Dear colleague,
Chair’s introduction
Hello and welcome to the February edition of the Waltham Forest LMC newsletter.
We hope this update helps keep practices informed about what is happening across general practice locally. Within this edition, you will find updates on service changes, contractual developments, and the ongoing discussions we are having on your behalf at borough and North East London level.
Our aim is to ensure transparency around the issues affecting practices, to clarify the contractual position where needed, and to represent your concerns constructively and robustly in system conversations.
We hope you find this newsletter useful and relevant. As always, we are open and receptive to feedback , whether on the issues covered here or others that may be affecting your practice.
Below, you will find details of your LMC representatives and the PCNs they are linked with. If you have any concerns or would like LMC support, please contact your LMC rep directly. They are well placed to listen, advise, and escalate matters where appropriate.
Thank you for your continued engagement and for the work you do every day for patients in Waltham Forest.
Waltham Forest LMC Membership and Contact info
What has Waltham Forest LMC been working on recently?
Elemental
The LMC is aware of NELFT’s plan to rollout Elemental as a referral portal. Colleagues highlighted potential benefits if the system works well (notably clearer referral tracking and visibility of outcomes), but also raised concerns that a partial rollout could fragment admin workflows (Elemental vs eRS vs email) and create avoidable additional work. Some PCNs are already piloting this system, and whilst we await the results of the pilot, the LMC wanted to clarify the contractual position. The GMS contract requires practices to use electronic referrals where available (i.e. eRS), Elemental is not part of eRS and there is no contractual obligation for practices to adopt a specific third-party portal. Therefore before advising on wider adoption, we are awaiting the pilot findings—particularly the impact on practice workload, training requirements, and whether it genuinely improves efficiency and reduces “email-black-hole” referrals.
MAR Charts and Community Palliative Services Update
A significant amount of work has been taking place at London level regarding MAR charts and the ongoing issue of inappropriate workload transfer into general practice.
Londonwide LMCs recently issued a formal communication to community providers to re-establish the contractual position and to address the recurring problem of workforce dumping onto practices. The intention is to ensure that responsibilities sit with the correct provider and that general practice is not undertaking unfunded, non-contractual work.
Waltham Forest LMC and other clinicians have also been liaising with NELFT about their new Compass – Community Palliative Advice and Support Service. We have agreed streamlined processes around MAR charts and a reduced requirement for District Nurse Authorisation Forms.
Compass Community Palliative Advice and Support Service
A new service, Compass – Community Palliative Advice and Support Service, has now launched in North East London. This is a new model of care provided by NELFT for patients in Waltham Forest requiring palliative and end-of-life support.
The service has been developed following engagement with clinicians and community teams who identified gaps in current provision. The Compass team will integrate into existing services.
Referrals are for patients aged 18 and over via the designated palliative referral form. Practices are advised to review the detailed communication circulated by the ICB for full referral guidance.
MAR Charts – Process Changes
Following LMC engagement, improvements have now been made to the MAR chart process:
- Pre-populated MAR charts are now available
- Separate end-of-life MAR chart forms are in place
- Dedicated syringe driver MAR chart forms are available
- District Nurse Authorisation Forms are no longer required for end-of-life care
- No printing is required
- No wet signatures are required
- MAR charts should be completed and emailed directly to NELFT
- FP10 prescriptions should be sent as usual
- The removal of duplicate authorisation processes should significantly reduce unnecessary administrative burden for practices.
District Nurse Authorisation Forms – Clarification
District Nurse Authorisation Forms are no longer required for routine injections, including:
- Vitamin B12
- Prostap
- And other similar routine injectable treatments
- The only remaining scenario where DN authorisation forms are still encouraged is for housebound diabetic patients requiring insulin administration.
This represents an important step in reducing avoidable administrative workload for practices while maintaining safe and appropriate care pathways.
GP engagement event 29 January
It was fantastic to see 122 colleagues, representing the vast majority of Waltham Forest practices, face to face — to network, discuss shared challenges, and recognise the achievements and long service of some prominent Waltham Forest GPs.
At the Waltham Forest GP Networking event attended on 29 January by over 120 GPs and staff from practices across Waltham Forest, the following dedicated and long-serving GP leaders received special awards for “Outstanding contribution to the work of Waltham Forest Local Medical Committee in:
Chingford:
- Dr Michal Grenville
- Dr Sanjoy Kumar
Leyton and Leytonstone:
- Dr Dinesh Kapoor
Walthamstow:
- Dr Gabriel Ivbijaro
- Dr Abdul Sheikh
Waltham Forest:
- Dr Elliott Singer
They have our warmest thanks and commendations for their services to the LMC and to general practice and our patients in Waltham Forest.
What we heard
Concerns and priorities include:
- Ongoing interface pressures and inappropriate workload transfer into general practice.
- The need for clearer shared care boundaries and governance.
- Funding, contractual stability and protecting vulnerable practices.
- A preference for practical, borough-wide corrective action rather than policy statements.
- Clarity around PSA and DOAC monitoring, midwife prescribing, and improvements to hospital and community interfaces.
The strong and consistent feedback mandates the LMC’s priorities moving forward.
The event was very positively received, with high usefulness scores and a clear appetite for future sessions, ideally held in the evening and at least twice yearly.
What Happens Next
- Plan another networking event aligned to the new contract and LES discussions.
- Strengthen engagement by LMC reps with PCNs .
- Invite general practice colleagues to a Unified Voice meeting.
- Review feedback at the next LMC meeting to agree priority actions.
- Update colleagues as work progresses on the priorities identified
NHS Health checks – new spec
Public Health has confirmed the proposed NHS Health Checks arrangements for Waltham Forest from April 2026. The intention is to continue the current delivery model for the next two years: practices can continue to deliver Health Checks, with the option of FedNet support where practices want it. The tariff remains £30 per completed Health Check, and Public Health clarified that there is no minimum threshold—payments are per completed check and not dependent on hitting a minimum level of activity. The updated service specification will place greater emphasis on quality and outcomes, particularly better reporting on onward referrals to lifestyle services, and will encourage (but not mandate) point-of-care testing. We raised concerns about significant variation in delivery between practices. Public Health indicated they will offer targeted support to low-delivery practices.
Community colorectal clinic
Following on from our last update, the LMC has raised further concerns about the planned closure of the community colorectal clinic in Waltham Forest at the end of this financial year. While the ICB has cited safety and cost-effectiveness issues as the rationale for letting the contract end, our focus has been on the patient impact and the loss of local investment. We have challenged the recurring pattern of community services being withdrawn from Waltham Forest without clear, equivalent reinvestment, and have asked for transparency on what happens to the funding attached to the service and how any resources will be retained for local benefit. We also stressed that “prioritising” referrals for a limited period is not enough without additional capacity at Whipps Cross, otherwise waiting times will inevitably increase. In particular, we flagged the risk of worsening delays across the whole pathway — including Advice & Guidance, outpatient access, and diagnostics such as colonoscopy — and requested clear written assurances and ongoing monitoring arrangements so practices can be confident patients will not be disadvantaged.
Advice & Guidance
The LMC raised significant concerns about hospital Advice & Guidance (A&G) performance, particularly where specialties are not responding within expected timeframes, e.g. Urology, creating avoidable knock-on workload in general practice (repeat patient contacts, chasing, and additional appointments). For Waltham Forest, around 6,300 A&G requests were recorded in Q3. Overall, just under half of A&G requests were responded to within 7 working days, and just over half were converted to a referral, broadly in line with NEL averages. We challenged that current reporting based on a pool of “8+ days” masks the real issue—10+ days, 30+ days, and longer delays—and asked for more granular specialty-level data and clear actions to reduce breaches and backlogs. The ICB agreed this needs to be taken away and returned with more detailed monitoring and an improvement plan.
SNSs/KPIs
The commissioner advised that Enhanced Service arrangements for 2026/27 are being reviewed, with the intention of moving toward a more consistent, NEL-wide “standard offer” from 1 April 2026. A new NEL Proactive Care and Quality Outcomes Framework is being developed and is expected to supersede the current LTC-related schemes, including some borough-specific KPI approaches currently used in Waltham Forest (e.g. long-term condition indicators such as CKD, COPD and asthma).
It was also acknowledged that not all schemes have had time to be reviewed. As a result, some will roll over unchanged into 2026/27—for example post-attack childhood asthma reviews and the vulnerable children scheme—with an intention to review these in-year. Separately, for services that already have NEL-wide specifications (including phlebotomy and wound care), the commissioner indicated these may be taken forward via Direct Award B to ensure compliance with the Provider Selection Regime (PSR).
We highlighted the level of uncertainty this is creating for practices and requested urgent, clear written communication on what will continue from April and what will change.
Quality alerts
There remains concern that practices do not receive timely responses or clear feedback on what changes have been implemented as a result of Quality Alerts. The ICB quality team confirmed that agreed response timeframes and guidance sit on the Primary Care Portal, and that trusts are expected to provide six-monthly reports summarising alerts received and actions taken. The quality team acknowledged responses are not consistently meeting agreed timeframes. Advice & Guidance (including cancer-related themes) is a recurring issue within alerts, and the ICB team encouraged practices to keep using the system, noting alerts are reviewed at senior level within trusts. Where responses are late, absent, or inadequate, practices can escalate to the ICB quality team who will take this up directly with the relevant provider.
London General Practice Awards 2026
These were awarded on 5 February at the Houses of Parliament. There was a lot of highly positive work to celebrate and we congratulate all the winners, especially some of our neighbours in NE London. As an LMC we would like to encourage more GPs and practice teams to nominate work in the borough for the 2027 awards, when nominations open towards the end of the year.
North East London sector issues
Many issues affecting Waltham Forest are also NEL-wide and we work closely with our counterparts in other boroughs. There is also a newsletter for the sector work – the February issue covered Shared Care, Enhanced Services, MSK and ADHD pathways, GP phlebotomy, the formulary status of DOACs, ICB clinical leadership changes, the dementia pathway and referral form, Oliver McGowan training and the NEL winners at the London General Practice Awards. You can read it here.
Exclusive deals for practices
Our substantially updated Buying Group offer provides a range of opportunities to save money and improve the quality of products and services you use.
- Get excellent prices and next day delivery on consumables, with a supplier who can respond quickly to your practice needs.
- Access a comprehensive online learning platform, plus packages to manage HR, finance, compliance and rotas.
- Let a specialist GP insurer make sure you have the right cover, with knowledge on developing areas like cyber security, AI scribes and contract holding at PCN level.
- Our records digitisation partners can help free up premises space and recent changes with the National Document Repository have improved practices’ options.
- Intelligent, end-to-end call-and-recall automation does more than simply send reminders, it tailors messages and helps to improve QOF.
- The latest in cloud telephony integrates with clinical systems, provides stats on patient contacts and automates many tasks.
- Reward yourself and your colleagues with free and discounted tickets to concerts, theatre shows, sports and more!
Waltham Forest LMC
You can find contact information, meeting dates and membership information for Waltham Forest LMC here.
We are this month adding details of the LMC members assigned to link with each PCN in the borough.
Yours faithfully,
Dr Asad Ashraf
Chair
Waltham Forest LMC