Chair’s introduction
There is a lot happening in general practice, both nationally and locally. I would particularly encourage colleagues to join us for our Waltham Forest LMC event on 19 November, where we will focus on neighbourhood working and local contracts. These changes will increasingly shape how general practice works locally, so it is important that practices are part of that conversation.
Practices will have received an ADHD FAQ from the ICB – Londonwide LMCs is feeding back on this and there is more detail in the newsletter below.
We are currently looking for another GP to join the Waltham Forest LMC. If you have an interest in representing colleagues and helping shape local general practice, please do consider applying by the end of October.
Finally, I want to highlight FP69 and patient list cleansing. Although this is a national issue, we need to recognise the very real impact it can have on every practice locally. Londonwide’s latest analysis shows that more than 315,000 registered patients were lost from London practice lists between January and September, and the issue continues to be raised nationally and with MPs. Earlier analysis identified Waltham Forest as one of the London boroughs most affected, with concerns about patients losing continuity of care as well as the financial destabilisation of practices.
This is not simply about list numbers. The impact can fall particularly heavily on patients who are harder to contact or whose circumstances change frequently, while practices can face additional administrative work and loss of funding when patients are removed and subsequently need to be re-registered. I would therefore encourage every practice, whether or not you feel significantly affected at present, to review FP69 deductions carefully and report your experience and figures to the LMC. Londonwide LMCs specifically needs practice-level figures and examples alongside the national data to strengthen the case for change.
As always, please keep feeding back the issues affecting your practices. That evidence is what enables us to represent Waltham Forest general practice effectively, both locally and nationally.
Best wishes
Dr Asad Ashraf
Chair
Waltham Forest LMC
Waltham Forest GP Engagement Event
We will be hosting an afternoon general practice engagement event – Thursday 19 November, from 12.30 to 4.30pm at Walthamstow Library. This is for all Waltham Forest GPs, practice managers and PCN colleagues. Planned content includes: local contracts including the new LTC framework; neighbourhood development; public health updates; Londonwide buying group providers; what your LMC is doing for you. Refreshments will be provided.
What has Waltham Forest LMC been working on recently?
Whipps Cross Advice & Guidance
Significant delays remain in gastroenterology advice and guidance, with the five-working-day response target not consistently met. Practices should continue escalating clinically significant delays through established routes and may retain or pass to the LMC examples of inappropriate discharge requests, including requests for GP-issued sick notes or discharge medication. Further work is expected on clearer referral pathways, investigation requirements, clinical responsibilities and more meaningful waiting-time data across the service. NEL Quality Alerts can be found here.
Neighbourhood Integrator and Alliance planning
Planning for the Waltham Forest Neighbourhood Integrator and wider Neighbourhood Alliance continues. The ICB has confirmed that the integrator is intended to provide support and infrastructure for neighbourhood working and may later host delegated functions, but is not intended to become a provider organisation or decision-making body. Questions remain about its powers, governance, funding and relationship with PCNs, the federation and multidisciplinary teams, as well as the proposed move from seven PCNs to three neighbourhoods. Clinical Directors have nominated representatives to help develop the Alliance agreement, while local GP leaders have pressed for direct LMC and practice representation. We will update further with developments in this area.
MSK pathway and MRI access
Waltham Forest practices continue to raise significant concerns about the community MSK pathway. Issues reported include reduced access to MRI investigations, increasing patient dissatisfaction, referrals being returned to practices rather than managed within specialist services, and confusion over whether an onward referral, such as to the pain clinic, has been rejected or successfully made. Local GP leaders have argued that this is creating unnecessary workload for practices and avoidable delays for patients. The MSK service has agreed to attend a future LMC meeting and discussions are underway regarding both the current pathway and the proposed MSK Single Point of Access planned for 2027.
Practices should continue to submit service alerts and share examples of pathway failures so these can be used to support ongoing discussions with commissioners and providers.
Skin cancer referral delays
Concerns have emerged regarding urgent dermatology and suspected skin cancer pathways. Information shared with the LMC suggests that large numbers of patients are currently waiting, some for extended periods, to have two-week-wait dermatology referrals booked. The issue has already been escalated through the quality alert process and further discussion with providers is anticipated. Practices should continue to document delays affecting patients, submit quality alerts where appropriate and escalate concerns through established channels.
NEL interface consensus and Barts engagement
NEL LMCs continue to progress the Londonwide interface consensus document as a framework to support practices in challenging inappropriate workload transfer between primary, community, mental health and secondary care services.
A positive development has been the recent Barts interface workshop, where Londonwide LMCs presented a proposed interface consensus document. This secured constructive engagement from senior Barts colleagues and agreement to develop a Barts-wide interface document by December 2026, with socialisation and implementation between then and March 2027. Local LMCs are expected to be involved in co-production.
Barts also committed to progress electronic consultant-to-consultant referrals, including two-week-wait referrals, by March 2027, and to explore further priorities including a directory of services, a “You said, we did” newsletter for GPs, greater GP involvement in education and research, and the potential role of a GP liaison officer.
The LMC view remains that a NEL-wide interface solution is needed, but securing Barts engagement is an important step forward and a potential model for wider system adoption.
Adult ADHD LES
Practices were asked to sign up to the LES by 9 October 2026. NEL LMCs’ position on this specification remains largely unchanged from previous communications – the final version of the specification has not addressed all of LMCs’ serious concerns raised. These included that the pathway does not appear to be NICE compliant, care is transferred not shared, the tariff is far below comparable schemes elsewhere and NHS national payment guidance, and there is still no formal NEL accreditation for Right to Choose providers. Therefore Londonwide LMCs is not able to endorse this specification. There is a fuller statement in the NE London sector newsletter.
During discussion, Londonwide LMCs secured an improvement in the form of a clarification that patients should only transfer to general practice once medication has been initiated, titrated and stabilised, with ELFT/NELFT providing specialist advice and re-titration support. However, this support is not yet live and LMCs remain unconvinced that the providers will be able to meet the stated 24-hour urgent and 72-hour routine response times.
The LMC view is that practices should think very carefully before accepting any scheme that transfers specialist prescribing and monitoring responsibilities without adequate funding, safeguards and continuing specialist support. Practices should consider these risks carefully before making any decision to sign up.
Enhanced Services Review and Future Funding
NEL ICB is reviewing locally commissioned and enhanced services. Londonwide LMCs continue to press the ICB to level up borough-level funding and ensure that resources released through service redesign remain within the borough where they originate. GP leaders have raised concerns that uncertainty around future commissioning arrangements is creating anxiety for practices and may affect workforce planning and service sustainability. Practices should remain alert to future communications and continue sharing examples of services that are important to patient care and local system resilience. Please see the NEL Newsletters for more information on the Enhanced services review.
Patient List Cleansing and Funding
London-wide concerns continue about FP69 list cleansing and its disproportionate impact on practices serving deprived, mobile and vulnerable populations. At the local level, the LMC is seeking to engage with local MPs. Practices should use the NHS England option to identify patients with no fixed address where appropriate, support patients who may struggle to respond to letters, and share anonymised examples of wrongful removals or local impact with the LMC.
Serious Mental Illness Physical Health Checks
NELFT reports that annual physical health checks for people with serious mental illness are available through the Jane Atkinson Centre, including ECGs, blood tests and home visits for patients unable to attend. Results should be entered into EMIS, but practices have reported gaps in receiving completed information. Practices should check whether expected results are visible in the patient record and report recurring transfer problems through the agreed local route so the end-to-end process can be tested and improved.
Public Health and Vaccination Services
The adult tier 2 weight-management service will be recommissioned from 1 April, while the children and family service will close. Practices should continue referring during the transition and watch for alternative signposting for families. The community smoking-cessation service will also be recommissioned, retaining behavioural and medication support.
Flu vaccination will continue through general practice and other providers; COVID vaccination includes GP and care-home delivery. NEL ICB has also commissioned a LES for Winter Housebound checks and vaccinations. Londonwide LMCs advice on this LES is on the October NEL Newsletter (LINK). Practices experiencing rejected higher-tier weight-management referrals should retain examples and check current eligibility guidance.
Community Phlebotomy and Podiatry
There is a pilot contract with NELFT for FedNet and the E4 PCN to deliver domiciliary phlebotomy. This is to be for 3 months, with a view to discussing longer-term provision.
Specialist podiatry remains available for high-risk patients, but routine nail cutting for low-risk patients is not provided by NELFT; these patients should be directed to available voluntary-sector or alternative services while the Waltham Forest commissioning gap is reviewed.
Opportunity to join Waltham Forest LMC
The Waltham Forest LMC is seeking to fill a vacancy following the departure of a committee member. Recruitment discussions are currently underway, with local leaders keen to identify a GP who can contribute to representing the interests of practices across the borough. This provides an opportunity for GPs interested in influencing local policy, commissioning and system development to become involved in the work of the LMC. Colleagues from partner, salaried and sessional backgrounds are encouraged to consider putting themselves forward or discussing the opportunity with existing committee members. Please send your details and one paragraph about why you would make a good LMC member to ian.williamson@lmc.org.uk by Friday 30 October.
North East London sector issues
Many issues affecting Waltham Forest 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 latest issue of the sector newsletter contains a spotlight on guidance on the GP Reimbursement scheme, commissioning updates on LES reviews, Same-Day-Access and others, and other sector news including ICB Clinical Director roles, and our proposed secondary care interface principles. You can read it here NEL Newsletters.
Get new deals with the Londonwide LMCs Buying Group
Our Buying Group suppliers not only offer great deals to practices looking to switch, they also aim to offer the best value to existing customers in the Londonwide LMCs area, including explaining new products and features as they get rolled out.
- X-on Health – Brings together cloud telephony, AI-powered care navigation, voice agents, ambient voice technology, and data to improve access and reduce practice pressure.
- 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. Now with a new pay per appointment booked, subscription-free option.
- 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.
- 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!
- Hillcroft Surgery Supplies – Get next day delivery and industry leading stock availability, thanks to their investment in substantial warehouse facilities.
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 Waltham Forest LMC committee, including meeting dates and previous local and NEL newsletters.
Best wishes
Dr Asad Ashraf
Chair
Waltham Forest LMC