Waltham Forest LMC – Newsletter October 2024
Local contracts
LMC members are holding an intensive series of meetings with the ICB Primary Care team to work on aspects of the Local Incentive Scheme. Points agreed include that payment for childhood immunisations is triggered by making referrals and providing the list of referrals made to the GP Confederation. We have negotiated down proposed increases in targets for Long-Term Conditions, and secured the removal of a proposal to make practice payments dependent on achievement by all PCN practices.
Work continues on outstanding local contract issues, including access to Accelerate Click for wound care. Work is also beginning on negotiating contracts for next year, in the light of the target increases and goodwill shown by general practice this year.
Progress has been slow despite the LMC working hard on these questions. As the negotiations have taken the first half of the year, payments for this time will be made. Some recent meetings have been cancelled by the ICB, and the LMC is being flexible on the meeting dates while pushing for the discussions to resume.
Sub-contracting
The LMC with other GP leaders in the Unified Voice meeting has advised that practices sub-contracting with the GP Confederation can leave them holding risk, and so the ICB has been advised to contract directly with the federation. A resource on sub-contracting arrangements, including risks for practices to be aware of, is in the process of being finalised and will be shared with practices in due course.
PCN funding streams – Capacity and Improvement Plans
There is funding available for signing Capacity & Improvement Plans – be aware that practices qualify for the funding as long as they sign by 30 March 2025. Earlier sign-up is not required. There is an NEL claims form.
AccuRx SMS messaging
The LMC, along with other LMCs in NE London, has been lobbying the ICB over support for practices to text message patients, as an effective and accessible way to exchange information without taking up appointments unnecessarily. The ICB has withdrawn proposals to cut the budget this year, but to stay within its budget will insist on capping how many free text message fragments each practice can send (per weighted patient) – practices should be advised of their allocations. Any fragments over the practice allocation will be charged to the practice. The LMC, supported by Londonwide LMCs, is strongly arguing against this decision by the ICB and we have made it clear that we will not support it. We have also said there should be a live dashboard to see fragment usage to help practices understand how they are using their allocation and when they are nearing their cap
The ICB will be approaching practices that are top users of text messages, to review their data and understand what strategies can be put into place to optimise text message utilisation, for example length of text messages. Consideration must be given to the use of the NHS app and other channels where possible or appropriate. Practices should also think carefully about any requests from other services to send SMS text messages on their behalf.
Patient deductions from lists
Practices have been reporting issues with patient list deductions, and the admin time taken to reinstate patients who are still in the area and requiring services. There is a national issue, but if there are severely affected practices, or especially patients being deducted without any FP69 process, please contact the LMC.
Working with secondary care
Progress has been made on several issues:
- Paper sick notes are now available and being issued – electronic notes will take more time to implement.
- Consultants have been reminded to put GP actions at the top of discharge summaries. This is a particular challenge with the outpatient systems. Secondary care should be completing their own follow-up investigations where appropriate.
- Earlier in the summer there were issues with 2-week wait referrals being rejected without notifying GPs. GPs should now be informed.
- Consultants have agreed to refer directly to other consultants where urgent or within the same specialty. Referrals for different conditions may still go through primary care where appropriate.
GPs and hospitals share similar issues with the national PatientsKnowBest app, including generating patient queries with unclear results or results appearing to patients before a clinician can contact. Whipps Cross is raising concerns and will use the LMC’s feedback to underline that this is a common problem.
Advice & Guidance / Advice & Referral remains an ongoing issue. Whipps Cross is working on gaining a consistent approach across specialties, and ensuring space in job plans for responding to A&R. Their hospital position is that A&R cases will go on to referral where appropriate. The LMC shared examples with the Whipps Director of Surgery of cases where consultant responses had been felt inappropriate. Londonwide LMCs has heavily fed into a proposal by the ICB to review and evaluate A&R, including the additional work undertaken by General Practices to support the A&R implementation, which at this stage still remains unpaid. LLMC has urged the ICB to honour the payments for the local incentive scheme and we are working with them to identify a solution. GPs can refer to the Londonwide LMCs guidance.
Low-Traffic Neighbourhoods
The LMC raised with Waltham Forest council public health department that some practices had been impacted by LTN implementation, whether with traffic being diverted to their road, or access issues for less mobile patients. The council has agreed to include the LMC as a consultee on future schemes, as well as the individual practices involved.
ADHD services
The LMC talked with NELFT about adult ADHD services. From the NELFT point of view it is becoming less sustainable to absorb the increasing caseload within the general service provided. The LMC raised issues including how far private mental health services go in titrating and stabilizing patients on medication before signposting to GPs. The LMC also reiterated an offer to support a primary-secondary co-design of a resource for patients to self-manage pre-diagnosis.
Substance misuse services
The local service is provided by Change Grow Live, and there has been positive feedback. Patients can self-refer but GPs and other providers can also refer via a CEG form in EMIS, and are encouraged to do so.
ICB financial position
LMC members, alongside colleagues from other boroughs in NE London, have been lobbying the ICB to invest in general practice as an essential and highly cost-effective part of the NHS system, despite the budget deficits that the ICB faces. ICB managers have acknowledged this principle and discussions continue, but due to the challenging financial position of the ICB, savings are still being sought from the General Practice budget. LLMC has asked for clarity from the ICB on how these savings will be achieved and from which budget. We are awaiting further details on this.
BMA actions
The GP Committee of the BMA, which is the Trade Union for the profession, is leading a call for collective action to make their case to the national NHS and the Government. A ballot in July on a menu of 10 actions that are possible within national contract requirements was overwhelmingly supported by the BMA membership. Practices can choose the actions that they may wish to undertake, as and when. There is information from the BMA here.
The LMC is not a Trade Union and is therefore legally barred from leading or co-ordinating such action. LMC members have linked with the BMA’s local GP rep to arrange her attendance at other meetings of local GPs, including in Waltham Forest.
To help GPs and our other stakeholders understand and prepare for potential impacts of the BMA action, there is a survey to gauge intentions. One lead Partner for each practice is invited to complete the survey each month, here.
Safe Working
Londonwide LMCs has produced a major resource pack for safe working, including guidelines on safe workload and on what work is and isn’t required by contract, template letters for pushing back unresourced extra-contractual work, posters and materials for communicating with patients, and guidance for dealing with abusive and violent patients. There are also pointers to other relevant LMC work and sources of support. The index page for the resource pack is here and the newly released safe working webinar is here.
LMC information
You can find information about LMC members, contact channels, meeting dates and so on at our web page.
If you have any feedback on the above, or anything you wish to bring to the attention of the LMC, you can contact via the Committee Liaison Executive [email protected].
Yours faithfully,
Dr Mike Grenville, Chair, Waltham Forest LMC
Dr Asad Ashraf, Vice-Chair, Waltham Forest LMC