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New enhanced deals

GPs will be incentivised for practice-based commissioning, Choose and Book, access, and implementing IT changes under new enhanced services to start in April.

By Rob Finch

The four directed enhanced services (DESs) focus on the Government's policy agenda and represent the only new money put into the contract. Potentially most lucrative for GPs is a £1.90-per-patient DES for practice-based commissioning, revealed exclusively by Pulse (10 December). Practices will get £0.95 per patient for drawing up a plan for how they will make savings by cutting hospital activity.

But GPs will get the other half only if they achieve their plan but find their PCT cannot pass back efficiency savings because of financial deficits. The one-year DES also will not override any existing support from PCTs beyond the £1.90 per patient level.

GPs said the deal, which would net the average practice £11,400, was better than nothing but did not cover their costs. Dr Phil Taylor, a GP in Axminster, Devon, who ran a commissioning pilot, said the funding was 'a good start', but compared poorly with fundholding start-up money.

He said: 'It's money for clinician engagement. Without that, practice-based commissioning is a non-starter.' Dr Laurence Knott, a north London GP, said £1.90 per patient was 'a number out of a hat'.

On access, the DES will replace the 50 quality points and the existing 24/48-hour access enhanced service. Instead, GPs have to offer 48-hour access to a GP consultation ­ either face-to-face or by phone ­ better telephone access, ability to see a practitioner of the patient's choice and advance booking.

Payments will be decided by a new patient experience questionnaire being developed. This will also be used to determine payments for a Choice and Booking DES.The DES will pay GPs up to a maximum of £1 per patient for offering choice and booking appointments either manually or via new software.

The money will be split between aspiration and achievement. Referral data will be used as well as the survey to work out final payments. Dr Angus Carnegy, a GP in Basingstoke, Hampshire, predicted GPs would still resist offering choice. He said: '£1 is not enough, but even with £10 per patient it's still not giving any positive health outcome.'

The DES for IT will pay GPs up to £1.30 per patient for implementing electronic prescribing, GP-to-GP record transfer, Choose and Book and the NHS Care Record.

How new DES payments work

Practice-based commissioning

  • 95p per patient for drawing up commissioning plans
  • 95p per patient for meeting plans for reducing hospital activity ­ paid in lieu of savings if none available from PCT
  • Runs for one year only


  • Approximately £6,250 per average practice for providing consultation (face-to-face or telephone) within 48 hours, advanced booking, choice of GP and good telephoneaccess
  • Money comes from 50 quality points plus existing access DES
  • Payment based on a new patient experience survey

Choice and booking

  • £1 per patient for offering choice of hospitals and booking either electronically or manually
  • Each component to have 50 per cent aspiration payment and 50 per cent for achievement
  • Delivery of choice measured by patient experience survey
  • Delivery of booking measured via number referrals made using new systems


  • £1.30 per patient for adopting electronic prescribing, GP-to-GP transfer of electronic records and the NHS care records service
  • Cash is for training and preparation, not for signing up
  • One year only, but likely to be repeated

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