Avon LMCs Newsletter on 27-05-26

---

The ALMC Newsletter

Welcome to our weekly newsletter, sharing the latest news and topics of interest for practices.

---

– LATEST NEWS –

---

Since the start of May practices across Avon have re-engaged thoughtfully with the collective action guidance from the General Practitioners Committee England around Data Sharing Agreements/Requests. As always, Avon LMC’s role is to support practices in understanding both the opportunities and the practical implications of any proposed action locally.

Last Friday, General Practitioners Committee England announced a new area of collective action for June focusing on the removal or non-use of non-contractual medicines optimisation software. This recommendation reflects increasing concern within the profession regarding the transfer of medicines optimisation workload into general practice without contractual agreement or appropriate resource.

Practices will understandably make individual decisions about whether and how they wish to engage with June’s collective action recommendation. However, Avon LMC would like to remind practices within BNSSG that the Prescribing Quality Scheme payment remains linked to achieving prescribing financial balance. ScriptSwitch is only one of several mechanisms used by practices and practice pharmacists to support prescribing efficiency and financial balance. Practices considering changes in this area should therefore ensure they understand the potential local financial implications before taking action in June. Greater clarity is going to be circulated by GPCE in the next few weeks.

Alongside the newer areas of collective action, it is also important to remember the original principles underpinning collective action during late 2024 and into 2025. A key objective was to help practices regain greater control over workload that sits outside the core general practice contract.

Many practices have already made positive changes by returning inappropriate workload requests to the originating provider. These include requests for practices to undertake prescribing, arrange referrals, or chase investigations that are the responsibility of another organisation or clinician. Similarly, many practices have adopted the use of generic referral forms for the majority of referrals in order to reduce unnecessary administrative burden and variation.

These actions remain entirely relevant. Practices continue to have opportunities to challenge inappropriate workload transfer and to establish safer, more sustainable boundaries around contractual responsibility. To support this, the LMC template letters for returning inappropriate requests remain available within EMIS.

Further information on collective action, including supporting resources and template materials, is available on the Avon LMC website: https://avonlmc.co.uk/collective-action-2/
 

Scroll to the bottom to find a temperature-related dad joke.


Lee Salkeld
Chair: Avon LMC

The LMC has circulated an invitation to practice managers for a virtual membership consultation taking place on Tuesday 02 June 2026 at 13.00.

The purpose of this meeting is to seek an operational mandate ahead of Board elections for Bristol and North Somerset, to prevent multiple Board members being elected from the same PCN. While this proposal was agreed by the committee at the previous meeting, membership approval is now being sought for this interim operational change prior to a formal constitutional amendment being presented at the Annual General Meeting in September.

There will be one vote per practice, and it is essential that all practices are represented, as the vote requires the support of two thirds of voting members (present at the meeting) to pass.

If your practice manager is on leave, or if your practice has not received the invitation, please contact info@almc.co.uk

Avon LMC has been collaborating with One Care, the ICB, and secondary care representatives to agree local guidance about interface issues. This is also hosted on Remedy which includes a summary infographic.
The full guidance covers issues such as:

• Communication – with patients and with colleagues
• Referral/Advice and Guidance Principles
• Follow-up of test results
• Fit note provision
• Prescribing

Question: Could I clarify the LMC’s position on practices declining requests for domperidone for lactating mothers? Our practice policy is not to prescribe since the MHRA alerts, but we are facing considerable pressure about this.

Answer:
The Remedy page categorises this as a “blue” drug (i.e. suitable for prescribing in general practice, but as a second-line option).

A brief review of the literature highlights important limitations in the evidence base, including small sample sizes and incomplete control of confounding factors. There is some evidence of benefit in specific groups, particularly mothers of preterm infants, but overall, the effect appears modest.

In terms of safety, MHRA (and FDA) guidance highlights risks primarily associated with higher doses, increasing age (particularly over 60), underlying cardiac disease, and concomitant medications that may prolong the QT interval.

While domperidone is not licensed for this indication, it is worth noting that off-label prescribing is common in both pregnancy (e.g. hyperemesis) and paediatrics where the evidence base supports use.

Ultimately, the LMC supports any GP in declining to prescribe where:

• the request falls outside their competence and requires specialist input
• they judge that the risks outweigh the potential benefits

the treatment is not commissioned or funded

NHSE England published guidance on the principles of improving chaperone practice and a summary of this guidance can be found here. 

Avon LMC acknowledges the challenges general practice faces with implementation of this guidance and has collaborated with local Paediatricians and ICB Safeguarding Leads to develop some local, pragmatic guidance which can be found here 

This information was published recently by NHS England and can be found here.

As well as including useful links to the SFE, PCN DES and QOF, it also provides more specific information on the practice level GP reimbursement scheme

This can be found here

• 2 June Avon LMC Membership Consultation 1pm 
• 16 June Virtual LMC drop-In, 1pm – 2pm

Please note that our training webpage will undergo scheduled maintenance every Friday from 9:00 AM to 10:00 AM. During this period, the system may be temporarily unavailable, and enrolment forms submitted may not be received or processed.

We apologise for any inconvenience this may cause and sincerely appreciate your understanding and cooperation.

• Tuesday 26 May General practice bulletin
• Thursday 21 May General practice bulletin

---

A temperature appropriate joke this week:

Why doesn’t the sun go to college? Because it already has a million degrees

---

– LATEST TRAINING AND EVENTS –

---

---