Avon LMCs Newsletter on 18-03-26

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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 this will be my final Chair’s Blog, it feels like an appropriate moment to pause and reflect on the journey of the past few years. I joined the Avon LMC Board in June 2023 and had the privilege of becoming Chair in January 2024. What followed was a period that tested our resilience, sharpened our purpose, and reminded me time and again of the extraordinary commitment that exists within general practice.

The closing months of 2023 were spent addressing legacy issues and ensuring the organisation itself had firm foundations. Quite literally, that meant securing a roof over the LMC’s head. I remain deeply grateful to our Managing Director, Rebecca Kemp, whose determination and leadership ensured the building was secured within just six months of her taking up post. It was a reminder that strong organisations are built not just on vision, but on the steady, often unseen work of capable people.

My early months as Chair were focused on strengthening governance and ensuring the LMC was equipped for the challenges ahead. Working closely with the LMC Committee, we introduced a new constitution to provide clarity, accountability, and structure—one that is now reviewed annually to ensure it remains fit for purpose. Good governance may not be glamorous, but it is the quiet architecture that allows organisations to endure difficult times.

Then came what could only be described as a baptism of fire: GP Collective Action. Following the dispute announcement by GPC England in 2024, Avon LMC moved quickly to understand the mood and priorities of local practices. A practice survey was rapidly circulated, followed by a members’ conference that helped shape the direction of collective action across the BNSSG footprint. That collective organisation proved crucial to the progress that practices are now benefiting from. I remain enormously grateful to the GPCB Clinical Leads whose energy, collaboration, and resolve made this possible.

Yet the landscape we face in 2026 feels markedly different. We have a government whose rhetoric speaks of protecting the GP partnership model, while policy decisions increasingly undermine it. At the same time, Integrated Care Boards face workforce reductions of up to 50%. Hospital waiting lists remain vast, health inequalities continue to widen, and moral injury within the profession has never been more apparent. It is difficult to see how this trajectory can be described as progress.

As ever, it is the most vulnerable members of our communities who will feel these pressures most acutely. This creates a profound tension for general practice: the need to push back against unfunded and non-commissioned workload while remaining steadfast in our commitment to those who rely on us the most. But perhaps it is precisely this commitment—to equity, compassion, and social justice—that should guide our efforts to create capacity within our already crowded days.

There is a simple truth in medicine: the healer cannot heal if they themselves are wounded. In the turbulence of modern general practice, it is easy to forget this. But if we are to sustain the care our communities deserve, we must first protect the wellbeing of those delivering it. Sometimes the most responsible act is to secure our own oxygen mask before helping others.

It has been an honour to serve Avon’s GPs during this time. General practice has never been an easy calling, but its importance to our communities has never been greater. I leave the role of Chair in the capable hands of Lee Salkeld, who I know will lead Avon LMC with great judgment and commitment.

“In the midst of winter, I found there was, within me, an invincible summer.” — Albert Camus

Shaba Nabi
Chair: Avon LMC

This virtual drop-in was deliberately postponed to Tuesday 31 March to allow more detail to follow-through on the GP contract. It is also after GPC England meets on 26 March so we hope as many of you can join us to engage with a robust discussion about the new GP contract and next steps.

Please register for this drop-in using the following link.

This is your last chance for all GPs who are BMA members to vote in the GP Referendum which runs until 25 March. This referendum is asking a simple question:

Do you accept the 26/27 GP contract, or do you want the government to return to direct negotiations with GPC England to jointly develop a new GMS contract?

BMA GP and GP Registrar members working in England will receive an email with your voting link from Civica. It will come from bma@cesvotes.com.

If you have not yet received your electronic ballot:

• please check your junk folders
• please check you BMA member profile – are you listed as a GP or GP registrar practising in England?

If you still then do not receive your electronic ballot, please let the BMA membership team know here.

If you have any issues trying to submit your vote, please email gpcontract@bma.org.uk.

As we are potentially heading into another season of GP Collective Action, it’s more important than ever for members to remain updated of any issues.

Feel free to join our broadcast only WhatsApp group – this means only the LMC Board and office staff can share broadcast messages and polls, which reduces your social media burden.

If you haven’t already joined and would like to do so, please email marcus@almc.co.uk.

Following the announcement of the new elective care referral pathway within the GP Contract, a Single Point of Access will be introduced for all referrals. These will be triaged by specialists and directed to a range of possible outcomes, including Advice and Guidance rather than an outpatient appointment.

Both Avon LMC and GPC England are clear on one principle: GPs must always retain the right to refer. Advice and Guidance can be a valuable adjunct to patient care, but it cannot replace an outpatient referral where one is clinically required.
There are many reasons why the ability to refer must remain with the GP, including:

• The potential transfer of medico-legal risk to the GP
• Conditions that fall outside the competency of general practice
• The workload implications of shifting activity from secondary to primary care
• GMC guidance on delegation and referral
• Patient choice, particularly in line with Jess’s rule

Avon LMC will ensure that practices have access to template letters to challenge inappropriate referral rejections should the need arise.

A local school has issued letters advising parents and carers to arraQuestion: We have been asked by a midwife to prescribe antibiotics for a newborn baby following a swab result. Is this something that GP practices are expected to manage, or is there a hospital pathway that should be used for neonatal prescribing in this situation?

Answer:
Thanks for your email regarding the community midwife team asking you to prescribe antibiotics following a swab result.

There are two key considerations here: the commissioned pathway and the clinical appropriateness.

In terms of the commissioned pathway, this activity is included within the supplementary basket LES (prescribing common medications on behalf of midwifery), which all BNSSG practices participate in. As such, practices are funded to undertake this prescribing.

However, the clinical decision to prescribe must always remain with the prescriber. If you felt that prescribing antibiotics was not the appropriate management based on the information available, you are entitled to decline. In those circumstances, it would be reasonable to provide an explanation and, where possible, suggest an alternative management plan.

The BBC ran a news article on sick notes last week and interviewed the Chair of Avon LMC. This can be heard here.

As part of the GP contract change for 26/27, practices are required to deal with clinically urgent patients on the same day. NHS England has produced guidance on how to record this.

This has just been released and can be found here.

It offers no insight into contractual frameworks but expands on some of the narrative within the 10 Year Health Plan, including:

• Integrated Neighbourhood Teams serving populations of 30,000 – 50,000
• Population Health approach to deliver proactive care to highest need in the community
• Integration with social care, public health, and voluntary sectors
• GPs supervising MDT roles: both clinical and non-clinical
• Shared care records across organisations

The NHS has introduced new population health delivery models to facilitate organisational change, supporting ICBs to commission providers around the needs of defined populations. ICBs – working with partners, including local authorities and health and wellbeing boards – will agree neighbourhood footprints that form clearly defined populations. Single neighbourhood, multi-neighbourhood and integrated health organisation contracts will be commissioned around these populations.

The publication can be found here.

Are PHSO financial remedy recommendations mandatory?

As far as we can see, PHSO financial remedy recommendations are not legally binding. They are recommendations, not enforceable orders. However, not complying can lead to escalation to a full investigation, with potential for greater reputational impact, higher eventual financial remedy, and public criticism.

The PHSO explicitly states that it makes recommendations where appropriate when an organisation has not put things right. These include recommendations on financial remedy but are not described as mandatory. Their guidance clarifies that recommendations aim to be proportionate based on their severity of injustice scale, but they remain recommendations. [theioi.org]

Although not mandatory, failure to comply risks a formal investigation, adverse findings published publicly, and possible commentary on individual actions — many practices therefore comply to avoid escalation and reputational or regulatory scrutiny.

Is there insurance or indemnity cover for this?

There is no specific insurance product that pays PHSO?recommended ex gratia financial remedies. CNSGP does not cover complaint handling or PHSO financial remedy, because these remedies relate to service failings rather than clinical negligence claims, CNSGP only responds if the matter becomes a formal negligence claim. [resolution.nhs.uk]

Medical defence organisations can provide advice and support with complaint responses, and guidance on risk mitigation, but don’t usually fund PHSO?recommended financial payments, because these are not negligence claims.

Is there BMA / GPC guidance on how practices should approach PHSO?related cases?

There is no single BMA document dedicated specifically to PHSO financial remedy, but there is  guidance on dealing with complaints more generally here: Dealing with complaints made against you in primary care

NHS Complaint Standards

• PHSO’s NHS Complaint Standards (endorsed for use across the NHS) give a consistent approach for complaint handling and how organisations should prepare for potential PHSO involvement. [ombudsman.org.uk]

CQC expectations

• CQC guidance (aligned with GMC Good Medical Practice) reinforces proper complaint handling and transparency. [cqc.org.uk]

Can practices signpost to NHS Resolution in a complaint response if a potential claim is identified?

Yes, in cases where it appears the matter may amount to a clinical negligence claim rather than a service complaint.

MDDUS guidance notes that complaint responses must include information on the complainant’s right to escalate to PHSO and distinguishes between complaints and claims. While it does not forbid signposting to NHS Resolution, it clarifies that providers must manage complaints locally and that claims should be directed appropriately.

This can be found here.

• 31 Mar 2026: Virtual LMC drop in, 1pm – 2 pm
• 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.  

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

Date: Wednesday 1st April 2026
Time: 09:30 – 16:00
Venue: UWE Bristol
 
A reminder that?all?general practice and PCN management colleagues are invited?to our annual conference -?including Practice Managers, PCN Managers, Deputy and Assistant Managers, Team Managers, and anyone aspiring to these roles.? 
 
The conference will be a dedicated space to?develop your leadership, strengthen your management skills, and connect with peers. Join us for a day of updates, workshops, networking, and learning to support you in your role.? 
 
The attached flyer contains agenda and link to register. 
For further information, please contact Louise Carthy, Project Lead, at L.Carthy@nhs.net.

BRIG meeting: Thursday the 26th of March at 1pm. 
Please come and join us to discuss anything respiratory related – joining link attached.

Please find the attached flyer for more details.

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– LATEST TRAINING AND EVENTS –

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