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July 9, 2026

July 2026 Update

Doncaster IHO update

Over the last year, the LMC has engaged extensively in discussions around the development of an Integrated Health Organisation (IHO) model for Doncaster. Our position throughout has been consistent: we fully support efforts to strengthen integration, improve system fairness, and create a model in which general practice can participate as an equal and valued partner.

Following careful consideration, the LMC has concluded that we cannot continue in a formal support role for the current IHO development process. At this stage, we do not have sufficient confidence that the conditions required for a genuinely effective and sustainable model are in place.

While there has been progress in some areas, key elements of the vision for an inclusive and balanced partnership have not yet been realised. In particular, the emerging approach appears unlikely to deliver the breadth of cross‑sector collaboration needed to ensure that general practice, local authority services, DBTH, RDaSH, and the VCSE can operate together on equal footing. Without strong, mature relationships across all partners, there is a significant risk that the IHO will evolve into a loose alliance rather than a truly integrated system.

In light of this, the LMC is adjusting its focus. Rather than remaining within a process that is not currently aligned with the conditions needed for full and equal GP participation, we are pivoting. This is not about the LMC determining the future structure – that responsibility sits with the system partners leading the work. Our role is to ensure that Doncaster general practice is ready, organised, and well‑positioned to engage constructively with an effective and deliverable model.

This pivot reflects our responsibility to champion general practice, safeguard its voice, and support practices through a period of uncertainty. We remain committed to constructive engagement with system partners and will continue to represent practices in all relevant forums. Further updates will be shared as the situation develops.

GPC Update: Leadership Changes

The BMA’s General Practitioners Committee (GPC) has confirmed a change in leadership. Dr Katie Bramall has stood down from her role on GPC England. Following this, GPC England has appointed Dr Clare Bannon as its new Chair.

Dr Bannon will now lead GPC England’s work representing the profession at national level, including negotiations, policy engagement, and discussions with NHS England. Practices may wish to familiarise themselves with upcoming communications from GPC England as the committee sets out its priorities under new leadership.

Further updates will be shared as national guidance and direction evolve.

DBTH Leadership Update

Doncaster and Bassetlaw Teaching Hospitals (DBTH) has announced several changes within its senior leadership team. Acting Chief Executive Zara Jones will be leaving the organisation at the end of September to take up the Chief Executive role at East Cheshire NHS Trust. We thank the steady transitional leadership she has provided during a period of organisational change.

The Trust has also confirmed that Dr Nick Mallaband, who has been acting up as Chief Medical Officer, has now been formally appointed to the role. It’s good to see Dr Mallaband providing continuity and stability for medical leadership across DBTH.

We will continue to share updates with practices as DBTH moves through these transitions.

Gabapentinoid resources - now available on the MO website

Gabapentinoid resources – now available on the MO website

The following Gabapentinoid resources are now available on the Medicines Optimisation website :

NHS Warning on Unauthorised Access to Patient Records

NHS England has launched a national campaign reminding all staff that accessing patient records without a legitimate clinical or operational reason is unlawful and carries serious consequences. The message follows recent incidents where individuals were dismissed for viewing the records of victims involved in high‑profile cases.

The NHS Chief Executive has emphasised that inappropriate access – whether out of curiosity, personal interest, or any reason unrelated to direct care – is a breach of patient trust and a breach of the law. Staff who access records without justification may face disciplinary action, dismissal, referral to professional regulators, or criminal prosecution.

Alongside the campaign, NHS England has issued updated guidance for all organisations on preventing, monitoring, and investigating unauthorised access. The guidance outlines:

the types of unlawful access
expectations for monitoring and audit
when incidents should be reported to the ICO or police
the importance of role‑based access controls and technical safeguards
the need for multi‑factor authentication and minimising access to highly sensitive information

Some modern electronic record systems can now flag suspicious activity in real time, and organisations are encouraged to make full use of these capabilities.

The campaign will be visible across NHS organisations through screensavers, posters, and staff communications, reinforcing the message: having the ability to view a record is not the same as having a legitimate need to do so.

Protecting Patient Records: A Timely Reminder on Access Governance

Maintaining the integrity and confidentiality of patient records is one of the most fundamental responsibilities in general practice. As services evolve with Extended Access, ARRS roles, subcontracted providers, federations, and cross‑practice working, the number of individuals who could access clinical systems has increased. What has not changed is the legal and professional duty to ensure that only those with a legitimate, authorised purpose can view patient information.

Recent conversations with GPs across Doncaster have highlighted the importance of regularly reviewing who has access to your clinical systems, what level of access they hold, and whether that access is appropriate for the role they are performing. It is easy for permissions to drift over time, especially when staff move between organisations or when subcontracted services are delivered from practice premises.

Why this matters

Under UK GDPR and the Common Law Duty of Confidentiality, practices remain the Data Controller for their registered patients. This means:

You are responsible for deciding who can access patient records.
You are accountable for ensuring access is lawful, necessary, and proportionate.
You must be able to evidence that access is monitored and reviewed.

Even when services are subcontracted (for example, Extended Access or specialist clinics) the practice does not hand over unrestricted access or clinical governance authority. Access must always be role‑based, time‑limited, justified and auditable.

Key actions for practices

To support safe and compliant data handling, practices may wish to:

Review access lists for all clinical systems (EMIS, SystmOne, Docman, AccuRx, etc.)
Check that permissions match the role – e.g., direct care vs administrative vs reporting.
Remove legacy accounts for staff who have left or changed roles.
Confirm that subcontracted providers only have the access explicitly agreed in your contracts and data sharing arrangements.
Ensure locums, sessional clinicians, and ARRS staff are set up correctly, with access limited to what they need for direct patient care.
Audit access logs periodically to ensure there is no inappropriate or unexplained activity.
Revisit subcontracting agreements to ensure they accurately reflect data controllership and access boundaries.

GP Fatigue

GP Fatigue

General practice has always been demanding, but the modern working day places an unusually heavy physiological load on clinicians. Many GPs describe a familiar pattern: by late afternoon they feel light‑headed, faint, shaky, or “washed out”, despite eating and drinking normally. These symptoms are often dismissed as simple tiredness, yet the underlying mechanisms are well‑documented and far more specific.

The Cognitive Load of General Practice

General practice involves rapid decision‑making, emotional labour, risk assessment, and constant task switching. Studies using cognitive load indices show that clinicians operate at a sustained level of high cognitive demand throughout the day.

The prefrontal cortex, responsible for executive function, has no energy reserves of its own. It relies on a continuous supply of glucose and oxygen. Prolonged cognitive work increases metabolic demand, and even small dips in glucose availability or cerebral perfusion can produce dizziness, fogginess, and a sense of detachment. This is not a reflection of poor resilience; it is a predictable physiological response to sustained executive load.

Orthostatic Stress and Reduced Baroreflex Sensitivity

Many GPs spend long periods sitting, followed by sudden transitions to standing. Prolonged sitting leads to venous pooling in the lower limbs and abdomen. At the same time, mental fatigue reduces baroreflex sensitivity. This combination means that standing up after a busy clinic can produce transient cerebral hypoperfusion. This manifests as light‑headedness, greying of vision, or the need to pause before walking. Occupational health studies show that mental fatigue significantly worsens orthostatic tolerance.

Autonomic Fatigue from Continuous Micro‑Stressors

General practice is characterised by a steady stream of micro‑stressors: time pressure, emotional conversations, safeguarding concerns, diagnostic uncertainty, and the constant awareness of risk. These activate the sympathetic nervous system repeatedly throughout the day. Over time, this leads to autonomic fatigue. Heart rate variability declines, parasympathetic tone falls, and sympathetic responses become less efficient. By late afternoon, the autonomic system is less able to regulate blood pressure and heart rate effectively, contributing to dizziness, shakiness, and a sense of physiological depletion.

The Cortisol – Glucose Mismatch

Cortisol follows a diurnal rhythm, peaking in the morning and declining through the day. It supports glucose mobilisation during periods of cognitive or emotional stress. When cognitive demand remains high but cortisol levels fall, a mismatch develops: the brain continues to require energy, but the hormonal support for maintaining stable glucose availability is reduced. This mismatch can produce symptoms that feel very similar to hypoglycaemia even when blood glucose levels are normal and food intake has been adequate.

Practical Measures That Can Help

Several small adjustments can reduce the physiological load:

Brief movement breaks every 20 – 30 minutes to reduce venous pooling
Standing up slowly after prolonged sitting
Adequate hydration and modest salt intake earlier in the day
A small carbohydrate‑and‑protein snack mid‑afternoon to reduce the cortisol–glucose mismatch
Short periods of slow, diaphragmatic breathing to restore autonomic balance

These are not cures, but they can meaningfully reduce the intensity of end‑of‑day symptoms.

Pharmacy investment

Pharmacy investment

The Government has announced a £340 million investment to significantly expand the role of community pharmacy from Autumn 2026, positioning Independent Prescribing pharmacists as a major new access route for patients seeking assessment and treatment. This forms part of a wider national shift in the 10‑Year Health Plan, with ministers explicitly stating that the intention is to reduce GP referrals, ease pressure on urgent care, and move more first‑contact activity onto the high street. Pharmacy First has already delivered over three million consultations in the past year, and this new funding is designed to accelerate that trajectory by enabling pharmacists to diagnose and prescribe for a broader range of conditions, including areas of women’s health, mental health support, and long‑term condition monitoring.

This represents a significant substantial structural change in how patients will access NHS care, and it will inevitably influence the case‑mix and workload profile within general practice. While we welcome improved access and the contribution of the wider primary care workforce, it is essential that this expansion is underpinned by robust clinical governance, clear responsibility boundaries, and fully integrated digital systems. Pharmacy‑initiated prescribing must be visible, safe, and seamlessly incorporated into the GP record to avoid fragmentation, duplication, or unplanned workload transfer back to practices. As pharmacists take on more autonomous prescribing roles, the LMC will be seeking assurances around safety‑netting, follow‑up responsibilities, and the management of medicines that require ongoing monitoring.

The changes will be monitored closely, particularly around bounce‑backs, continuity of care, and the increasing complexity of the patients who remain within general practice. The LMC will also be making the case that while pharmacy is receiving substantial new investment, core general practice must not be left behind. If the system is to function safely and sustainably, investment must follow the workload and support the parts of the system managing the most complex care.

Research opportunity: Accessing Continuity study

The University of Bristol, working with the Primary Care Academic CollaboraTive (PACT), is inviting general practice teams across the UK to take part in a national study exploring continuity of care. The Accessing Continuity project aims to understand how relational continuity varies between practices and how different access models influence patients’ ability to see the same clinician over time.

Continuity of care remains a central pillar of general practice, yet pressures on access, workforce, and appointment systems mean it is increasingly difficult to maintain. This study offers practices a structured way to measure continuity using validated tools, compare their results, and contribute to national research on how continuity can be strengthened.

Who can take part?

The study is open to anyone working in UK general practice – clinical or non‑clinical, permanent staff, locums, trainees, registrars, and students. The research team is seeking one participant per practice.

What participation involves

Participants will:

Measure continuity of care in their practice using tools provided by the research team
Complete a short questionnaire about their practice’s access systems
Potentially take part in a semi‑structured interview (if selected)

Why it may be useful for practices

Taking part offers several benefits:

A practical introduction to measuring continuity of care
A bespoke report showing how your practice’s continuity scores compare nationally
CPD evidence and portfolio material
Named collaborator status on resulting publications
Contribution to national understanding of how continuity can be improved for patients

For practices reviewing access models or considering changes to appointment systems, this study may provide helpful insight into how different approaches affect continuity.

Find out more

Further information and registration details are available via PACT: Accessing Continuity (2025–ongoing) – Primary Care Academic CollaboraTive (PACT)

Communities Learning Together (CLT) End of Life Care Programme Session 2: Advance Care Planning and ReSPECT Awareness

Communities Learning Together (CLT) End of Life Care Programme Session 2: Advance Care Planning and ReSPECT Awareness

End of Life Care Programme 2026

Communities learning together are running Last Days of Life Care into Loss Grief and Bereavement sessions on –

Thursday 16^th July 2026 at 2pm – 4pm via Teams

Foundations In Symptom Management Awareness – Friday 21^st August 2026 at 10am – 12pm via Teams

If you wish to secure your place onto the session and receive the Teams link, please email CommunitiesLearningTogether@swyt.nhs.uk with your name, job title, and place of work.

Resources and certificates will be issued.

GP practice vaccine and immunisation catch up campaign

National GP Contract Requirement: 2026/27 Catch‑Up Campaign

As part of the GP contract, practices are required each year to participate in a national vaccines and immunisations catch‑up campaign. NHS England has now confirmed that the 2026/27 campaign will focus on measles, mumps, rubella and varicella (MMR/V). This follows recent measles outbreaks and the loss of England’s elimination status, making improvement in childhood immunisation coverage a national priority.

The campaign will centre on identifying under‑vaccinated children and young people, reviewing records, and offering catch‑up doses where appropriate. Practices should expect further operational guidance from NHS England in due course, but the contractual requirement to participate is already in place.

Campaign timings

The campaign will run from June 2026 to March 2027 and will focus on the following:

General practices will be required to undertake local call and recall for eligible individuals aged 12 months to less than 6 years who are missing 1 or 2 doses of MMR/V.
Practices are asked to support requests for vaccination of individuals aged 6 years up to and including 11 years. This will work as follows:
- Cohort will be identified through a phased national invite.
- Where parents and carers contact their practice after receiving an invitation, practices are required to check the individual’s vaccination status for valid vaccinations (for example, given at the correct age and at the correct intervals) and book an appointment for vaccination if clinically appropriate.

Please note that there is also a selective catch-up of varicella vaccination that was agreed as part of the MMRV roll out in January 2026. The selective catch-up will be for those eligible individuals who have not yet had a chickenpox infection or 2 doses of varicella vaccination. The catch-up will run from Sunday 1 November 2026 to Friday 31 March 2028.

Autumn/Winter 2026 COVID‑19 Vaccination Programme

Following advice from the Joint Committee on Vaccination and Immunisation (JCVI) and confirmation from Government, NHS England has announced that the autumn/winter 2026 COVID‑19 vaccination programme will run from 1 October 2026 to 31 January 2027.

Key points:

The programme will run alongside the seasonal flu campaign.
Co‑administration should be offered where clinically appropriate.
Eligible cohorts remain unchanged from last year.
Further operational detail will be issued nationally.

Prescribing Responsibilities and Processes in General Practice

Following queries from non-prescribing nurses, nursing associates and other clinical staff about being asked to re-authorise medication after completing reviews such as chronic disease management and contraception in general practice clinics.

Guidance has now been produced which aims to give clarity, around what constitutes prescribing and good governance processes. This is intended as supportive guidance for maintaining patient safety and safe practice for all general practice employees.

It is intended to support clinicians in understanding the boundaries of their role and to help practices ensure that safe, proportionate and auditable prescribing processes are in place.

Invitation to Webinar Series: Developing Breathlessness, Cough and Sleep Pathways

HIN Oxford and Thames Valley are running webinar series on breathlessness, cough, and sleep pathways (5 webinars in total). Please can you see the invite bellow for the first session on 13 July.

Better elective respiratory pathways: early insights and practical guidance

Date: Monday 13 July 12.00 – 1.00pm

Registration Link: https://events.teams.microsoft.com/event/c59921b9-d572-4cd3-8753-fc42b0e68096@2a9cd5ba-2408-4347-8400-7c5d88c277fb

This webinar provides an overview of the national Elective Care Respiratory Pathway programme, focused on improving pathways for sleep, breathlessness, and chronic cough. You will be introduced to our implementation toolkit, with practical guidance on how to adopt and scale best practice pathways in your own organisation, and hear directly from early adopter sites.

Why attend

Whether you are looking to reduce referral to treatment times, address unwarranted variation, or strengthen multidisciplinary working across primary and secondary care, this webinar will give you practical tools and real-world perspectives to help you get started.

Who should attend

This webinar is for clinicians, service leads, commissioners and anyone working in or across respiratory services who wants to improve the sleep, breathlessness and/or chronic cough pathways for their patients.

About the programme

The Elective Care Respiratory Pathway programme is commissioned by NHS England and led by Health Innovation Oxford and Thames Valley (HIOTV). HIOTV is coordinating delivery across England and supporting NHS teams to implement recognised best practice in sleep, breathlessness and cough in a way that works in real services. The programme supports providers to reduce referral to treatment times, address unwarranted variation and strengthen multidisciplinary working across primary and secondary care.

LMC Buying Group

Doncaster LMC is been a member of the LMC Buying Groups Federation.

Buying Group membership entitles practices to discounts on products and services provided by the Buying Group’s suppliers.

Membership is free and there is no obligation on practices to use all the suppliers. However, practices can save thousands of pounds a year just by switching to Buying Group suppliers. To view the pricing and discounts on offer you need to register for access to the Buying Group’s online portal: https://buying.plexusportal.co.uk/Register.

What is the purpose of the Buying Group and how does it work?

The sole purpose of the Buying Group is to save its member practices money by negotiating discounts on goods and services which practices regularly purchase. The Buying Group team negotiate with suppliers, after which they identify ‘approved’ suppliers, who guarantee to give you significant discounts over what you would otherwise pay for their services, in return for the Buying Group’s endorsement and help in making you aware of what they offer.

Does it cost us anything to be part of the group?

No, membership is free and members are free to use as many discounts as they wish.

Is there any obligation to take up the deals offered?

No. Each practice is free to take up or decline any of the deals the Buying Group have negotiated. If you wish to take advantage of any of the offers in question, you will be given contact details, and all communications take place between you and the individual supplier*.

*The Buying Group accepts no liability for any contract willingly entered into by a practice with an approved supplier. Practices are advised to check that the terms of any contract with suppliers are consistent with those the Buying Group have negotiated and are advised to inform the Buying Group team of any discrepancy. The Buying Group do not, however, accept any responsibility for any member practices’ failure to check the terms of the relevant contract and the principle of caveat emptor (buyer beware) applies in all cases. Your rights as a consumer under the Consumer Protection Act are unaffected. With respect to any services to which the provisions of the Financial Services Act 2000 might apply practices are advised to seek independent financial advice as may be appropriate.

What happens to my details?

When a practice signs up for Buying Group membership, they will keep your basic contact details (practice address) on a secure system. On the membership application form, they also ask you how they can use your personal data (i.e. your email address) but even if you do sign up to receive their emails you can stop them at any time by clicking the unsubscribe button.

What if I am not happy with the quality of goods and services supplied?

Always let the Buying Group know if you encounter any problems getting what you want, and they will endeavour to sort it out.

Contact the Buying Group

The Buying Group is managed by Plexus Support Services Ltd:

Tel: 0115 979 6910

Email: info@plexussupport.co.uk

Website: https://www.plexussupport.co.uk