Chairman Report 2025/26

This report covers another demanding year for general practice, and it remains a privilege to serve as Chair of Cheshire LMC through it. The pressures on our practices have not eased. If anything, the year has made the direction of travel harder to ignore.

The share of NHS spending reaching general practice has fallen again to its lowest level in at least a decade. Over the same period the volume and complexity of our work have risen relentlessly. We are being asked to carry more of the NHS's work for less of the NHS's money, and no amount of warm words about the value of general practice changes that.

Every policy document points towards neighbourhoods: care closer to home, delivered by Neighbourhood Teams, with general practice at the centre. The money points the other way, and year on year a larger share of it settles in Acute Trusts. Judged by where it spends rather than by what it says, the NHS is not becoming a Neighbourhood Health Service. It is becoming, more completely each year, a National Hospital Service. Neighbourhood working cannot be delivered on a share of resource that continues to shrink.

Reorganisation has added considerably to the strain. Excessive restructuring of commissioning has stripped out institutional memory at exactly the moment stability was most needed. All too often it is GPs within the system who are left to pick up the pieces and carry on the valuable work regardless. I remain continually amazed by the dedication, skill and tenacity of local colleagues fighting for what is right in the NHS.

I want to record my thanks to the LMC colleagues who continue to take that fight on. Our Executive and officers have worked patiently and forensically through multiple challenges over the year, questioning, amongst other things, the LES reviews, the prescribing scheme and the distribution of System Development Funding. These threats differ in scale but not in significance, and they share a direction: the erosion of the viability of the independent contractor model, one scheme at a time. It is detailed, unglamorous work to resist them. It is also the work that protects practice income and, ultimately, practice survival, and it has been done to a standard of which I am proud.

The Committee itself continues to go from strength to strength. Meetings are well attended, robustly argued and focused on solutions, bringing together GPs and practice managers with real expertise and a shared commitment to the profession. The team in the LMC office remain the quiet engine behind all of it, and practices across Cheshire benefit daily from advice and support whose workings they rarely see.

The year ahead will bring further reorganisation, further reviews, and further pressure on the independent contractor model. Cheshire LMC will continue to make the case for general practice on the evidence, to hold the system to the commitments it has made, and to represent our practices without fear or favour. General practice remains the foundation of the NHS. It is long past time it was funded as such.

Dr David Ward
Chair