Avon LMCs Newsletter on 18-02-26

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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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It has been a busy and energising start to the year at Avon LMC, marked by the arrival of two new GP Specialty Trainees who will be working with both Avon LMC and One Care over the next twelve months. These innovative roles combine clinical general practice with exposure to leadership, system working and commissioning – equipping future GPs with the skills needed to flourish in the evolving landscape of modern general practice.

They have already begun immersing themselves in the work of the LMC Board, observing key meetings and gaining insight into how the wider system functions. Over the coming months, they will move from observation to action, leading on discrete projects that support our practices and patients locally. If you see them at meetings or events, please do make them feel welcome – they are an important investment in the future leadership of our profession.

“Talent is like a little seed; when nurtured, it will flourish.” – Matshona Dhliwayo

Shaba Nabi
Chair: Avon LMC

We have decided to move the date of the next LMC drop-in from 3^rd March to 31^st March. The reason for this is to ensure the new 2026/27 GP contract can be discussed.

Some of you may have seen the HSJ article indicating that these contracts are not expected to go live until at least 2027. This will follow a public consultation on the purpose of neighbourhood contracts, with draft proposals anticipated to be shared early next year.

The GP contract for 2026/27 has not yet been shared with the BMA’s GP Committee. It is expected to be considered at the emergency meeting scheduled for 26 February.

Question: I have observed that my referrals are increasingly being triaged by consultants and returned with management advice, without offering the patient the option of a direct specialist consultation. This raises concerns regarding patient expectation and choice, as well as the transfer of unfunded workload to general practice.

Answer: Thank you for getting in touch and for raising these concerns, which are shared by many colleagues.

We are aware that a number of specialties have already moved to an advice and guidance–first approach. This includes Urology, where Cohese (formerly GP Care ) has been commissioned to triage referrals, and we are also aware that paediatrics is expected to move to an advice and guidance–first model over the coming months.

Unfortunately, we have also been advised that there are NHSE plans for referrals to many more specialties to move to an advice and guidance–first approach in the next financial year. This may also be accompanied by rigid national pre-referral workups or expectations. This is not a move that the LMC supports, and there are significant concerns being raised by the national GPC England team.

We strongly share your concerns that converting referrals into advice without collaboration with the referring GP is inappropriate. The decision to refer is a clinical one, made in partnership with the patient, and it cannot always be safely or appropriately overruled by someone who has not met the patient. We are also very concerned about the inappropriate transfer of unfunded work from secondary to primary care.

We firmly believe that GPs must retain the right to refer a patient for specialist assessment where this is clinically indicated, and that patients should be able to be seen by a specialist if this is what they want or what their GP feels is the most appropriate course of action.

We will continue to raise these concerns robustly at both local and national level and would encourage practices to keep documenting and sharing examples where advice and guidance is being used inappropriately in place of a referral.

The LMC has been made aware of some providers pushing back on the LMC template letters sent by practices in response to secondary to primary care workload transfer.
We would like to remind our members that Corrective Action is a permanent re-set to manage workload within General Practice, and as such, we would encourage practices to:

• Use the LMC template letter self-populated within EMIS to pushback on workload transfer such as fit note requests, chasing investigations, and pre-op work up
• Use the LMC template letter self-populated within EMIS to pushback on prescribing workload transfer, including initiation of any medication on behalf of specialists

All this information is still available on the Avon LMC Collective Action web page.

Following some queries about these roles, Kerri Magnus, the LMC advanced multi-professional lead, has shared the following guidance:

Independent Prescribers (IP) are separate from being an ACP and any registered profession can be an IP and prescribe within their scope of practice.

The key here is that they must prescribe within their EMPLOYED scope of practice following appropriate training and supervision. Each profession should have a ‘standards for proficiency’ set out by their registered council but they all use this to support their ongoing prescribing practice: Royal Pharmaceutical Society’s Competency Framework for All Prescribers – The Nursing and Midwifery Council

Advanced Clinical Practitioners (ACPs) are autonomous practitioners who should be working at Master’s level, typically across all four pillars (clinical, leadership, education, research). They assess, diagnose, manage, and prescribe independently if they have the relevant qualification. As this is not yet a formally registered role yet, it is up to the individual practice how they wish to govern their ACPs

Supplementary prescribers are non-medical healthcare professionals (e.g., nurses, pharmacists) who prescribe medicines in voluntary partnership with a doctor/dentist for a specific patient under an agreed Clinical Management Plan (CMP). They manage chronic conditions, adjusting doses and medication within their competency and the patient’s plan. They are dependent.

This can be found here.

• 3 March 2026: Virtual LMC drop in, 1pm – 2pm
• 5 May 2026: Virtual LMC drop in, 1pm – 2 pm
• 7 July 2026: Virtual LMC drop in, 1pm – 2pm

Discover a world of knowledge with ALMC Learning Hub! Our monthly newsletter is your backstage pass to course updates and expert insights straight to your inbox.

Subscribe now and stay informed, you would find out what additional training will be coming up and know more about our trainers. 

This can be found here

• Tuesday 17 Feb General practice bulletin
• Thursday 12 Feb General practice bulletin

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– LATEST TRAINING AND EVENTS –

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