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Update on enhanced services

How enhanced services have developed and changed since they were introduced in 2004.

LESs, DESs and the QOF have absorbed many NESs
LESs, DESs and the QOF have absorbed many NESs

GP practices can contract with their primary care organisations (PCOs) or, in England, clinical commissioning groups (CCGs) to provide enhanced services (ES) in addition to core GMS services.

Types of contract
The three contract types are national enhanced services (NESs), directed enhanced services (DESs) and local enhanced services (LESs).

NES contracts have national conditions and payment terms but are seldom commissioned nowadays.

DES contracts have standard conditions and payment terms and PCOs/CCGs are obliged to offer them to their practices.

LES contracts have locally negotiated conditions and payment terms and PCOs/CCGs have discretion over whether to commission them.

Directed enhanced services
While some DESs have continued to be commissioned year on year, others are for limited periods of one, two or three years, say.

Some DESs are UK-wide, but each of the four UK countries also have their own limited period DESs depending on their health departments’ current priorities.

Current DESs


  • Childhood pneumococcal and HIB/Men C vaccinations
  • Influenza and pneumococcal vaccinations
  • Supporting staff dealing with violent patients

Conditions and payment terms with these DESs are subject to variation in the different UK countries.


  • Alcohol reduction
  • Extended access
  • Learning disabilities
  • Minor surgery
  • Patient participation


  • Asylum seekers
  • Care homes
  • Diabetes
  • Extended opening
  • Homeless
  • Minor surgery


  • Extended hours access
  • Osteoporosis
  • Palliative care

Northern Ireland
The Department of Health, Social Services and Public Safety (DHSSPS) in Northern Ireland commissions services as ‘clinical priorities’ rather than DESs and the according to its Health and Social Care Board it is difficult to compare clinical priorities with DESs in England, Scotland and Wales.

Northern Ireland clinical priorities akin to DESs elsewhere:

  • Healthcare for adults with a learning disability
  • Minor surgery

National enhanced services

Some NESs 'have long since stopped', according to a BMA spokesperson. Instead, most contracts that could be offered as NESs are in many areas commissioned as LESs. Other NESs have been absorbed into the Quality and Outcomes Framework (QOF) or become directed enhanced services (DESs) contracts. The table shows what has happened:

Alcohol misuse NES DES
Anticoagulation monitoring NES QOF
Care of the homeless NES LES
Drugs misuse NES LES
Intra partum care                   
Immediate/first response care (out of hours providers) NES No information
IUCD fitting
Minor injury services NES LES
Multiple sclerosis patients
Near patient testing NES LES
Patients with depression NES
Sexual health services NES LES

Local enhanced services

LES contracts are negotiated locally for a set period of time (one or two years, for example) and practices do not normally have an automatic right to renew them but must re-apply.

There is anecdotal evidence that PCOs have withdrawn some LES schemes because of NHS funding constraints.

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