Avon LMCs Newsletter on 01-10-25

The ALMC Newsletter

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

– LATEST NEWS –

It’s been an incredibly busy couple of weeks for general practice, and I know many of you will be feeling the strain as we face another period of significant change. With the GP contract access requirements due to take effect today, there has been a flurry of national discussions and local conversations as we all try to understand what these changes will mean for practices.

Last week, on 18 September, the General Practitioners Committee England (GPCE) met to debate our collective response to the government’s plans. After extensive discussion, GPCE voted to move into formal dispute with the government over these contract requirements. This was not a decision taken lightly, but it reflects the very real concerns we all share about the impact these changes could have on the sustainability of general practice.

At the heart of our concerns are the trinity access requirements – with all three access pathways needing to remain open throughout core hours, placing practices under unprecedented pressure. This model risks creating an unlimited and unmanageable workload, with no realistic mechanism to prioritise patient need or protect clinical safety.

Alongside this, there remains a lack of safeguards around GP Connect. While in principle we all want better system integration and improved access for patients, there are legitimate concerns about accountability, data sharing, and the potential for inappropriate workload being pushed into practices without the resources to manage it.
Both Avon LMC and the BMA have been working hard to provide you with clear and practical guidance.

Last week, Avon LMC published Frequently Asked Questions (FAQ) document to help practices navigate these requirements.
The BMA released their own detailed guidance on 26 September, which is well worth reading as you consider the implications for your practice.

We know many of you will be deeply concerned about how your teams will cope in the weeks and months ahead. Please don’t struggle in silence – reach out to Avon LMC, One Care and the ICB. We are here to listen, to advise, and to support you as we navigate these challenging times together.

Amidst the intensity of the past fortnight, I was fortunate to end last week on a very different note – attending our Annual Trainers’ Day at Tortworth Court. It was a truly uplifting experience to spend time with GP Trainers, many of whom I’ve known for over 15 years. The room was full of energy, laughter, and that unique camaraderie that comes from shared experience. At one point, several of us were talking over each other like siblings fighting for airtime, comfortable in our shared familiarity. It was a timely reminder of the strength we find in our professional relationships – and the importance of staying connected.

“Communication is merely an exchange of information, but connection is an exchange of our humanity.” – Sean Stephenson

Dr Shaba Nabi
Chair: Avon LMC

BBC Radio Bristol Live Interview with Chair Avon LMC

Yesterday, the Chair spoke with John Darvall on BBC Radio Bristol about both the upcoming GP contract changes and the government’s plan to introduce virtual hospitals. You can listen to this here.

BMA Guidance on October Contract Changes

The BMA shared guidance last week which includes the following:

You may also find these FAQs from Surrey and Sussex LMCs helpful.

LMC Annual General Meeting (AGM) reminder

Last chance to register for our Annual General Meeting scheduled to take place remotely on 6 October 2025, 7:00 pm. This meeting is open to all Avon LMC members, but there will be one vote per practice.

Thank you for completing the form for attendance.
Annual General Meeting Registration

You asked, We said

Question: Our practice has never offered inclisiran injections and we understand the current contract with another practice is ceasing. As such, we are facing considerable pressure to take up this activity when we have opted out of this.

Answer:
The LMC has been meeting regularly with both the ICB Medicines Optimisation team and the ICB Primary Care team. During these discussions, we have consistently emphasised that the administration of inclisiran is a non-core activity and therefore not mandatory for practices.

We have also made it clear that the LMC’s support for the removal of the practice LES—given that drug reimbursement now exceeds the LES payment—does not imply that inclisiran administration is now a mandatory requirement for all practices. It remains a voluntary, non-core service.

With commissioning via Concorde now ceased, we have advised that it is the responsibility of the Commissioner to establish an alternative service for any practice that does not wish to provide inclisiran.

We understand that BMA guidance on Inclisiran is in progress but in the meantime, this guidance from Wessex may be helpful.

ADHD and Right to Choose providers

It has been brought to our attention that some Right to Choose providers offering ADHD assessments are either asking GPs to submit referrals via online portals or they are declining standard referral forms via secure mechanisms such as Egress.

We have communicated with two of the RTC providers, ADHD360 and Clinical Partners, reminding them that there is no contractual obligation for GPs to refer patients using anything other than the standard NHS referral form.

Both providers are aware of the need for GPs to be able to send clinical information via secure mechanisms. Clinical Partners have confirmed that they have a secure nhs.net email address for GPs to send referrals to. Despite ADHD360 being advised that GPs have no contractual obligation to use online referral forms, they have expressed a preference for them, however we are aware that ADHD360 have access to a secure nhs.net email address.

We have also had practice queries about RTC providers asking them to request ECGs and cardiology referrals. Our advice is that as per the standard NHS contract, it is the responsibility of the provider to be making their own onward referrals. This includes RTC ADHD providers requesting cardiology referrals, which just requires them to write a referral letter to the relevant trust, if they are operating from a remote base.

This request can be rejected using the LMC workload transfer letter and ticking the relevant bullet point covering onward referral.

Local Enhanced Service Contract Variation

GPC England had been contacted by several colleagues who expressed concern about guidance issued by NHS England in September 2023, which sets out how integrated care boards (ICBs) can commission Local Enhanced Services (LES) (also often known as Locally Commissioned Services) (LCS) through primary medical care contracts.

Following discussions with LMC colleagues in the Southwest, they have advised that, to their knowledge, all their practices agreed, and nobody was forced; as a result, the administrative burden was considerably reduced.

The conclusion (see below) uses the term MAY rather than MUST. The use of this wording allows practices to agree with or disagree with the changes, as outlined in the attached guidance.

“In conclusion integrated care boards (ICBs) may commission local enhanced services from general practice and this may be arranged using the GP contract as the contracting vehicle rather than the NHS standard contract.”

Medical Examiner information video for the Public

You may wish to share this video produced by the local Medical Examiner Team with bereaved relatives.

GP Premises Survey in England

The survey was conducted between 13 June and 18 August 2025 and had a total of 1,914 respondents.
Key findings:

50% of respondents considered their premises to not be suitable for present needs.
83% of respondents consider their premises to be unsuitable for future needs.
74% of respondents do not have enough space to provide training for new GPs.
A quarter of respondents reported having been invoiced with inaccurate service charges and less than half of these described the charges as ‘resolved’.
The responses from NHSPS and CHP tenants highlight a stark difference between buildings managed by these landlords. Over 65% of respondents in NHSPS buildings and over 74% in CHP buildings said they have received incorrect invoices.
54% of NHSPS tenants and 35% of CHP tenants said that service charge disputes were affecting the sustainability of their practices.
35% of NHSPS tenants and 26% of CHP tenants have considered handing back their GP contract due to service charge disputes.

The full survey and results can be found here.

ALMC Learning Hub – Upgrading Booking Form (9-Oct)

Due to increased demand, we are upgrading our booking form to better serve you. Please note that the current booking link will be temporarily unavailable during this transition scheduled on 9 October (Friday).

We apologize for any inconvenience this may cause and appreciate your understanding and patience.

Thank you for your continued support.

ALMC Learning Hub

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