National Enhanced services (NES)
The stated purpose of enhanced services is to :
a. improve patient care for all patients and for specific
b. improve patient choice
c. aid the resourced shift of work from secondary care to
d. allow practices to develop enhanced services for their
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
3. the contract states that “most contracts for enhanced
services are likely to be placed with GMS or PMS providers…”
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
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