Background
In August 2024 following the almost universal support for both the referendum and non-statutory ballot, the LMC started to encourage every practice in LLR to undertake at least one of the 10 collective actions.
It was always indicated that ‘this will be a marathon and not a sprint’. The LMC produced a guide which breaks down the different areas to be relatable to LLR. Practices can review and implement as many of the actions as they like at a rate that they feel comfortable with, and we have attached a supportive document which you can discuss with your practice teams.
This is called for time that we protect practices and not the system. It is time when we work to improve patient services, patient safety and patient satisfaction.
In LLR, we have demonstrated that unity and working together is key. Last year, by the majority of LLR practices working together, we achieved significant improvements in local contracts. If we work together across England we can achieve similar improvements in the national contract, benefitting general practices and our patients.
You may be asked to provide information to the ICB or NHS E about what actions your practice intends to undertake. YOU DO NOT need to respond to these requests.
Current Position regarding protecting local practices (this supersedes Collection Action)
On 19th March 2025, at the LMC England Conference it was confirmed that GPC England has now fully agreed to the 2025/26 contract. GPCE had received the received the Government’s commitment in writing “to working with GPC England to secure a new substantive GP contract within this Parliament, without preconditions, based on collaborative work, and in the spirit of mutual trust and good faith…with General Practice at the heart of a neighbourhood health service.”
GPCE will focus on key aspects of the current 2025/26 contract and look forward to beginning work with the Government on a substantive new contract that can provide safety, stability and hope to general practice. GPCE recommends practices to continue to prioritise their delivery of safe, high-quality patient care and to work with LMCs and ICBS to renegotiate local contracts that are under resourced or are required to fill gaps in service for some of our most vulnerable patients.
Many of the items on the collective action menu will be superseded by the 2025/26 contract agreement, and GPC plans to share updated guidance and clarity in due course. GPC still have the template letters available within the long-standing safe working guidance to help practices manage workload and limit capacity to deliver safe, high-quality care.
The following areas continue:
- Referrals
- Safeworking Guidance
GPC will be adjusting the tracker survey in April to reflect the shift to local action. Please refer to our GP Campaign page for more information on these changes.
Now that the 2025/26 contract changes have been agreed it is important that we continue to work on the benefits for general practices in LLR.
- Changes based on clinical safety including limiting number of contacts to a safe level and increasing normal GP appointments to 15 minutes in recognition of increasing complexity. It is important that practices consider this to be the ‘new normal’ and that any practice that has not yet implemented these changes considers doing so.
- ‘Mind the gap’ with GPs refusing to be an ‘all you can eat buffet’ service, continuing to decline to provide unfunded/non-contracted services or those which are underfunded.
- Actions designed to cause irritation to the system – like not signing up to new data extractions, or not using OptimizeRx etc.
- Data Sharing Agreements. Practices should still consider whether to sign up to a DSA on an individual basis. If the DSA is part of a process which will result in unfunded additional work for the practice, consider not agreeing to it.
- OptimizeRx. Practices who stopped using OptimizeRx can decide whether to reinstall it. To do this, please follow the instructions to install as on this guide.
- PRISM Templates. These remain non-contractual to use. The LMC would continue to advise practices to use them for Two Week Wait referrals (and we will continue to work with UHL and the ICB to ensure that the templates do not introduce additional work). Otherwise, practices can choose whether to use them or not.
- Not a community house officer. Practices should continue to resist taking on inappropriate or under/unfunded workload.
- Referral from a private to NHS service. If a private consultant wishes to refer a patient to an NHS service, they can and should do this themselves. They have the appropriate clinical information and are best placed to organise this. We are working with the ICB to enable private providers to send TWW referrals electronically.
The LMC will keep practices up to speed with developments, but we would welcome GP/practices views on this. If you would like any more help or information, please contact the LMC.
Launch of BMA GP Safe Working Guidance Handbook
Following the overwhelming YES vote in our ballot over the summer, practices are starting to take action as part of our ‘Protect your Patients and Protect your Practice‘ campaign.
GPC England have published a ‘Safe working guidance’ handbook to help GPs and practices in the delivery of safe, high-quality care for their patients and communities. The profession wants to provide care without risking harm to others or ourselves.
At a time of unprecedented pressures, we must make changes to our workload to preserve patient care in the face of a shrinking workforce and rising demand. This will help to protect the sustainability and future of general practice.
We recommend you do this by focusing on the delivery of General Medical Services, in line with the needs of your patients and practice, and deprioritising work and activities that fall outside of your core contractual requirements. This guidance reflects the contractual changes imposed by NHS England in April 2024. We offer ways of doing this that still enable you to stay within the terms of your GMS/PMS.
The guidance outlines how to manage workload effectively, setting safe limits of 25 patient consultations per day in line with UEMO recommendations, and encouraging practices to adopt systems that protect both patients and staff.
The BMA handbook can be downloaded and saved from the website: www.bma.org.uk/GPsSafeWorking.
Further guidance and resources such as webinars and FAQs can also be accessed, with patient information posters and social media graphics to download and share.
We cannot care for our patients if we do not care for ourselves and our colleagues.
Advice & Guidance Enhanced Service
NHS England has published the Advice and Guidance Enhanced Service – CLICK HERE.
Practices will normally have up to 27 May 2025 (unless the ICB agrees to a different date) to sign up to the ES on CQRS and in writing to the ICB. Once signed up practices will be able to claim for each pre-referral A&G request made since 1 April 2025.
An Advice and Guidance episode will include using the e-Referral Service OR dedicated email OR a telephone call.
Practices must have a protocol which should include what is in paragraph 6.2.1 of the Enhanced Service. Consider using the SNOMED CT concept ‘Choose and Book Advice and Guidance Request’ (820641000000100) to record referrals.
Practices will receive £20 per episode (i.e. if two A&Gs are sent regarding the same patient and issue, only one fee will be paid).
The amount is capped nationally so the ICB can cap the number of A&Gs requested on a monthly, quarterly, or annual basis. The LMC will work with the ICB as part of the interface working on this and other aspects of A&G.
The ERS service enables a referrer to preauthorise the provider to convert an A&G request to a referral, and we would recommend that practices tick this on the ERS referral as default. In addition, the purpose of A&G is NOT to allow inappropriate transfer of work from hospitals to practices. We therefore recommend that you consider adding the following, or similar, to each A&G request:
If you would like any more help or information, please contact the LMC
Referrals
As part of working rule, we have updated our template letters which you may wish to use going forward if not completing prism forms
If a referral is rejected or further information is requested, which isn’t relevant to a referral is being asked for, we are attaching another template that can be used.
Please remember the principles of a referral as from the GMC: https://www.gmc-uk.org/professional-standards/professional-standards-for-doctors/delegation-and-referral/delegation-and-referral.
Data Sharing Agreements (DSA)
Following the agreement of the 25/26 GMS contract, we advise practices to contact the LMC office ahead of signing any new Data Sharing Agreements if they are not sure about signing and we can advise.
