Primary care bulletin - 3 December 2025

Primary care bulletin schedule over Christmas and New Year

The last bulletin before the Christmas and New Year period will be Wednesday 17 December 2025 (content deadline 3pm Monday 15 December 2025).

There will then be a break until Wednesday 7 January 2025 (content deadline 3pm on 5 January 2025).

Arrangements for sending any urgent material out over the festive break period will be outlined in the 17 December 2025 edition.

There will be a bulletin next week as usual.

Significant increase in demand on urgent and emergency care

The urgent and emergency care system is experiencing a significant increase in pressure this week driven by the recent changes in weather and related presentations. London Ambulance Service is at REAP level 3 and has moved to CSP level Red to ensure they can maximise safety and continue to manage the high number of 999 contacts being made each day and reduce the wait for emergency ambulances.

To help us manage this demand today and over the next few days please can we request support with the following:

not to refer patients to 999 unless it is absolutely clinically necessary or the patient has a life-threatening emergency
not to refer patients to 111 unless the patient has an immediate urgent need and advise patients to use 111 online or to contact their local pharmacist
consider utilising rapid response teams and other alternative care pathways including pharmacies. Only send for an ambulance if it is an emergency
ensure that non clinicians are not referring patients to 999 or 111 as an alternative to primary or community care unless it is a life-threatening emergency.

Support your patients in accessing emergency dental care appointments

Extra appointments are now available for people in who need urgent dental care.

Your patients can get an urgent appointment by visiting NHS 111 or phoning 111. They do not need to be a patient with the dental practice already. This service is available via NHS 111 24 hours a day 7 days a week.

The appointments are for urgent conditions including:

severe toothache: persistent and intense pain that cannot be managed with over-the-counter painkillers
dental abscess: infection causing swelling, pain, and possibly fever
broken or knocked-out tooth: trauma resulting in a fractured or completely dislodged tooth
bleeding in mouth following a dental procedure or an injury that doesn’t stop by itself but can be self-controlled using local measures. Note that if bleeding cannot be controlled, emergency care may be necessary
swelling: significant swelling in the mouth or face that could indicate an infection
fractured, loose or displaced fillings causing pain
severe bleeding from gums, or acute conditions affecting other soft areas of the mouth (such as cheeks or tongue) which require urgent treatment.

Other treatments may be available at the discretion of the dentist. These treatments may require extra visits and costs.

More information on urgent dental conditions is available at NHS.uk/urgentdentalcare

Please download and share relevant materials including posters and website banners so patients know when to seek urgent treatment via NHS 111.

Cervical Screening Administration Service Update

The latest update (PDF) has been published. It includes the latest screening data, alongside key information for sample takers.

East London NHS Foundation Trust de-prescribing clinic

We are aware that East London NHS Foundation Trust has established a de-prescribing clinic outside of normal contractual arrangements, and that North West London ICB has received requests to fund this clinic outside the currently commissioned pathways.

The North West London ICB Mental Health Clinical Reference Group has reviewed the evidence on de-prescribing and has offered further training to GPs to support them in undertaking this work within primary care. If GPs require additional support, they may refer patients to secondary mental health services, where consultants and specialist pharmacists are available to provide expert guidance.

As there is a clear commissioned pathway in place, the ICB will only consider funding referrals to the de-prescribing clinic where the existing pathway has been followed and referrals are supported by a CNWL or WLT pharmacist and consultant.

November edition of UK Health Security Agency's Vaccine update is now available

This month's edition features:

chickenpox vaccine joins the routine schedule
COVER data
vaccine coverage
updated vaccination timeline
routine and non-routine vaccine supply.

Download the newsletter from Gov.uk.

Mental health support in north west London

please make sure all of your patients are aware of our mental health crisis alternative services, by sending them the summary of services poster attached if you’re communicating with them, and displaying it in services. We also have a webpage with the information
remember to use and refer to the Hub of Hope, which is a national mental health directory, and The Coves, a local community safe space opening 2-10pm every day, 7 days a week, offering 1:1 appointments in person or virtually The Coves and Best for You for young people
out of hours: SPA is open 24/7. CNWL’s Mental Health Crisis Assessment Services are open 24/7 and offer a calm and therapeutic alternative to attending an emergency department.
physical health support: This page has information to support local communities with any challenges they may face during winter and includes simple steps to help prevent falls, stay hydrated and warm and keep well at home.

A patient facing poster (PDF) can also be downloaded to place in your surgeries.

Continued use of Hib/MenC (Menitorix) as part of phase 1 changes to the child immunisations schedule

There have been queries regarding the continued use of Hib/MenC (Menitorix) as part of the Phase 1 changes to the Childhood Imms Schedule. We can confirm current guidance as part of the PHASE 1 changes to the National Child Immunisation Schedule is as follows:

Children who turned 12 months of age on or before 30 June 2025 will remain eligible for Menitorix and should continue to be offered this vaccine until central stock levels are depleted, after which any child presenting for the vaccine should be offered a hexavalent (6 in 1) vaccine (to provide the 12-month Hib dose element which is still required). Due to the success of the adolescent MenACWY programme in controlling meningococcal C (MenC) disease across the population a dose of MenC-containing vaccine is no longer recommended at 12 months.

Children who turn 12 months of age on or after 1 July 2025 will not be offered a 12-month Hib/MenC vaccine but instead will receive a routine hexavalent dose at a new 18-month appointment from 1 January 2026 onwards.

Find out more (PDF).

Introducing the WID Easy Test Pilot at West Middlesex Hospital

West Middlesex Hospital will pilot the WID Easy Test this November – a non-invasive blood test aimed at earlier detection of endometrial cancer. This PDF document explains how this innovative approach could improve patient care and reduce unnecessary procedures.

MMRV vaccination guide for parents

A PDF guide has been published by the UK Health Security Agency. It is written for parents and carers of children offered the MMRV vaccination which protects against measles, mumps, rubella and varicella.

Updated Patient Group Directions

NHS England - London has published an updated and a new Patient Group Directions (PGD) on its website. This can be accessed on the NHS England website.

The updated and new PGDs, which can be found toward the bottom of the page are:

NHSE UKHSA MMR PGD v6.0
NHSE UKSHA MMRV PGD v1.0 (new).

Practices should ensure that any registered healthcare professional who is due to administer vaccinations under this PGD should be made aware of this updated version.

Please also note the MMRV: patient group direction (PGD) template has been published.

If you have any queries, please contact the London Immunisations Team.

Education and training