NHS GP Update (Last update: 04.09.20) | QCS

NHS GP Update (Last update: 04.09.20)

Dementia Care
September 4, 2020

Download our NHS update here, including information on the Direct Enhanced Services (DES), Local Enhanced Services (LESs) and more!

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Are you delivering work outside of your NHS contract without funding?

We know how busy every Practice is, so we want to take the opportunity to remind you what may not be within your contractual work. This is in addition to any secondary care workload that should not be passed to General Practice unless you have a localised agreement. Remember that any Patient requests for private letters, including mask exemption requests, are not core NHS contractual work which may detract from your funded, NHS work activity.

Nationally, there are agreed Direct Enhanced Services (DESs) that must be offered to all GP Practices in England, but Practices do not have to sign up to a DES, which may include:

  • Network Contract Directed Enhanced Service Scheme
  • Learning Disabilities Health Check Scheme
  • Violent Patients Scheme
  • Childhood Immunisation Scheme
  • Influenza and Pneumococcal Immunisation Scheme
  • Minor Surgery Scheme

However, local commissioning groups (CCGs) continue to develop Local Enhanced Services (LESs) and offer these to local Practices to supplement services already offered in the core General Practice contract. Again, Practices do not have to sign up to a LES but there are currently almost 90 enhanced services that have been commissioned somewhere in the UK. Your LMC may provide a RAG rating for these to evaluate the Patient and business impact.

We have listed the 89 LES’s in a table from 2019 which have been commissioned locally in the UK so if you are currently providing any of these services without a LES agreement, you should  seek funding. We suggest that you contact your CCG in the first instance, either independently or through your Primary Care Network (PCN), especially if there are differences between local Practices in the same CCG for services provided

1.      24-hour ambulatory blood pressure monitoring

2.      Ad hoc audit LES

3.      Additional clinical services

4.      Administration of gonadorelins for Patients with carcinoma

5.      Administration of PCV and hib/men C vaccinations

6.      Administration of Zoladex implant in general practice

7.      Alcohol and substance misuse

8.      Anticoagulation

9.      Asylum seekers and refugees

10.   Atrial fibrillation

11.   Bank holiday working

12.   Cardiovascular health checks

13.   Care home support

14.   Carers

15.   Chlamydia screening

16.   Choose and book

17.   Complex leg ulcer treatment

18.   Contraceptive device fittings, specifically Contraceptive implant

19.   CVD risk assessment

20.   Delivery of brief interventions to Patients to reduce alcohol related harm

21.   Denosumab

22.   D-dimer / DVT management in the community to avoid hospital admissions

23.   DMARDs under an effective shared care protocol

24.   Domiciliary falls/minor injuries

25.   DVT pathway contract

26.   Ear syringing

27.   ECG recording

28.   Emergency box palliative care

29.   Emergency treatment of minor injuries in general practice

30.   Emergency hormonal contraception service



31.   Extended hours

32.   Flu immunisation

33.   Glucose tolerance testing

34.   GNHR (Zoladex/Prostap)

35.   Gold therapy

36.   Gonadorelin analogue treatment

37.   Heart failure

38.   Hip B catch up

39.   HIV in primary care

40.   Homeless Patients

41.   Infant hep B vaccination programme (post exposure immunisation)

42.   Infectious disease immunisation

43.   Insertion of contraceptive devices

44.   Insulin initiation or conversion

45.   Learning disabilities

46.   Lithium

47.   Mental health depression counselling service

48.   Meningitis C vaccine for university entrants

49.   MMR vaccinations provided to under 25-year olds

50.   Minor injuries

51.   Minor surgery

52.   Near Patient testing

53.   Neonatal checks carried out by GPs

54.   Nexplanon

55.   Nursing homes

56.   Nursing homes virtual ward scheme

57.   Over 75 LES – med reviews and health check including house bound Patients

58.   Phlebotomy

59.   Post-op suture removal

60.   Pre and post op swabs/investigations

61.   Primary care provision for Patients who have had difficulty maintaining registrations and require frequent allocations



62.   Primary care provision for Patients who have had difficulty maintaining registrations and require frequent allocations

63.   Primary care sexual health scheme

64.   Primary preventions of coronary heart disease

65.   Prostate cancer follow up

66.   Provision of immediate and first response care

67.   Provision of wound care and minor injuries service

68.   Provision of wound care minor injuries

69.   Referral review scheme

70.   Ring pessary insertion

71.   Rheumatology drugs

72.   Screening of/vaccination/provision of prophylactic antibiotic or antiviral treatment and other services required for asymptomatic individuals or for outbreaks in institutions at the request of Public Health England

73.   Secondary care generated bloods

74.   Secondary care wound management

75.   Shared care / specialist drug monitoring

76.   Sigmoidoscopy

77.   Smoking cessation programmes

78.   Specialised primary care service for depression

79.   Spirometry

80.   Student health

81.   Treatment room support

82.   Treatment room/basket services

83.   University students

84.   Vaccination against hepatitis B

85.   Vasectomy

86.   Violent Patients

87.   Warfarin prescribing

88.   Wound care

89.   Wound care leg ulcers level 1

a.      Wound care leg ulcers level 2 – pressure dressings (higher tariff than level 1)