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Local enhanced services should be opened up to other providers to increase ‘integration’, says NHS Commissioning Board

CCGs will be able to drive greater integration between primary care and other services by removing enhanced services from practices and commissioning ‘wrap around' community services instead, says the NHS Commissioning Board.

The new guidance contains plans to radically revamp the way primary care is commissioned, opening up to £1 billion of primary care funding to alternative providers under AQP.

The guidance, Securing Excellence in Primary Care, says CCGs will be responsible for developing local services ‘more tightly defined and managed' than LESs, which will be renamed to reflect their availability to a wider range of providers.

The Board will commission directed enhanced services nationally, but this guidance is designed as a starting guide for local area teams – the local arms of the Board - to reshape the way GP services are organised locally.

It says GP practices themselves will be able to provide services formally badged as LESs, as long as CCGs can ‘demonstrate that they go beyond the ‘core' services expected under the GP contract, that they provide good value for money, have followed an appropriate procurement route, and that they have appropriately managed conflicts of interest'.

The guidance says such services should form part of ‘a broader network of integrated, community-based care for patients, with shared clinical leadership, clinical pathways/protocols, and clinical information systems'.

The GPC last week urged CCGs not to ‘flog off' local enhanced services to the private sector, amid fears that any change to current arrangements would fragment patient care, and strip practices of valuable resources.

But Dame Barbara Hakin, national director of commissioning development at the NHS Commissioning Board, said it was important that other providers were given an opportunity where appropriate. 

She said: ‘CCGs will want to look at the services in place and ensure they are value for money and they are delivering what they need.

‘What I think will be more important is where they want to commission a new service, it will be important that CCGs follow good procurement rules. Where services could be provided by someone other than in registered list holder, then actually others ought to be given the opportunity to provide them, particularly if they are new services.'

Dame Barbara told Pulse that the shift away from the term Local Enhanced Services reflected the fact that they were moving further away from the GP contract.

She said:  ‘We haven't got a specific name for the services for LESs because the term "local enhanced services" is specific to the GMS contract. Because these services won't be commissioned through the GMS contract, arguably they don't need a name because some of them will be services that can only be provided by practices, and some would be services practices could provide and so could others.'

Dr David Jenner, a GP in Cullompton, Devon, and GMS/PMS contract lead for the NHS Alliance, said: 'This Government thinks competition is a powerful tool for change, but the jury's out on whether private providers will be any better than the GP practice. At the moment for many of the services only GPs are in the position to provide them as they hold the registers.'

'Under AQP a lot of patients will choose to get their services at their local surgery anyway, although a community pharmacy is well placed to compete for some services.'

'I'd advise all practices to put enhanced services into an at-risk income, look at the services that they think only the surgery could provide and bid for them. For the others, they'll have to decide whether it's worth chasing business.'

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