There are three categories of enhanced services: designated enhanced services (DESs), national enhanced services (NESs), and local enhanced services (LESs). Although the PCTs have an obligation to commission DESs for all patients, and the practice is generally offered first refusal, there is no obligation for a practice to take up any enhanced service. The NESs are services with nationally uniform specifications and payments, while the LESs have specifications and payments determined by the local PCT. For NESs and LESs there is no obligation on the PCT to commission services, and the quantity and variety of options available to practices varies from place to place.
How this fits in
Larger practices are thought to provide a greater volume and diversity of services, but there is no study confirming this. While very small practices provide less diversity and volume of services, there is little difference in enhanced service provision between average-sized practices and ‘supersurgeries’. Any variation that does exist is associated, to a certain extent, with deprivation. Larger practices do not provide a greater volume of extra services after accounting for deprivation. Therefore, a policy to create larger practices may not automatically lead to a transfer of work from secondary to primary care.
Enhanced services are paid separately from other funding sources and are therefore easily identifiable. Practice payment data were requested for enhanced services between 2005 and 2007.
The total payment for all enhanced services provided by each individual practice was divided by the practice size (number of registered patients), to give a measure of the volume of enhanced services provided. Volume represents income generated and is therefore displayed in £ per patient per annum.
The diversity of enhanced services was derived from the number of different enhanced services provided by each practice.
