Directed enhanced services

DESs (directed enhanced services) are nationally agreed and have to be offered to all GP practices in England. Practices can decide whether they sign up to a DES or not, but they must be offered the opportunity to do so.

The legislation underpinning these DESs is set out in the DES and the statement of financial entitlements directions. Any updates to DESs are announced with the outcomes of the national GP contract negotiations.

Local enhanced services

Local commissioners can develop LESs (local enhanced services) to offer to local practices to supplement services already offered in the core practice contract.

As LESs are not agreed nationally, they vary across the country in scope and funding. Practices can decide whether they sign up to a LES.

The following list shows examples of enhanced services that have been commissioned somewhere in the UK. This list is not exhaustive, but rather provides practices with an indication of the kinds of services that they may be able to seek funding for.

• Anticoagulation - DOAC monitoring
• Anticoagulation - Warfarin monitoring
• Cardiac - 24 hr BP
• Cardiac - ambulatory ECG
• Cardiac - AF screening
• Cardiac - Non-urgent ECG
• Cardiovascular screening health checks
• Complex LTC care by GPwER or NwER
• Extended hours
• Hospital care - Post discharge input
• Hospital care - Post-op suture removal/wound care
• Hospital care - Pre and post op swabs/investigations
• Mental health - Dementia diagnosis and treatment initiation
• Mental health - Provision of depot antipsychotic medication
• Mental health - depression counselling service
• Mental health - Learning disabilities HC
• Mental health - Learning disabilities support
• Minor surgery - lumps and bumps
• Minor surgery - MSK
• Minor surgery - vasectomy
• Monitoring - MGUS
• Monitoring - PSA in cancer
• Monitoring - PSA in non-cancer
• Near patient testing
• Pathways - A&G
• Pathways - Bariatric surgery - postoperative monitoring of patients >2 years post surgery
• Pathways - Bank holiday opening
• Pathways - Catheter changes and management
• Pathways - Eating disorder physical monitoring and blood monitoring
• Pathways - D-dimer / DVT management in the community to avoid hospital admissions
• Pathways - Dermatology Skin Cancer Monitoring Shared care monitoring for high risk conditions – post op Melanoma, Post op SCC, and Lichen Sclerosus
• Pathways - Dermoscopy
• Pathways - Diabetes care including insulin initiation
• Pathways - Falls
• Pathways - Glucose tolerance testing
• Pathways - Heart failure management
• Pathways - ICB requested audit
• Pathways - ICB requested education/pathway design
• Pathways - Over 75 LES - med reviews and health check including house bound patients
• Pathways - neonatal checks
• Pathways - referral review scheme
• Pathways - Sigmoidospcopy
• Public health - Administration of PCV and hib/men C vaccinations
• Public health - Alcohol and substance misuse
• Public health - Delivery of brief interventions to patients to reduce alcohol related harm
• Public health - Hep B catch up
• Public health - Infant hep B vaccination programme (post exposure immunisation)
• Public health - Immunisation catch up campaigns
• Public health - flu immunisation
• Public health - Infection prevention - flu antivirals, pen v post meningitis exposure, scabies outbreak, etc
• Public health - Meningitis C vaccine for university entrants
• Public health - MMR vaccinations provided to under 25 year olds
• Public health - Screening of/vaccination/provision of prophylactic antibiotic or antiviral treatment and other services required for asymptomatic individuals or for outbreaks in institutions at the request of Public Health England
• Public health - Smoking cessation
• Respiratory - FENo
• Respiratory - Spirometry
• Safeguarding - to support the delivery of statutory responsibilities
• Secondary care - Pre-referral paperwork & Template referral forms
• Secondary care - investigations, and other procedures
• Secondary care - Referral review scheme
• Sexual health - Administration of gonadorelins for patients with endometriosis
• Sexual health - Chlamydia screening
• Sexual health - Contraceptive device fittings
• Sexual health - Emergency hormonal contraception service
• Sexual health - injectable and depo contraception
• Sexual health - Mennorhagia insertion of mirena
• Sexual health - non-HIV
• Sexual health - ring pessary
• Sexual health - HIV in primary care
• Special allocation scheme - people who have been removed from multiple surgeries
• Special allocation scheme - violent patients
• Special groups - Homeless patients
• Special groups - Asylum seekers and refugees
• Special groups - Nursing home care incl virtual ward
• Special groups - Care home support
• Special groups - Carers support
• Special groups - Difficult to reach communities
• Special groups - Student Health
• Specialist drug monitoring - cardiology
• Specialist drug monitoring - dermatology
• Specialist drug monitoring - gastroenterology
• Specialist drug monitoring - gender dysphoria
• Specialist drug monitoring - haematology
• Specialist drug monitoring - neurology
• Specialist drug monitoring - psychiatry
• Specialist drug monitoring - rheumatology
• Treatment room - Administration of "specialist" injections eg gold, -umabs
• Treatment room - Administration of gonadorelins for patients with carcinoma
• Treatment room - Complex leg ulcer treatment
• Treatment room - complex wound/ulcer management
• Treatment room - Ear care
• Treatment room - Phlebotomy
• Treatment room - post op wound care incl suture removal
• Treatment room - pre and post op swabs/investigations
• Treatment room - simple dressings
• Treatment room - wound care
• Urgent care - Management of minor injuries
• Urgent care - Emergency box palliative care
• Urgent care - palliative care
• Urgent care - responding to emergencies in practice area
• Urgent care - supporting ambulance service with advice

If you are signed up to a LES that is not included in the above list, please pass on the details and we will add them.