Avon LMCs Newsletter 28/10/26

Chairs Blog

Yesterday saw the publication of the agenda for the England LMC Conference, taking place in London on 20 November which can be found here

This is an important date in the general practice calendar, brining together representatives from Local Medical Committees across England to debate the issues affecting our profession and agree the priorities that will shape the work of GPC England

Looking through this year’s agenda, there are some particularly important debates that will resonate with practices across BNSSG.

One motion calls for a greater proportion of enhanced services to be commissioned nationally. It challenges the growing reliance on locally commissioned schemes to fund work transferred into general practice.

Another significant debate concerns Advice and Guidance and Single Points of Access. A motion calls for an unequivocal contractual right for GPs to refer patients directly for specialist assessment whenever this is clinically necessary. This is particularly relevant as local referral pathways continue to evolve.

There are also motions addressing the impact of NHS England’s list-cleansing exercise on practice workload and income, the future of shared-care prescribing, and the need for adequate GP representation in ICB decision-making. These are not abstract policy discussions. They reflect the day-to-day pressures experienced by practices and the need for general practice to have a meaningful voice in decisions that affect how we work and care for our patients.

The conference is one of the ways that grassroots concerns of GPs can influence the national negotiating agenda. I look forward to seeing these issues debated and to Avon LMC contributing to the wider discussion

Supporting practices affected by Silicon

Closer to home, I also want to acknowledge the challenges facing the small number of practices in our area affected by the collapse of Silicon, their website and online consultation provider.

Importantly, this situation has arisen because of the collapse of an external organisation, entirely outside of the control of the practices affected. They should not be left to carry the operational consequences alone or be expected to absorb the additional workload without understanding and support.

I am grateful that the ICB is taking a supportive approach to the predicament these practices now face. A constructive response from commissioners is important in helping practices navigate the disruption, identify workable solutions and maintain services for their patients during a difficult period. The ICB have been supported by the Digital and Resilience Team from One Care at this challenging time.

National Living Wage Increase: Potential Impact on General Practice

Ahead of today’s Budget announcement, reports suggest that the National Living Wage could rise from £12.71 to £13.20 per hour. While increases in pay are welcome and help support lower-paid staff with ongoing cost-of-living pressures, they will place additional financial strain on general practices if not matched by a corresponding uplift in core funding.

Without a commensurate increase to the Global Sum, practices will face further pressure on already stretched budgets, adding to the challenges of delivering high-quality patient care while managing rising employment costs.

Avon LMC will continue to press GPC England to secure appropriate funding uplifts that fully reflect increases in workforce costs and protect the financial sustainability of general practice.
 

You asked, we said

You Asked:
A patient has requested that all communication be in writing, including via SMS or secure messaging, as a reasonable adjustment. Are we required to accommodate this request in all circumstances, or can we retain the option of telephone contact where clinically necessary, particularly in situations requiring urgent assessment?

We Said:
Under the Equality Act 2010, practices have a duty to make reasonable adjustments for disabled patients. Requests for written communication should therefore be considered individually and accommodated wherever reasonably practicable.

However, practices are not necessarily required to guarantee that telephone contact will never occur, particularly where immediate communication may be necessary for patient safety.

We recommended agreeing an individual communication plan that identifies preferred contact methods, arrangements for routine and urgent care, and appropriate alternatives where immediate contact is required.

Agreed adjustments should be clearly documented, with consideration given to the NHS Reasonable Adjustment Flag to support consistent communication.

The key consideration is balancing accessibility with clinical safety. A patient’s preferred communication method should not unnecessarily delay access to urgent care, and practices should explore accessible alternatives rather than automatically defaulting to telephone contact.

Information for rural practices

The Policy Exchange has written an interesting document on The Rural Penalty. It highlights that NHS funding formulas and workforce policies are disadvantaging rural communities.

The challenges include:

  • Dispersed populations over a large geographical footprint
  • Limited access to pharmacies
  • Few opportunities for economies of scale
  • Provision of education, transport and employment
  • Seasonal variation of need

Key recommendations are:

  • Reform NHS funding: strengthen rurality weighting in primary care funding
  • Protect small rural practices: introduce an Unavoidably Small Practice Adjustment to support practices where geography prevents economies of scale
  • Account for seasonal demand: Adjust funding to reflect temporary residents
  • Review staff pay and incentives: Reform High-Cost Area Supplements and recruitment and retention payments to better reflect rural recruitment difficulties
  •  Protect continuity of care: Make continuity an explicit, measurable consideration when designing and commissioning services
  • Expand the role of dispensing GP practices: Enable them to deliver commissioned pharmacy services, including vaccinations and public health programmes
  • Design neighbourhood health around geography: Account for travel times and local geography, not just population size
  • Measure deprivation and need more accurately: Account for hidden pockets of deprivation, ageing populations, poor transport and distances to services.

SPoA Guidance

To support systems and providers with implementation, the following resources are available:

  • Elective SPoA Clinical Toolkit – this will be published at a later date. It will set out what good looks like in clinical practice, supporting safe, patient-centred communication and collaborative working across primary and secondary care, with practical examples and guidance on clinical responsibility.

  Providers are expected to introduce specialist clinical review of all elective referrals and A&G requests in priority specialties, with elective SPoA arrangements in place from October 2026 and expanded as local readiness and capacity allows.

Avon LMC and One Care continue to push for the following principles within any SPoA system:

  • Patient safety and clinical autonomy: SPOA must support timely access to appropriate care, respect GP clinical judgement and must not impose additional barriers or inappropriate referral thresholds.
  • No unfunded workload transfer: Specialist assessment, investigation, treatment and follow-up must remain the responsibility of the appropriate service unless a transfer of work is explicitly agreed, resourced and supported by clear protocols.
  • Clear accountability and timely access: Responsibilities, response times, escalation routes and follow-up arrangements must be explicit.
  • Transparency and evaluation: SPOA must be evaluated against patient outcomes, safety, waiting times, inequalities and the impact on general practice workload—not simply referral diversion or reduction.

Joint DHSC and NHSE written evidence for DDRB 2027/28

Written evidence can be found here.

The key point is that the government’s financial plans assume a 2.4% pay uplift for 2027–28. It states that anything above this would need careful consideration of how it could be funded from existing budgets. The DDRB is still being asked to make its own independent recommendations.

GPC England Update for LMCs 16th October

This can be found here

OneCare’s latest Bulletin

This week’s dad joke has been provided by a local GP:

“I used to race snails and decided to remove their shells to see if they went faster. Unfortunately, it just made them a bit sluggish”

Practice and PCN Management Development Programme “Explore Your Learning Choices”

Not sure what development opportunity is right for you?

Whether you’re aspiring to a management role, new to management or looking to build on your experience, the PPMD Explore Your Learning Choices guide can help you see what’s available.

It brings development opportunities together in one flexible menu, allowing you to choose individual modules, combine topics or build a personalised learning pathway over time.

Take a look and explore the opportunities available to support your next step.

For more information, please contact: Louise Carthy, Training Hub Project Manager, at L.Carthy@nhs.net.

Cameron Fund Christmas Appeal 2026

On behalf of our Treasurer, Dr Simon Parkinson, please find attached details of the Cameron Fund’s Christmas Appeal for this year. 

We would be very grateful if you could share this with your members and ask them to consider making a donation to the Fund. 

If possible, please could you forward the letter to Practice Managers with a request to distribute to all GPs at their surgery as well.

This letter is also available on our website at: www.cameronfund.org.uk/news/2026-christmas-appeal

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October 28, 2026

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