What is the DES?
A Directed Enhanced Service which allows GPs to conduct minor surgical procedures, including injections and incisions or excisions must be commissioned by area teams. Many areas also allow cryotherapy, cauterisation and curettage as an additional service.
When was it introduced?
1 April 1990
Who can do it?
GPs who are accredited with their local area team, or otherwise on their health authorities minor surgery lists. In some areas, such as London, area teams have recently introduced more stringent requirements for accreditation and infection control which local GP leaders are trying to renegotiate after several practice abandoned the DES.
How much does it pay?
Currently, £43.54for injections and £87.08 for incisions/excisions.
But Arden, Herefordshire, and Worcestershire area team has also introduced new regulation which prevents a GP from receiving two payments for two procedures performed in a single consultation.
Why do GPs do it?
Evidence from the UK and abroad demonstrates that GPs can provide these services on practice premises with a high degree of cost effectiveness and patient satisfaction.
What’s the alternative?
GPs can refer patients to secondary care, but this is not as cost effective and GP leaders have expressed concern that it transfers financial responsibility for services from area team budgets to CCG budgets.
In areas where practices have been prevented from performing cryotherapy services, GPs have expressed concern that this hasn’t taken into account individual practice facilities or clinical evidence of the benefit of performing procedures outside hospital.