Tower Hamlets LMC – Newsletter February 2025
Here is the February newsletter from Tower Hamlets LMC, covering developments over the winter of 2024-25 to date.
We know that 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 Toolkit is full of advice and resources to help you to do this, and none of it involves breaching your contract.
Radiology
The LMC met with David Fitzgerald the Divisional Director responsible for radiology at the Royal London. We heard of his work to turn the radiology department around and reduce the backlog. We asked that the hospital communicate better about these issues, and Barts sent an email to GPs in November explaining the delays, assuring that turnaround times for GP-requested x-rays were back to 7 days, and giving a contact point for queries.
Fit notes
The Royal London has a policy to issue fit notes covering the full expected duration of recovery for patients who are expected to need time off work. We have been assured that all departments now have access to paper fit notes. We heard some reports of this policy not being observed and raised it with our contact, who said he would like to know if specific departments are not always issuing the right notes. If GPs find cases, please raise a Service Alert, and if you wish let us know.
Care Navigation Service
There is a proposal to remove the part of this service that supports patients with less complex needs, who would then need to be more self-caring or supported by other primary or secondary care services with needs like ordering alarms or self-administering insulin. We expressed our extreme disquiet at cuts to this service – the costs will move elsewhere in the system as patients can’t get the care they need in a timely manner. Care Navigation and coordination are key components of the emerging models for integrated neighbourhood teams, which are seeing a significant national push, so it is counterintuitive to reduce this capacity in the system.
Digital Facilitation
We met with a representative of the NEL ICB digital team, who told us of their work to support practices with engaging patients digitally – they can support practices in their work on channels such as the NHS app, and potentially attend a meeting with the practice PPG.
We advocated the return of services direct to patients, such as in public venues like libraries. The team said they would look at doing this, though resources are tight.
Vaccination uptake – Bangladeshi community
We heard from Public Health that Covid vaccination uptake has fallen in the local Bangladeshi community, and one of the reasons is felt to be that GPs are not providing the service, which makes the vaccination seem less important to a patient population that has high trust in GPs.
We fed back that the Covid vaccine could be commissioned again as part of the GP routine vaccination service and co-delivered with flu, but that otherwise most practices found the separate vaccination logistics and bureaucracy too onerous to offer Covid unfunded. Public Health are also asking for it to be nationally commissioned.
IT outage
We made strong representations that the IT outage late last year which occurred over the weekend and affected many practices badly on the Monday should have been dealt with over the weekend. The ICB primary care team said they had previously had a business case for weekend support turned down because of the ICB’s financial situation, but would look again at the issue.
ELFT services
We spoke with ELFT about their need to make savings, in common with other community health trusts. They were positive about seeing service change as an opportunity, for example for patients to become able to do their own insulin injections, reducing stress and increasing quality of life. We highlighted that when patients lack services they come to general practice and that we do not have the capacity to soak up work that comes our way due to cuts they make. ELFT stressed that they are keen to know about the quality of care to patients and look at service alerts about their services.
Locally-commissioned services
We discussed future commissioning with NEL ICB at the Tower Hamlets level. Also at the NE London level we are engaging with the ICB in response to their proposed review of locally commissioned services in NEL. In collaboration with other NEL LMCs, we have drafted key principles and priorities to inform the review process. Some of the key areas we are focusing on are:
- The lack of uplifts on service budgets over many years across NEL and the need to review tariffs in the light of cost pressures on practices (including the NI increase).
- The need to ensure that budgets are preserved at least at the current level. Any reduction in funding needs to be reflected in the new specs, with lower demands on practices.
- Demanding impact assessments on patient care for any changes to current services.
- Understanding disparities in investment levels across boroughs in NEL.
If GPs feel there are specific contracts which need looking at or are not worth participating in, please let us know. Contact Daniele Serdoz ([email protected]).
SMS messages
Practices will be aware that the ICB is working to keep practice SMS (text message) bills within its budget, and has announced a cap on the annual amount of messaging per patient. Londonwide LMCs has lobbied the ICB intensively to make the case for funding SMS as an efficient way to communicate with patients, promote the uptake of services and reduce unnecessary appointments and DNAs. The ICB has acknowledged that practices are reporting that DNAs have increased and vaccinations decreased as practices send fewer prompts and reminders.
As it stands, practices will face some limits on the number and length of messages they can send without being charged for the excess. Following LMC pressure, the ICB should be giving communications to help practices monitor and control their texting. IT facilitators are also visiting practices.
Practices may consider increasing their use of email to contact patients. Londonwide LMCs has provided some guidance. If you are texting a patient in AccuRx, an option to send by email may appear if you click on the word Mobile at the top right.
Withdrawing unfunded work
Given financial and workload pressures, practices may be considering giving notice to elements of unfunded, non-contractual work that they may have been providing to cover commissioning gaps. Londonwide LMCs has provided a letter template which can be used for this purpose.
Care Homes spec
The LMC has seen a new proposal for the Care Homes locally commissioned service and has considerable concerns, including:
- The lack of an uplift to the tariff.
- The shift in the payment model, which will see 50% of the payment dependent on achievement of 7 KPIs, which all have unrealistic targets.
- The significant workload involved in delivering all elements of the specification.
- The lack of acknowledgement of the level of resources involved in delivering this service especially in home where there is a high turnaround of residents.
We have provided detailed feedback to the ICB and raised our concerns around the sustainability of this service in the current proposal. As currently structured, the LMC cannot recommend implementation of this specification. We are meeting with the ICB this month to have further discussions.
London Ambulance Service procedures
LAS have developed a decision-making tool for LAS staff to observe which clearly articulates the circumstances when crews should contact GP practices. These are agreed for the following situations:
- End of life care.
- Information sharing regarding/surrounding a safeguarding referral.
- Expected death.
- GP admission request where on arrival of the LAS crew the patient is refusing conveyance which the patient’s GP has arranged.
For all other situations there are other processes for ambulance crews to follow including accessing internal LAS clinical support and advice. Incidental findings will be shared with details of the London Care Record or via an electronic form – patients will be advised by the LAS crew to contact the GP for a routine follow up.
London General Practice Awards
The 2025 London General Practice Awards were celebrated in the Houses of Parliament on 6 February. Dr Peter Buchman (E1 Medical Centre) was commended in the Long Service category, and Dr Jackie Applebee (Tower Hamlets LMC Chair) received the NE London LMC Member award. The full roster of winners and commended nominations, with photos and report, is available here.
Annual conference of England LMCs
The LMC Chair Dr Jackie Applebee and Vice-Chair Dr Emma Radcliffe attended the annual conference of England LMCs in November. Dr Applebee’s motion on Advice & Guidance and Dr Radcliffe’s motion on GP models of care were passed by the conference – details on these and other resolutions are available here.
Yours faithfully,
Jackie Applebee, Chair, Tower Hamlets LMC