Directed Enhanced Services (DES) are special services or activities provided by GP practices that have been negotiated nationally. All practices can choose whether or not to provide these services.
The following DESs have been agreed for 2008/09:
- Five new clinical DESs:
- Heart Failure DES - improving the treatment of heart failure and including incentives to provide beta-blockers to appropriate patients. Practices will get £35 per patient treated under this DES.
- Alcohol DES - helping to reduce the risk of adults, aged 16 years or over, drinking at 'hazardous and harmful levels' defined by the World Health Organisation. Practices will get £2.33 for each new registered patient that has been screened.
- Learning Disabilities DES - annual health checks for people on the local authority learning disability register. To participate in this DES, practices need to attend a multi professional education session run by their PCT. Practices will get £100 for every health check.
- Osteoporosis DES - encouraging practices to diagnose and prescribe appropriate pharmacological secondary prevention for patients with osteoporosis. Payments will be based on three criteria covering diagnoses and treatment. The payment per average practice that meets all three criteria is £588.21
- Ethnicity DES - rewarding practices for recording the ethnicity and first language of all the patients on their practice list. Practices will get 5.6p per registered patient
- Extended Opening Hours Access DES - practices are rewarded for providing around 3 hours extra appointment time per average practice a week, at times that suit the needs of their patients. Practices are paid £2.95 per registered patient. The Department of Health (DH) has issued more detailed guidance to PCTs
- IM&T DES (rolled over from 2007/08) - practice eligibility to receive one-off payments will continue for England for 2008/09. The Department of Health (DH) has amended the Statement of Financial Entitlements (SFE) to allow PCTs to make payments until 31 March 2009
The DH is currently drafting the legal documentation for the five clinical DESs. In the interim, the detailed guidance aims to support PCT discussions with practices on providing these DESs. You can find more details on the inflationary uplift and Access DES on the DH website.
Access DES
The Department of Health has issued guidance to PCTs and strategic health authorities that clarifies the detail of the access DES. In particular:
- it explains how PCTs with existing local schemes should discuss these with the relevant practice(s)
- it highlights some key issues that PCTs should consider when commissioning extended hours such as the provision of linked services, safety and security and religious and cultural sensibilities
- the guidance provides a clear definition of the requirements of the DES, including detail about how the extended opening hours should be calculated and how the hours should be provided
- it describes how PCTs should monitor performance and delivery of the DES and instructs PCTs how to monitor the progress of the DES using Unify2
- it explains the payment arrangements for the DES.
