As Chair of Waltham Forest LMC I would like to thank the LMC members for their support and contributions over the 2021-23 term, especially those stepping down from the LMC following the elections: Dr Rishav Dhital, Dr Gabriel Ivbijaro and Dr Sudeshna Sarkar.
I would also like to thank all the NE London team at Londonwide LMCs: Dr Elliott Singer, Dr Shabnam Quraishi, Shimi Loo and Ian Williamson.
The LMC expresses its deepest condolences and support to LMC member Dr Sanjoy Kumar and his family, following the sudden and tragic death of his daughter Grace O’Malley-Kumar.
There are nationally widespread problems with the NHS Property Services charges being billed to some practices. A court case, supported by the BMA, has seen some of these charges significantly reduced for the practices involved.
Advice from the BMA includes to engage constructively, to dispute charges that seem unreasonable, to seek detail and evidence of what the charges are for and that they are reasonable, and to take advice on your own case. Practices should make provision for payment, as it cannot be guaranteed whether or how much charges will be reduced. Londonwide LMCs GP support team can offer some guidance.
Going forward, practices may wish to consider an internal insure and repair lease – in which case it is important to establish the state the building is in, including a schedule of dilapidation.
Minor Ailments Scheme
The LMC, along with others across NE London, is pushing for the restoration of the Minor Ailments Scheme, to provide free over-the-counter remedies for simple ailments via pharmacies. This would simplify the patient journey and reduce the significant amount of GP time taken up with consultations that do not require their expertise. Some pharmacies are participating in the current Community Pharmacy Consultation Scheme, but not in all neighbourhoods.
In response, the ICB has proposed a scheme which is welcomed as far as it goes, but has limitations and is means-tested. The LMC continues to lobby for a comprehensive scheme, noting that for all patients entitled to free prescriptions the cost of medicines falls on the NHS in any case, and the load on GP consultations is additional, as is the administrative burden of means testing.
Safe care, workload levels and access requirements
The LMC’s Medical Director, Dr Elliott Singer of Londonwide LMCs, has given a webinar on safe working in general practice in the context of the GMS contract imposed by the government. It is available here.
Whipps Cross clinical forum
The LMC, alongside members from Redbridge LMC, is working to set up a clinical forum for GPs and secondary clinicians from Whipps Cross hospital. Terms of Reference have been agreed and attendance and practicalities are being developed. It is hoped to provide a forum to directly resolve clinical issues between primary and secondary care.
Whipps Cross radiology
The radiology department has been refurbished recently and is more fit for purpose (and there is progress on the new hospital building). They are urgently seeking more funds for a second x-ray machine and so do not currently have a walk-in service for x-rays, but most other Barts Health sites do for GP referrals. The wait for routine x-rays was reportedly around 2-3 weeks; the LMC has secured an extension to the validity of referral forms so that they do not need re-doing if the wait for an appointment is more than 3 weeks. (They will still need a new form after 6-8 weeks – there is a requirement for some time limit.)
There is direct access to CT scans and KUB radiographs in accordance with national guidelines. There is also access for GPs to ultrasound. The LMC has asked to look at the pathways for imaging to ensure that GPs are not left with responsibility for interpreting results beyond their skillset and patients have a good experience.
There is also a plan to redevelop a ward for Same-Day Emergency Care, diagnostic surgery and other services.
Londonwide LMCs has heard that the ICB proposes to reduce the resource it puts into Service Alerts, leaving it to GPs to contact and chase service providers directly. Led by Tower Hamlets ICB and supported by Waltham Forest and others, the response has been that this amounts to transferring unresourced work to GPs and failing to capture system learning about what issues in secondary services are causing recurrent or widespread problems. A letter signed by LMC Chairs has been written to the Chair and Chief Executive of the ICB.
The LMC, supported by Londonwide LMCs has been working hard with the ICB to finalise local contracts. Agreement has been reached on most aspects and the Long-Term Conditions details are being finalised. Contracts should be forthcoming soon.
LMC members asked at the last meeting about this demand and capacity reporting tool, which has been adopted by NEL ICB. Practices need to sign up to it if they wish to participate in the data quality LES. Under the PCN DES contract (clause 5.4.4), there are a number of requirements that rely on service data, which practices will need to show how they intend to meet; for this contract no data service provider is specified and there are a number that could contribute.
The ICB now commissions dentists, opticians and pharmacists. Londonwide LMCs is working with the ICB on a system approach to increase the retention of responsibility by non-GP primary care practitioners. Please let the LMC know (via firstname.lastname@example.org) if you find cases where dentists are asking GPs for medication advice or prescriptions.
Londonwide LMCs is offering support to GPs in the first five years of their careers. If you would like to know more please contact email@example.com.
The ICB is expected to make resources available for immunisation campaigns targeting specific groups. Interested practices can contact the ICB immunisation co-ordinators, who can work with practices to identify patients. Although a recent measles outbreak has ended, there is a focus on MMR, and also on polio which has been identified as a risk in the borough. There is also funding available from national sources.
There have been some problems with how polio vaccines have been recorded in GP notes when they were given elsewhere. Londonwide LMCs is working with NHS London region to determine what if any actions practices may need to take and to ensure that systems are in place for the future.
FedNet is looking for venues such as practices to host a spirometry clinic, and also phlebotomy services – practices that may have space available and wish to have these services provided at a convenient location for their patients can make contact with Sheraz Younas.
Damp and mould
Waltham Forest Public Health is working on damp and mould in homes as a health hazard. Patients with problems or concerns about this in their home may tell their GP. Tenants can access advice and support directly here.
The LMC is working with the ICB and other partners on other issues including outpatient transformation, Extended Access and Enhanced Access.
Dr Mike Grenville
Waltham Forest LMC