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Independents' Day

GPs deserting Labour in droves as election looms

New guidance goes part way to meeting LMCs' demands, writes Rob Finch

The GPC has released a comprehensive list of enhanced services commissioned by PCTs to help GPs negotiate new deals for next year.

Negotiators have also listed services that PCTs cannot pay for out of their enhanced service spending floor.

The guidance sent to

LMCs this week goes part way to meeting last year's LMCs conference demand for 'unequivocal guidance' on what constitutes core work for GPs.

But some GPs said they still needed a precise definition of the type of work that should be included under each service to prevent PCTs exploiting practices.

Disputes over enhanced services are set to continue into the second year of the contract as GPs seek to end 'basket' deals and negotiate new agreements.

Dr Chaand Nagpaul, joint chair of the GPC's enhanced services sub-committee, said he hoped the list would force PCTs to make 'legitimate use' of enhanced services money.

He said: 'There has been too much misappropriation of funds. Our hope is that this list will facilitate clearer negotiations at a local level and speed up the processes that have dogged enhanced services for the last year.'

He added that the guidance had taken so long to produce because the GPC had needed feedback on where problems had occurred.

Dr Rob Barnett, secretary of Liverpool LMC, said the list defined the enhanced services that were 'contestable by GPs'.

He said: 'At the end of the day it is down to the PCT what they commission. There will always be grey areas but that can be useful for both sides.'

But Dr Paul Roblin, chief executive of Berkshire, Buckinghamshire and Oxfordshire LMCs, said the list still did not include a definition of what is and what is not an enhanced service.

'I don't mind where the definition comes from as long as it's clear,' he said.

'All the problems I have had over enhanced services have revolved around their definition.'

Enhanced services guidance

Services that can count towards a PCT's enhanced services funding floor

·All directed and national enhanced services

·Nursing/residential homes

·Refugees and asylum seekers

·Prescribing and monitoring drugs not done via a 'near patient testing' NES (eg lithium, gold, amiodarone)

·Initiation of secondary care drugs (eg insulin, Ritalin, depot antipsychotics)

·Suture removals (where there is a specific enhanced service)

·Dressings post operation/ leg ulcers (where there is a specific enhanced service)

·Minor/moderate surgery

·GPwSI work in the community

·Contraceptive implants/fittings

·Other implants/injections (eg Zoladex)

·Information collection for PCO

·Unscheduled vaccinations and immunisations

(eg MMR for students)

·Early morning, evening or weekend surgeries if requested and paid for by PCO

·Specialised chronic disease care schemes

·Pre-operative assessments requested by hospitals

(eg for MRSA)

·Phlebotomy that is not essential under GMS

·24-hour BP monitoring

·Cardiac event monitoring

·Routine neonatal checks following early discharge

or home birth

·Audiology screening

·Glaucoma screening

·Teenage sexual health drop-in clinics

·Obesity/weight management service


·ECGs upon external initiation

·Ring pessary insertion and changes

·Patients with learning disabilities

·Hospital transport/ ambulance organisation

Services that cannot count towards the funding floor

·GPwSIs in hospitals


(eg physiotherapy)

·Pharmacy work

·Dental work

·Secondary care carried out in the community

·Community hospital current contracts

·Normal out-of-hours work

·Prescribing incentive schemes

·PRIMIS facilitation

·Citizens advice workers

·Evercare nursing and community matrons

·Medical certificates for patients who have been in hospital

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