What is it?
An update from the NHS Commissioning Board setting out commissioning arrangements for enhanced services until further guidance or legislation is available.
The factsheet describes how enhanced services are commissioned from general practice and other primary care providers, such as community pharmacists, and how they will be commissioned in future by the NHS Commissioning Board, CCGs and local authorities. It explains transitional arrangements for existing services where PCTs will now be consulting with CCGs – and, in the case of public health enhanced services, with local authorities – to decide if services need to continue and what transitional contractual arrangements
need to be made. The document also makes it clear that CCGs commissioning community or practice-based services after the transitional period will need to use the NHS standard contract.
Now – it includes transitional arrangements to re-commission enhanced services for the next six to 12 months.
The main concern for GP commissioners is the potential for conflict of interest when commissioning services that fund member practices. No amount of tweaking will eradicate the potential for conflicts of interest when GPs commission services that may be provided by practices in their CCG. Managing these conflicts remains a thorny issue for GPs, whatever their roles locally. Sharing responsibility for commissioning enhanced services between different commissioners could be seen as a fudge. It could result in uncertainty and different approaches throughout the country depending on how the rules are interpreted locally.
The NHS Commissioning Board will be responsible for commissioning directed enhanced services through the current GMS contract. Although the NHS Commissioning Board retains the ability to commission local enhanced services through the GMS contract, it is unlikely to use this power, which will devolve to local commissioners. LES funding will be part of CCG budgets. Directed enhanced services (DESs) currently cover childhood immunisation, violent patients, extended access, health checks for patients with learning difficulties, flu vaccination, minor surgery, alcohol misuse reduction and patient participation. The NHS Commissioning Board will take responsibility for these for a year from April 2013.
Why it matters
GPs providing enhanced services will be affected when they move to the CCG’s remit, so commissioners must tell local GPs which services will be cut. GPs also need to know when services will be reviewed so they are ready to respond to procurement processes. Practices will want to identify now when contracts end, so they may want to know more about the commissioner’s intentions for the service.
- Will services procured through PMS agreements be managed by GP commissioners?
- How can CCGs involve patients in decision-making?
- How will opportunities to provide services be advertised in future?
- How will use of the NHS standard contract affect the flow of cash to practices and information to the CCG?
If you only learn one thing
Make sure your PCT publishes information about how and when your enhanced services will be reviewed and starts discussions now with current or potential providers and commissioners.
Rebecca Thornley is an associate director of NHS Primary Care Commissioning