbeing tanks.
We have reviewed a LARC specification proposed by Sutton council which will be offered to Sutton practices shortly.
Sutton practices were highlighted to have completed the greatest number of MKADs at the July Interface meeting with Epsom and St Helier Hospital, and it was noted the predominant theme was relating to Transfer of work.
Thank you to all our Practices completing these which raises the profile of the issue and highlights the problems.
Please continue to complete these and ask of all practices. LMC representation here will continue to question and support General Practice to address this with the relevant departments in the Trust.
To simplify completing the MAKD form for transfer of work, a brief summary detailed here can be saved and used relating to the relevant transfer of work.
The LCS/Engagement scheme underspend of £85,000 for 25/26 was disturbing to hear as there had been a phlebotomy cap that was imposed on practices for most of the year and these funds could have covered that cost.
LMC will be part of the group working with the ICB to ensure this is reviewed closely and does not recur.
Please optimise as much of your allocation as possible and highlight any issues to the LMC.
SMI LCS was noted to have the largest underspend.
Also scrutinise closely the quarterly practice activity that you are notified of and ensure all coding for activities is completed to receive payment.
The Docman duplication of documents in January – February of this year had resulted in large amounts of workload particularly admin time trying to address this. NHSE stated that there would be no renumeration to practices for this national issue. The LMC are disappointed by this response.
Dr Vidhya Thiagamoorthy
Chair
Sutton LMC
What is the LMC and what do we do? We:
- Are the representative body for General Practice in Sutton. LMCs are recognised in statute.
- Consult with NHS bodies, integrated care boards (ICBs) and local councils, negotiating local contract terms for general practice
- Work for and support individual GPs and practices and are the professional voice of general practice at a local level.
- Support GPs via knowledge of contracts, systems, stakeholders at all levels, including borough, ICB, regional and national.
- Inform and engage with workforce development, planning, education and training for all roles within general practice.
Your LMC
Your Sutton LMC committee members are listed below. Their term runs until 31 August 2028.
- Dr Cristina Augood, Salaried, Manor Practice
- Dr Junaid Masud, Salaried, Mulgrave Road Surgery
- Dr Priyadharshini Senthilkumar, Salaried, Wrythe Green Surgery
- Dr Vidhya Thiagamoorthy, Principal, The Grove Road Practice
- Dr Brygida Wimbush, Principal , The Old Court House Surgery
- Dr Adam Wright, Partner, Benhill & Belmont Centre
- Dr Charlotte Mason-Apps, VTS Rep, Sessional
- Katie Thorpe, Practice Manager Rep, James O’Riordan Medical Centre
What has Sutton LMC been working on recently?
Updates from recent Sutton LMC meetings – the LMC regularly meets with senior representatives from both the ICB and Sutton PCN. Below is a summary of our recent discussions.
- Change to Make A Difference Alert process: a new pathway came into effect on 1st July. There has been no prior discussion with the LMC about this. We have concerns about the bureaucratic nature of the new approach which holds no accountability. We have raised this directly with the ICB.
- Eating disorder referrals: Referrals for children no longer require an ECG, as there is no staff available to interpret ECGs. Adult ECG interpretation remains available, so the adult ECG requirement will stay on the referral form.
- SPoA communications: Work is underway and practices should expect further communications from the ICB.
- Engagement scheme payments: Most practices have received the £5,000 payment for engagement scheme group consultations; only one practice had not engaged with the scheme.
- Video fluoroscopy pathway: The referral pathway remains with the Planned Care Board. If local arrangements are not progressed, commissioning from Evelina was identified as a potential alternative.
- Safeguarding workload: The LMC raised concerns about increased safeguarding workload now that it is no longer a PMS KPI. The ICB will review how other boroughs are approaching this.
Funding and underspend
The ICB explained that underspend can no longer be carried forward as in previous years due to changed financial regulations. Funding may only be accrued where activity has been committed within the financial year. Members asked for greater transparency so practices can understand spending positions early enough to adjust schemes and avoid future underspend. Sutton’s 2025/26 underspend was reported as approximately £83,000, and will be discussed at PCOG, alongside future planning for 2026/27.
Service and pathway issues
- FIT testing: A harm review is underway for 292 patients who received an incorrect positive result. The LMC asked that patients be contacted by the relevant pathology team and that practices be funded for any work required.
- SWL consensus document: GPs expect potential transfer of work and plan to submit a letter through the Planned Care Board calling for reduced workload transfer and better collaborative working with trusts.
- Consultant-to-consultant referrals: Members raised concerns that GPs are being asked to make referrals that should happen between consultants. The ICB will review contractual guidance.
- SWL Cardiovascular Renal Metabolic (CRM) Pathway: Is being worked up across SWL to start in October 2026, tier 1 will focus on coding and case finding for CKD with tier 2 planned for 27/28. The financial envelope and business case is pending. Given that Sutton has a CKD PMS indicator, there is £70 000 ringfenced for this in Sutton for CRM related activity. If you have any ideas on how we may use this money, please do put your ideas forward to the LMC.
- SWL Frailty pathway. We are aware of early discussions about this new pathway. We are awaiting the specification, metrics and financial envelope attached to this.
PMS, LCS and engagement scheme activity
Members discussed whether underspend could be used to support ongoing DOAC monitoring. The current Sutton monitoring payment was noted as £89.76, compared with £112 in Merton and Wandsworth, despite the same specification being used across all three boroughs. The ICB is open to further discussion but would seek clinical advice and compare specifications across boroughs.
Secondary Care Interface
The LMC is represented on the SWL Primary Care/Secondary care interface group comprising representatives from primary care and the acute trusts. This group has been involved in the development of a consensus on the primary/secondary care interface working and the LMCs has commented on the draft.
The LMC continues to raise issues outside the interface group and has recently written to St George’s Hospital to express its concern that in recent years, some clinical pathways and service configurations have appeared to limit access for patients registered with practices in the periphery and surrounding areas, querying how these fit with patient choice.
SWL Clinically led strategy programme
SWL ICB is developing a clinical strategy as a mechanism to deliver the 10-year plan. As part of this work the ICB has set up specific clinical workshops and the ICB has invited LMC representation on the following groups: frailty and end of life care, LTCs and multi -morbidities, mental health, planned specialist care, maternity and neonatal, unplanned care.
The LMC role on these groups will be to ensure that General practice should not be expected to absorb additional work or fill gaps created by changes or reductions in other services or commissioning decisions and any new asks must not erode core GP capacity and practices cannot be expected to do more without additional funding.
The LMC working on your behalf
We have set out below how and where Sutton LMC represents constituents across the Borough, as well as highlighting some key issues that we have been working on.
PMS/LCS/ES Review for 26/27
The LMC will be reviewing the 26/27 PMS/LCS/ES specifications over the coming months.
LMC representation:
The LMC also represents Sutton constituents on the following groups:
- Sutton Primary Care Operations Group (PCOG)
- Primary and Community Care Transformation Group (PCCT)
- Cardiac Event Monitoring Task and Finish Group
LMC comments on referral forms, pathways and guidelines
Over the last 6 months Sutton LMC has provided comments in relation to the following:
- New LARC specification
- Updated C2C Policy
- Heart Failure Pathway
- SEL/SWL Integrated Primary Care Weight Management Pathway (see update below)
SEL/SWL Integrated Primary Care Weight Management Pathway: LMC update
SEL and SWL LMCs are engaged in discussions with SEL/SWL ICB regarding a proposed Integrated Primary Care Weight Management Pathway. We are aware that community pharmacists have been invited to express interest in delivering this service in SWL and want to keep you updated on how this is developing in SEL, and how your LMCs are seeking to work with the ICB to identify and address outstanding concerns.
SEL/SWL ICBs aim to implement a 2 year, neighbourhood based integrated weight management pathway across South London, using general practice for proactive case finding and community pharmacy for delivery, supported by wraparound behavioural services. The model would also see at-scale primary care organisations take on the role of Pathway Owners of a Community Pharmacy delivered Weight Management Service.
The target cohort in SWL:
- patients with BMI ≥35 with early onset type 2 diabetes, age 18–49 and not on insulin (2000 patients in SWL)
The target cohort in SEL:
- Patients >18yrs old, BMI of 40 or more and 3 or more comorbidities, atherosclerotic CVD, dyslipidaemia and hypertension on treatment (950 patients in SEL)
This approach seems to reflect one of the first Neighbourhood contracts we have had sight of.
Whilst LMCs support the ambition to improve patient access we remain concerned that the current model is not yet safe, sustainable, or sufficiently clear to enable implementation.
Key issues raised
- Clearer contractual, clinical accountability and governance arrangements are needed to avoid fragmented accountability across providers.
- Data-sharing, coding, system access, audit and communication processes need to be clarified and agreed before launch.
- Discharge and transfer-of-care arrangements must be explicit, funded and clinically supported before responsibilities move to general practice.
LMCs have warned that, without further work, unresolved workload, clinical and medico-legal risks may fall back to general practice. LMCs have asked that these issues are addressed before procurement and implementation progresses further and remain willing to work constructively with the ICB to achieve this.
Events
UK LMC Conference
Sutton LMC were represented at the recent UK LMC Conference held in May, by the LMC Chair, Dr Vidhya Thiagamoorthy. Motions raised by LMCs were discussed, and for those that were passed, will form the basis of negotiation between the GPC and the government.
A summary of the motions passed at the conference can be seen here.
Next LMC Conference
The next LMC conference will be the England conference, which will be held in London in November. As per the UK LMC conference, motions that have been submitted by LMCs across England will be debated, and if agreed, will form part of the negotiating process for GPCE, when engaging with government.
If you believe a specific area, or topic that is impacting general practice would benefit from a motion being submitted in advance of the November conference, please send them to david.moore@lmc.org.uk
Londonwide LMCs’ team supporting Sutton LMC:
- Dr Asiya Yunus, Medical Director, Asiya.yunus@lmc.org.uk
- Kate Hudson, Director of Primary Care, Kate.hudson@lmc.org.uk
- David Moore, Committee Liaison Executive, david.moore@lmc.org.uk
- Kat Lederle, Committee Administrator, katharina.lederle@lmc.org.uk
GP survival guide
Londonwide LMCs provide, via their website, a GP Survival Guide, which is your quick reference guide to useful resources to help manage your workload and avoid unsafe situations for both practitioners and patients.
The Survival Guide is intended as an easy to refer to resource for use during clinical sessions, allowing practitioners to:
- easily understand what activity they are required to undertake and what they can push back against,
- explain to patients, trusts, commissioners and other bodies why a piece of activity should be provided elsewhere in the system, and
- seek help from their local medical committee or the Londonwide LMCs team where your ability to deliver safe care is compromised by an issue outside the gift of the practice to resolve.
It also draws together other resources to help you to design and make changes that support safe effective working.
Londonwide LMCs exists to care for, value and protect everyone working in London general practice so that you can care for, value and protect your patients. It is the role of LMCs and Londonwide LMCs to raise requests for inappropriate workload transfers into general practice with the organisations who make them and seek to change behaviours, so such requests stop.
A key resource contained within the guide is a link to a set of template letters, that can be utilised by GPs/practice staff, to quickly explain that a request should not be actioned in general practice and detail where is the appropriate setting for the request to be made, if there is one. These are outlined below:
- Referral rejection due to lack of proforma
- Trust request for non-contractual task(s) (prescription of medications, arranging investigations, following up results, undertake monitoring, issuing MED3s, refer patient back, postoperative checks)
- Automatic discharge of patient following DNA
- Response for delayed clinic letters
- Housing applications
- DWP appeals
- Flying when pregnant
- Letter to schools regarding administering medications to children
- Requests for sick notes for illness lasting fewer than seven days
Other services that Londonwide LMCs provides on behalf of general practice across Sutton
GP Support team
The General Practice Support team comprises non-medics (Vicky Ferlia, Jan Swannell, Jacqui Perfect, Yvonne Frank, Vanessa Douglas) and Medical Directors (Dr Elliott Singer, Dr Kirsa Morganti, Dr Sara Riley, Dr Lowri Kew).
The team operates at different levels providing confidential, tailor-made, expert advice and assistance to individual doctors, practices and PCNs in difficulty. They offer contractual support to our primary care teams. Feedback/responses to papers & briefings to LMC reps. Policy influence at London level e.g. NHSE/ICBs, CQC. Attendance at Performance Advisory Group (PAGs) and Performers Lists Decision Panels (PLDPs). General Practice support includes:
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PCN Support
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For help or support please contact the GP Support team at gpsupport@lmc.org.uk .
Workforce-Training and Innovation (WTI)
Update from the Workforce, Training and Innovation (WTI) Team
Our refreshed Buying Group offer was relaunched in October, and we encourage you and your practice teams to explore the wide range of high-quality products, services, opportunities and offers now available to London general practice—at competitive prices and with excellent deals.
There is no sign-up required. Simply let the supplier know that you are a practice within the Londonwide LMCs area when placing an order.
Visit the Londonwide LMCs Buying Group to start benefiting from opportunities to:
- Save – access exclusive discounts, offers and deals
- Earn – benefit from rebates and funded projects, including research opportunities
- Sustain – support staff wellbeing and environmental sustainability
We also invite you to explore our training offer in the events brochure
If you have any questions or ideas, please get in touch at WTI@lmc.org.uk — we would be delighted to hear from you.
Ann Ayamah (Head of Workforce-Training and Innovation) on behalf of the team.
Well done to the prize draw winners from our Buying Group survey
Thank you to everyone that took part in our Buying Group survey, we plan to run another one in the autumn. The randomly selected winners of the gift vouchers were:
- Trudy Do, Havergal Surgery
- Karen Tobin, The Bromley Common Practice
- Anca Radulescu, St. Margarets Medical Practice
- Marian Negoita, Amersham Vale Practice
- Aparna Pal, Jubilee Garden Medical Centre
Our Buying Group suppliers are:
- Hillcroft Surgery Supplies – Get next day delivery and industry leading stock availability, thanks to their investment in substantial warehouse facilities.
- Practice Index – Pick and choose what you need out of their learning platform, or software to manage HR, finance, compliance and rotas.
- Hippo Labs – Have your call-and-recall work smarter, reach more patients and improve QOF attainment. Hippo Labs automatically customises many types of message.
- Equity Energies – Reduce energy costs, save time, become greener and remove the administrative burden of managing utilities by having experts do it all for you.
- Surgery Connect – Automates more tasks within your phone system, integrates with clinical records and seamlessly bridges in and out-of-hours.
- MIAB – You existing policies may have more gaps than you think, particularly in developing areas like cyber and ARRS employment. Rely on MIAB’s specialist expertise to ensure you are fully covered.
- Restore Information Management – Whether you need a room full of records doing or a steady flow of new registrations, Restore take the hassle out of digitising patient records.
- Tickets for Good – Reward yourself and your colleagues with free and discounted tickets to concerts, theatre shows, sports and more!