Avon LMCs Newsletter on 01-04-26

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The ALMC Newsletter

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

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– LATEST NEWS –

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As I step into the role of Chair of Avon LMC, I want to begin by expressing my sincere thanks to my predecessor, Dr Shaba Nabi, for her tireless work, strong leadership, and unwavering proactivity—particularly during the recent period of collective action. Her commitment to advocating for general practice and supporting colleagues across our area has been deeply valued, and I am grateful to be building on such a solid foundation.

Looking ahead, my focus will centre on two key priorities—one national, one local—both grounded in a simple but essential principle: resource must follow workload.

At a national level, we must continue to push for meaningful improvement in core funding for general practice. The mismatch between rising demand and constrained resource has never been sustainable. General practice remains the bedrock of the NHS, yet funding has not kept pace with the complexity and volume of work we now undertake daily. We will work with partners and national bodies to advocate clearly and consistently for investment that reflects the true value and workload of our profession.

I would also encourage colleagues to engage with the work highlighted at rebuildgp.co.uk, which sets out a compelling case for restoring and strengthening general practice. It is a useful resource in helping articulate the challenges we face and the changes required.

At a local level, we will focus on making the system work better for practices and patients alike. In particular, this means ensuring that:

• Interface issues between primary and secondary care are addressed constructively, pragmatically and reflecting contractual obligations
• Clinical pathway development genuinely reflects the realities of general practice
• Referral routes—especially via the Single Point of Access—are clear, efficient, and safe

Too often, additional workload is shifted into general practice without the necessary support or resource. We will continue to challenge this and advocate for pathways that are workable, equitable, and appropriately resourced.

Above all, our approach will remain collaborative but firm: we are committed to improving systems, but not at the expense of an already overstretched workforce.

Finally, while my predecessor was known for ending these updates with inspiring quotes, I’m afraid I’m better known for my dad jokes—so I’ll aim to end each bulletin with something to (hopefully) raise a smile. Scroll to the bottom of the bulletin for a rib-tickler…

Lee Salkeld
Chair: Avon LMC

You may have seen recent communications from GPCE outlining the outcome of the GP referendum. This resulted in a 98.9% rejection of the proposed 2026/27 GP contract and a clear call on government:

‘To return to direct negotiations with GPCE to jointly develop a new GMS contract for all that restores the viability of GP partnerships, provides fair remuneration for all GPs, and implements workload safeguards to keep GPs and patients safe.’

On the morning of 26 March, immediately prior to a scheduled meeting of the BMA’s GP Committee, the Secretary of State for Health and Social Care wrote to the Chair of GPC England expressing a willingness to resume negotiations on a reformed GP contract.

The committee voted unanimously to engage with these negotiations, subject to two conditions being met by 30 April:

1. Action to mitigate access demands once practices reach safe same-day capacity limits
2. A pause to the rollout of ‘Advice and Refer’

If these conditions are not met, further collective action is likely.

Be the first to hear about the latest news and policy documents by joining our Avon LMC Broadcast only WhatsApp group – open to all GP practice staff.

All you have to do is email marcus@almc.co.uk to be added.

Two of the first 27 Neighbourhood Health Centres nationally are set to be located in inner-city Bristol. A local media report has identified these as Montpelier Health Centre and Charlotte Keel Health Centre. Further detail is awaited on what this will mean in practice for the local population.

Question: We are seeing an increasing ‘Advice and Guidance’ responses from secondary care asking us to organise multiple tests before a patient will be accepted. Are we obliged to do this?

Answer: 
Advice and Guidance is intended to support clinical decision-making, and not to transfer workload or create barriers to referral.

However, GPs do have clear professional responsibilities under GMC Good Medical Practice. Before referring, you should take reasonable steps to assess, investigate, and manage a patient within primary care where this is clinically appropriate, within your competence, and in the patient’s best interests.

This includes, for example:

• Basic baseline investigations that would usually be expected in primary care 
• Initial assessment and safety-netting, including trial of first-line management where appropriate
• Straightforward diagnostics that are part of routine GP care and do not require specialist interpretation or follow-up (e.g. CXR)

You are not obliged to undertake tests where requests go beyond this—particularly when they:

• Require specialist interpretation or ongoing management
• Are being requested solely to meet secondary care triage thresholds
• Involve multiple or complex investigations that do not change your primary care management

Key principles to hold:

• GPs retain the right to refer. If referral criteria are met, you can proceed.
• Clinical responsibility sits with the requesting clinician. If secondary care requires specific tests to inform their decision-making, they should take responsibility for arranging them where appropriate.
• Patient safety overrides process. Do not delay referral where this would disadvantage the patient.
• Work within competence. You are not required to request or interpret tests outside your usual scope.

We are actively raising concerns with the ICB about inappropriate workload transfer through Advice and Guidance. Clear, agreed pathways are needed that do not shift unfunded work or medico-legal risk onto general practice.

If you are seeing repeated examples, please share them with us—this strengthens our ability to challenge at system level.

Dear colleague,

We are writing to request your participation in our survey regarding the recent proposal from the DWP (Department for Work and Pensions) to increase the GPFR (general practice factual report) rates.

The DWP has suggested raising the fee for each completed GPFR from £33.50 to £53.50, representing a 60% increase from the current rate, following the professional fees committee’s request for a higher payment. While this is a substantial improvement, the offer is subject to several conditions, including the need to encourage timely responses, promote high-quality reporting, facilitate training sessions, and support ongoing digitisation initiatives. The DWP would want to review progress against each of these principles 1 year after the increase has landed and if they have not been met, the Department would reserve the right to return to the current fee (£33.50).

Link: Complete the survey now.

Your input is vital in helping us decide how best to respond to the DWP’s proposal and to ensure your interests are represented in future discussions. We kindly ask that you take a few minutes to complete our brief survey and share your perspective; this survey will be open for 3 weeks.

Thank you for your time and support.

Yours sincerely,

Dr Rob Barnett
Chair of professional fees committee

This can be found here.

• 5 May 2026: Virtual LMC drop in, 1pm – 2 pm
• 7 July 2026: 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 31 Mar General practice bulletin
• Thursday 26 Mar General practice bulletin

The HMR amendments that have been under review since last year have now been approved. These include the introduction of the new Vaccine Group Direction which replaces the National Protocols used during the COVID pandemic.

Please have a look at the resources around these changes that have been published on the Specialist Pharmacy Services Website.

We will be including information about this in all our immunisation training – both introductory sessions and update webinars

This page details what the VGD is:
https://www.sps.nhs.uk/articles/understanding-vaccine-group-directions-vgds/

This links to a video which discusses the HMR amendments and David Green, one of our lead immunisation nurses at the UKHSA discusses the VGD in more detail:
https://www.sps.nhs.uk/articles/amendments-to-hmr-2012-supporting-vaccine-supply-and-deployment/

From 1st April 2026 Jenny Bowen and Helen Russell will no longer be using the legacy.nurses@almc.co.uk and their personal almc email addresses.  Please direct all future correspondence to Jenny.Bowen1@nhs.net and helen.russell15@nhs.net

Please also note that Jenny Bowen will no longer be leading on Student Nurse Associate and Registered Nurse Degree Apprenticeships.  Please refer to the BNSSG Training Hub website for details of how to access the programmes: Apprenticeships – BNSSG Training Hub and direct any enquiries to kerri.magnus2@nhs.net

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This week’s effort:
Why did the GP bring a ladder to work?
Because they heard the job involved a lot of climbing demand…
I’ll see myself out.

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– LATEST TRAINING AND EVENTS –

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