Providing additional services can offer many benefits for practices and communities alike
Enhanced services are commissioned through the primary medical care contracting routes of general medical services, personal medical services and alternative provider medical services. They are usually commissioned from GP practices but can also be commissioned from other primary care providers such as community pharmacists. Historically there were three types of enhanced services:
Directed Enhanced Service (DES). These were schemes that primary care trusts (PCTs) were required to establish or to offer contractors the opportunity to provide under direction from the Secretary of State for Health. These were linked to national priorities and agreements.
National Enhanced Service (NES). These were schemes that provided specifications and benchmark prices. These services were often amended to suit local conditions and converted into Local Enhanced Services.
Local Enhanced Service (LES). These were schemes that were agreed locally between PCTs and their primary care contractors to meet identified needs and priorities. These could either adopt national specifications or be locally agreed.
Following the Health and Social Care Act 2012, which came into force this year, responsibility for commissioning primary care services has transferred to NHS England. This includes taking responsibility for those DESs that have been re-commissioned for 2013/2014. These are now commissioned as Enhanced Services (ES). The ESs that are offered to GP practices are:
- Extended opening hours access scheme.
- Patient participation scheme.
- Alcohol-related risk reduction scheme.
- Learning disabilities health check scheme.
- Remote care monitoring preparation scheme.
- Facilitating dementia diagnosis and support scheme.
- Risk profiling and care management scheme.
- Improving patient online access scheme.
- Childhood immunisation target payments scheme.
- Influenza and pneumococcal immunisation scheme.
- Violent patients scheme.
- Extended minor surgery scheme.
NHS England has also commissioned on behalf of Public Health England the following vaccination programmes:
- Childhood influenza vaccination for children aged two and three.
- Pertussis (whooping cough) for pregnant women.
- Measles, mumps and rubella (MMR) catch-up campaign.
Signing up for NHS England enhanced services
NHS England area teams will seek to invite and sign up GP practices to participate in these Enhanced Services by 30 June 2013. NHS England will record GP practices’ participation on the calculating quality reporting service (CQRS). CQRS is replacing manual systems for calculating and reporting quality and outcomes for many GP services, including some enhanced services, where achievement data can be obtained from GP clinical systems via the GP extraction service (GPES). CQRS is more efficient and cost-effective as it automates the returns process, saving time for GP practices, clinical commissioning groups (CCGs) and NHS England.
Local enhanced services
As an interim measure for 2013-14, local enhanced services and the associated funds were delegated to CCGs to manage and administer on behalf of NHS England. As from April 2014, they will be given the freedom to review these LESs and decide if they wish to invest these funds in the current services or in alternative community-based services that benefit their patient population. All services commissioned by CCGs will be through the NHS Standard Contract. CCGs will need to decide whether these services could be delivered by a number of potential providers (which may include general practice), or if they can only be provided by general practice.
If the service can be provided by a number of providers the CCG will need to decide if the service is best delivered by a single provider (or a limited group of providers) and therefore go through a tender process, or use multiple providers and commission through the any qualified provider (AQP) route. If it is decided that only GP practices can provide the service, the CCG will commission through the single tender process from GP practices.
Local improvement schemes
CCGs do not have the authority to contract for services or pay for improvements in the quality of services provided under the GP contract. If the CCG identifies an opportunity to improve upon the quality of service provided under the GP contract and wishes to offer an incentive scheme to support this, they will be required to agree with their NHS England area team that their proposal is not already covered in the GP contract. They will then agree with the area team the funding the CCG will provide to support the additional service and the area team will then commission the service.
General practice extraction service
The general practice extraction service (GPES) has been developed in order to improve the way in which primary care data is accessed. Its function is to extract data from GP systems, with the consent of the practice, and deliver it to a wide range of organisations to directly improve patient care. It is responsible for extracting data to inform the quality and outcomes framework (QOF). By utilising a direct access interface, GPES will help reduce the administrative burden on GP practices. A GPES training package has been developed that all general practices must complete in order to implement the new service. Completion of the training will enable practices to release QOF information and receive payment (see Resources).
How to influence commissioning decisions
Membership of a local CCG gives practices the ideal opportunity to influence the development of local services that deliver the best care for your patient population. If you have an idea or have developed a service within your practice that you believe will improve care for patients, you should have the opportunity to share this with your CCG clinical leads. Under the new regulations, the CCG has the authority to develop this idea into a service that can be commissioned for the whole CCG area.
Mark Brodigan is senior programme manager of GP contracts at NHS England.