National Enhanced services (NES)

The stated purpose of enhanced services is to :
a. improve patient care for all patients and for specific vulnerable groups
b. improve patient choice
c. aid the resourced shift of work from secondary care to primary care
d. allow practices to develop enhanced services for their practice populations.

It would be against the spirit of the new contract for the PCO to ignore these aims by not investing heavily in enhanced services being provided from general practice.

The key features of the commissioning process for enhanced services are:
1. Primary Care Organisations are free to commission those enhanced services they believe will meet local health needs. This must be done in discussion/consultation with LMCs (or their equivalent). PCOs are, however, required to provide all directed enhanced services from April 2004.

2. PCOs have a minimum “floor” of expenditure they must spend but are free to spend above this minimum. The additional money can come from other sources e.g. their unified budget and waiting list initiative money. If they want a service to be available for patients then they may have to take money from these sources in order to provide it

3. the contract states that “most contracts for enhanced services are likely to be placed with GMS or PMS providers…” [paragraph 2.15(iv)]

4. There will be no obligation on practices to provide any enhanced service (notwithstanding that they have previously provided it) unless they enter into a new contract, which includes adequate funding, for its provision. All practices can stop providing all enhanced services from 1 April 2004 if they choose. Practices not feel obliged to deliver a service you previously provided if it is not being appropriately remunerated

5. There is a national specification and pricing information of most of the National Enhanced services which makes agreeing the process much simpler than in developing local enhanced services.

Reasons why these enhanced services should be provided from general practice:

• Patient access to services is much easier for patients from practices, rather than from fewer, more centralised locations.

• Much of the thrust of the new contract is to provide services closer to patients’ homes

• Patients forced to travel to hospitals for these services would place increasing strains on hospital transport services as well as incurring expenses for patients.

• There has been progressive determination for many years to bring as many services as close to patients as possible.

• Many practices will have the necessary staff in place, many of whom will have the skills to provide these services, having done so for years without funds. The advantage of having staff in place immediately, rather than the PCO or other provider having to recruit and train new staff, places practices in a good position to provide these services.

• Proactive PCOs should see this as an opportunity to move more of this kind of work into primary care now it has a clear funding mechanism for doing so. Practices providing the services now should be able to continue to provide these services. The PCO cannot expect GPs to continue to provide these services if they are currently doing so (paid or unpaid) after 1 April 2004 unless it offers the GPs a new, acceptable contract

Applications to provide
National Enhanced Services

Word documents PDF version
Minor injury services pdf
Near patient therapeutic monitoring pdf
Specialised care of depression pdf
IUCD insertion pdf
Sexual Health care pdf
Anticoagulation monitoring pdf
Patients who are alcohol misusers pdf

The specifications lay out the standards required for providing a quality managed service with registers being kep and audits carried out to demonstrate the standards being carried out.

Therefore not every practice will have the current capacity and resources to undertake a range of enhanced services. Initially your PCO may consider you are already doing to this standard as a priority compared to new services which may take longer to develop.

This part of the new contract does certainly allow for a properly resourced shift of secondary care work to primary care with great benefits for patients and providers alike.

Other areas which may be developed as Enhanced services
Intrapartum care
Immediate care and first response care
Specialised care of MS patients
Specialised care of drug misusers
Enhanced care of the homeless
Contraceptive implants
Insulin conversion
Erectile dysfunction
Pre-operative assessments
Post operative dressings and suture removal




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