Enhanced services are defined as ‘primary medical services other than essential services, additional services, or out-of-hours services‘
There are two types of enhanced services – directed enhanced services and local enhanced services. Directed enhanced services (DES) are nationally agreed and have to be offered to all GP practices in England; practices can decide whether they sign up to a DES or not, but they must be offered the opportunity to do so.
However, local commissioners can develop local enhanced services (LES) to offer to local practices to supplement services already offered in the core practice contract. As these are NOT agreed nationally, they vary across the country in scope and funding. Once again, practices can decide whether or not they sign up to a LES.
The following list, compiled by the BMA, shows examples of enhanced services that have been commissioned somewhere in the UK. This list is not exhaustive, but rather provides practices with an indication of the kinds of services that they may be able to seek funding for.
24-hour ambulatory blood pressure monitoring
Ad hoc audit LES
Additional clinical services
Administration of gonadorelins for patients with carcinoma
Administration of PCV and hib/men C vaccinations
Administration of goserelin implant in general practice
Delivery of brief interventions to patients to reduce alcohol-related harm
Denosumab
D-dimer/DVT management in the community to avoid hospital admissions
DMARDs under an effective shared care protocol
Domiciliary falls/minor injuries
DVT pathway contract
Ear syringing
ECG recording
Emergency box palliative care
Emergency treatment of minor injuries in general practice
Emergency hormonal contraception service
Extended hours
‘Flu immunisation
Glucose tolerance testing
GNHR (Zoladex/Prostap)
Gold therapy
Gonadorelin analogue treatment
Heart failure
Hep B catch up
HIV in primary care
Homeless patients
Infant hep B vaccination programme (post-exposure immunisation)
Infectious disease immunisation
Insertion of contraceptive devices
Insulin initiation or conversion
Learning disabilities
Lithium
Mental health depression counselling service
Meningitis C vaccine for university entrants
MMR vaccinations provided to under 25 year olds
Minor injuries
Minor surgery
Near patient testing
Neonatal checks carried out by GPs
Nexplanon
Nursing homes
Nursing homes virtual ward scheme
Over 75 LES – med reviews and health check including house-bound patients
Phlebotomy
Post-op suture removal
Pre and post op swabs/investigations
Primary care provision for patients who have had difficulty maintaining registrations and require frequent allocations
Primary care sexual health scheme
Primary preventions of coronary heart disease
Prostate cancer follow up
Provision of immediate and first response care
Provision of wound care and minor injuries service
Provision of wound care minor injuries
Referral review scheme
Ring pessary insertion
Rheumatology drugs
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
Secondary care generated bloods
Secondary care wound management
Shared care/specialist drug monitoring
Sigmoidoscopy
Smoking cessation programmes
Specialised primary care service for depression
Spirometry
Student health
Treatment room support
Treatment room/basket services
University students
Vaccination against hepatitis B
Vasectomy
Violent patients
Warfarin prescribing
Wound care
Wound care leg ulcers level 1
Wound care leg ulcers level 2 – pressure dressings (higher tariff than level 1)
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