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New DESs to target specific needs

New directed enhanced services for Scotland, Wales and Northern Ireland will focus on clinical areas of specific importance to each country.

Rob Finch

The move will mark a departure from England, where the four DESs ­ access, choice, practice-based commissioning and IT ­ are all non-clinical.Although negotiations are not complete in the other home nations, lead GP negotiators in each ruled out any enhanced services for the much-maligned electronic referral system, Choose and Book.

In Northern Ireland practice-based commissioning has been ruled out entirely, while in Wales and Scotland it has been put on the backburner. Each country will receive a per capita sum equivalent to the £100m invested in England: Scotland will get £12.6m, Wales gets £6.7m and Northern Ireland will receive £4m.

Dr Mary Church, joint chair of GPC Scotland, said its clinical areas would be interconnected. Discussions would conclude once the 'practicalities' of incentivising GPs for each had been ironed out. She said: 'They want to concentrate on health inequalities in Scotland this year.'

The Welsh Assembly wants to amend access targets and had agreed to set minimum levels for maternity pay. The decision contrasts with the maximum level of £1,500 set in England.

Dr Andrew Dearden, GPC Wales chair, said GPs would get 'equivalent money for equivalent work' to the rest of the UK.

Dr Brian Dunn, GPC Northern Ireland chair, said DESs for the province would be 'entirely clinical'. Final deals for the home nations are expected to be agreed well in advance of their introduction in April.

How the home nations compare


  • £12.6m ­ to be focused on health inequalities
  • No Choose and Book
  • No practice-based commissioning for now


  • £6.7m ­ to be used primarily in clinical areas
  • New access targets and money for IT
  • No Choose and Book
  • Commissioning possibly in 2007
  • Minimum maternity pay set

Northern Ireland

  • £4m for clinical DESs
  • No Choose and Book
  • No commissioning

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