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
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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
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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) |