How to choose the enhanced services you wish to offer
Most GP practices will want to involve themselves in at
least some enhanced services, believes Dr Eric Rose
One of the aims of the new contract is to help GPs to control their workload. In view of this some GPs might wish to concentrate entirely on the basic essential and additional GP services. Examples would be where there are high list sizes and there is difficulty in recruiting partners and nurses, or where surgeries are cramped for space.
But although there is no obligation to provide enhanced services, most practices will want to involve themselves in at least some. So how do you make the choice ?
First, remember your essential reference is the New GMS Contract 2003 Supporting Documentation the Blue Book. This contains very specific definitions of what constitute enhanced services. Second, think about what you are doing currently that equates to an enhanced service. Is it going to be financially worthwhile to continue to provide that service, and do you have the staff and facilities to do so?
For example, a practice with lots of children will almost certainly want to provide childhood immunisations and will be already set up with adequate space for a special clinic and a nurse or health visitor skilled in giving injections to children.
Unless you are without a computer you should easily be able produce a register of children under five and to do an annual audit. You will already be providing parents with information about the benefits of immunisation in order to ensure current target payments. Finally you should already have basic resuscitation equipment and drugs readily available to counteract anaphylaxis.
If you show your PCT that you fulfil the above criteria it is likely it will commission your practice to provide childhood immunisations. If you don't meet these standards you will either need to take remedial action or decide not to go ahead and offer this enhanced service.
Most practices will also want to apply for influenza immunisation, anticoagulant monitoring and near-patient testing because they already provide these services.
By the same token many rural GPs will already be providing treatment for minor injuries. They will also belong to immediate care schemes. The relevant enhanced services will now provide better rewards for work previously done out of altruism, although once again it is important to go through the Blue Book and make sure you can tick the right boxes.
Smaller practices may decide not to provide some services, for example IUCD insertion which needs a regular throughput of patients to maintain the necessary skill.
In the past GPs have taken on extra work by default monitoring anticoagulants and anti-arthritis
drugs for instance. The most
striking example of this is the treatment of drug addiction.
In many areas doctors ended up doing this work, sometimes without the necessary training or back-up. Now the fact that treatment of drug misusers is covered
by an enhanced
service means GPs can't be cajoled or blackmailed into
doing the work 'as part of GMS'.
Those who are prepared to do this work and meet the required standards will be paid for it at a fairer rate.
There are also opportunities for GPs with special interest or experience to offer services more widely across their PCT. For example, patients with MS can be difficult to deal with as most GPs have only one or two at a time and it would be helpful to have someone to whom they could be referred.
Indeed practices may wish to join together amd exert pressure to ensure the PCT does commission such a service.
Always remember the defining of enhanced services allows GPs to say No. If you don't have the skills or facilities, or if your PCT isn't prepared to pay, then you can and must decline to do the work.