Dear colleague,
Chair’s introduction
I have worked in Tower Hamlets General Practice for 22 years. Over this time, I have seen PCTs and CCGs come and go and the ICB develop. Not only has general practice in Tower Hamlets been delivering high quality care to patients despite all the barriers over this time, but it has been an innovative and inspiring place to work.
The cuts to clinical leadership and the loss of longstanding members of our primary care community threaten the good work that we are known for. Whilst the Tower Hamlets budget has at least not been reduced, many of the funds which facilitated transformation have now been used to provide uplifts for routine care. We are absolutely committed as an LMC to ensure that general practice in Tower Hamlets remains somewhere we want to work and where new ways of working are pioneered by our brilliant teams as they have done in the past.
Thanks,
Dr Emma Radcliffe
Chair
Tower Hamlets LMC
Member spotlight – Dr Ana Cuadrado
I have been working as a salaried GP at Blithehale Health Centre (Network 2) for the past four years. As a mid-career GP, I have developed a strong commitment to supporting general practice in the borough and ensuring that our practices are able to provide safe, high-quality care and continuity for our patients.
I was recently elected as an LMC representative and, while I am new to the role, I am working with the committee to support practices and help ensure that the voices of GPs are heard during this period of significant change in general practice. I hope to see many of you around at the unified voice meetings.
What has Tower Hamlets LMC been working on recently?
Local Enhanced Services
We have met with ICB colleagues to understand and negotiate the plans for the forthcoming year. Our ICCQ model will be renamed NEL LTC Proactive Care Quality and Outcome Framework; it will be implemented across North East London boroughs over the coming year for the management of long-term conditions. In Tower Hamlets we will be starting to phase in some of the new NEL indicators over the coming year, including some CKD indicators in exchange for dropping some indicators. We have expressed concern that the NEL proposed indicators are more numerous than in our current ICCQ LES and we will keep a close eye on the plans for us to transition in 2026/2027.
Many of the enabler funds are being repurposed to provide an uplift for phlebotomy (£5/bleed) and a new wound care tariff (£20.50 per appointment). Tower Hamlets is also the only borough in NEL that has maintained a funded domiciliary phlebotomy service.
We are aware that the IPO team budget will be reviewed over the coming year and the LMC will be supporting networks with this process.
Mental health
Dr Leah White, Clinical Director for Adult Mental Health at ELFT came to our LMC meeting. She told us about the Barnsley Street Project. We are supportive of the project and would like to see all our patients in Tower Hamlets receiving such holistic, patient-centred care. We have raised concerns about the closure of the Together Café and how this leaves limited options for many patients in Tower Hamlets who are experiencing a mental health crisis. We have been assured that the NHS 111 (option 2) mental health crisis line links directly into local mental health services. If you have experienced inappropriate transfers of workload from NHS 111 to a GP rather than to mental health services, we would like to hear from you – please contact ian.williamson@lmc.org.uk.
ELFT’s move to RiO
Following concerns raised by practices in Tower Hamlets and Newham, the LMCs wrote jointly to ELFT and commissioners about the proposed move to RiO and the risk of added workload for general practice. A key issue we highlighted was pathology workflows—for example, where community or mental health teams cannot request blood tests, imaging or other investigations directly from their own system, and instead ask GP practices to do this on their behalf, creating extra work and delays. In response, ELFT has advised that it is implementing tQuest within RiO for pathology and radiology ordering for mental health services, with this to be extended to community services once they transition to RiO. ELFT also says it is close to enabling pathology results from Barts Health directly into RiO, and is developing a separate solution for radiology reports, with the aim of reducing the need for clinicians to contact practices to chase results.
ELFT has committed to frontline testing of the new system to proactively identify and mitigate issues before full implementation. The LMCs will work with the provider to ensure general practice’s voice is represented in the testing phase.
Community Anticoagulation Service
Since August last year the LMC has continually highlighted to the ICB that by serving notice on the anticoag LES, they have also served notice on ongoing DOAC monitoring in Tower Hamlets. We have relentlessly campaigned for the reintroduction of a similar LES for general practice and we have been told that this is planned as part of a longer-term package of shared care and drug monitoring. However, in the short to medium term the ICB will put in place an interim solution, which will include referring some of our patients to community providers. We are communicating with the ICB regularly to ensure you are provided with regular updates about the interim solution which should be in place from 1st April.
NEL ICB restructure
NE London ICB’s new, much smaller, structure has been announced. Staff taking voluntary redundancy are leaving this month and recruitment to posts in the new structure has begun and will continue for several weeks. We have been and are working intensively with our commissioner colleagues to try to protect Tower Hamlets general practice but the ICB’s capacity will clearly be reduced, and familiar contacts will be changing.
GPs and practices are advised to use, or at least copy in, the ICB general contact address nelondonicb.nel-primarycare@nhs.net as individuals may have left and there are processes in place to route enquiries from the general address to current responsible staff.
Secondary care interface
Quality alerts remain an important part of monitoring workload transfer from secondary care, so please do ensure you fill them out as often as possible. Every quality alert to the Royal London gets reviewed by the Medical Director so there is senior oversight and he welcomes the fact that we have increased quality alerts from 338 to 550 over the last year. But quality alerts can be submitted for services at other hospitals too.
Tower Hamlets LMC is aware of concerns regarding Homerton maternity services asking GPs to prescribe antibiotics. The local LMC has been working extensively with Homerton to resolve this and progress is now being made, with the service moving towards electronic prescribing so prescriptions can be sent directly to patients’ community pharmacies. In the interim, for patients outside City & Hackney, Homerton should provide prescriptions directly for collection from the hospital. So if you are still receiving prescription requests from the Homerton’s Maternity service, please raise a Quality Alert.
Renal automated letters pilot
The renal team came to the LMC in November. They have rolled out a pilot where letters are sent to practices making suggestions about optimising clinical care for those with early diabetic nephropathy. The LMC have worked with the team to ensure that the timing of the letter’s arrival hopefully coincides with Part 2 care planning and the work suggested doesn’t exceed normal expectations of what a Part 2 should involve. They presented interesting data in November which demonstrated that Tower Hamlets and Hackney already had the highest level of optimisation in NEL. Let’s hope the lessons about investing in long-term conditions care in general practice can be learnt by commissioners.
North East London sector issues
Many issues affecting Tower Hamlets also affect other boroughs in NEL and we work closely with our counterparts to address and resolve them at sector level. We produce a NEL newsletter for the sector work. The most recent issue covered the NEL enhanced services review, the new NEL community anticoagulation service, NEL Quality Alerts, Blue Badge requests and other topics. You can read it here NEL Newsletters.
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Engaging with Tower Hamlets LMC
We are keen to listen to practices, to understand the issues they are worried about and the challenges they are currently facing – let us know if you would like a call or for an LMC member to visit your practice for a conversation. Please email ian.williamson@lmc.org.uk.
Please also visit the Londonwide LMC website for a one-stop shop on our support for practices—details of our services, practical resources (including template letters and guidance), and details of your Tower Hamlets LMC committee, including meeting dates and previous local and NEL newsletters.