Enhanced services FAQs


The requirements for enhanced services are defined in DES Directions or service specifications.

This section includes FAQs for the following areas:

General questions 

Extended hours access 

Facilitating timely diagnosis and support for people with dementia (DEM) 

Learning disabilities health check scheme 

Learning disability clinical coding changes 

General questions 

Q: Can the nationally defined service specifications for enhanced services be amended locally? 

A: No. The service specification is a legal document and commissioners cannot make changes to the content. Should they wish to do additional work relating to the enhanced service in their local area, this would be for local discussion, agreement and payment outside of the arrangements for the nationally defined ES.

This is the same for all nationally defined service specifications, including the minor surgery and violent patient schemes which allow for the local determination of pay.


Q: Can practices with a 'closed list' still participate in enhanced services?

A: Yes, there is nothing to prevent practices participating in enhanced services if they have a closed list.

General questions


Q: Does signing up to participate in a service on CQRS satisfy the requirement for contractual sign up?

A: No. Practices are required to agree to participate in a service with their area team based on the service specification. Sign up on CQRS is confirmation from the practice to the area team that CQRS will be used to calculate the payment.

General questions


Q: Where a practice has been using Read codes not included in the service specification, guidance and audit requirements, Business Rules or technical requirements document, are practices expected to re-code patients?

A: Yes, all services being supported by CQRS, require that practices who intend to participate in these services record their achievement in the clinical systems using the appropriate Read codes. This should be recorded using the relevant Read codes in the service specification, guidance and audit requirements, technical requirements document or Business Rules from the date those services commence. As such, practices would need to re-code using the relevant codes.

General questions


Q: Where can I find details of the arrangements for the violent patients and minor surgery scheme? 

A: The details for these schemes are included in the Primary Medical Services (Direct Enhanced Services) Directions 2014.  Minor surgery is also outlined within The National Health Service (General Medical Services Contracts) Regulations 2004.


Q: How long are practices required to retain evidence regarding work completed which is related/attributed to ES achievement? 

A: Practices are required to retain evidence of work completed which is attributed or related to payment, for up to six years. This evidence could reasonably be requested by any local commissioner or NHS England. Some of this evidence would be available from practices clinical systems but hard copies would need to be filed or digitised and held electronically. 

General questions


Extended hours access 

Q: If extended hours are provided on a bank holiday do they need to be re-provided on a day later in the week?

A: Commissioners are expected to maintain agreements for extended hours inherited from PCTs for this financial year. In the event the inherited agreement includes re-provision of extended hours that fall on bank holidays, then this should continue. Where this is not stipulated in the inherited agreement, the expectation is that commissioners will ensure they are seeking good value from the service and are pragmatic.

Where no agreements are in place (i.e. not inherited from PCTs) then commissioners should seek to ensure that they are obtaining good value from their extended hours proposals.

Extended hours access questions

Facilitating timely diagnosis and support for people with dementia

Q: Can practices re-examine the same patients assessed for dementia in previous years who were not subsequently diagnosed with dementia?

A: Yes. If a patient does not have a diagnosis of dementia and the clinician believes the patient to be at risk of dementia, then if it is clinically appropriate and with the consent of the patient, the dementia assessment can be repeated in 15/16 regardless of whether one was delivered previously. It is not however, a requirement of the enhanced service to repeat the assessment annually where a patient was not subsequently diagnosed with dementia if it is not indicated.

Dementia questions


Learning disabilities health check scheme

 Q: Why are there new codes in the learning disabilities health check cluster?

A: As part of a review of April Read release two new codes for ‘learning disabilities health assessment’ were identified as more appropriately reflecting the requirements and aims of this ES.

The codes are:

  • 9HB5 Learning disabilities annual health assessment
  • XaL3Q Learning disabilities annual health assessment 

These two new codes will be added to the code cluster and therefore count towards achievement for the 2016/17 LD ES. The ‘learning disability health examination’ continues to count towards achievement for 2016/17 to ensure practices do not need to recode all patients in one quarter in order to be paid. Practices should begin to migrate patients over to the new codes when they are available. However, these changes will not be picked up until the Business Rules have been updated and republished by NHS Digital.

As the new ‘learning disability health assessment’ codes more accurately reflect the requirements of this ES, the ‘learning disability health examination’ codes will be removed from the ES from April 2017. This means that only the ‘learning disabilities assessment’ codes will count towards achievement from this point. For details of these changes see the updated Business Rules, which will be published by NHS Digital in due course.

     Learning disabilities health check scheme questions


Learning disability clinical coding changes 

Q: Why has there been a change to the clinical codes for the LD register for the enhanced service (ES) and QOF?

A: Clinical informaticians identified some clinical codes which are deemed to no longer be suitable for use in coding patients with a diagnosis of a learning disability. Following discussions between NHS England, National Institute for Health and Care Excellence (NICE), NHS Employers, General Practitioners Committee (GPC) and NHS Digital the codes listed have been removed from QOF and the LD ES as of 1 April 2018.

Practices should review the records of the patients on their QOF LD register (LD003 in 2017/18) and their practices register for the ES to identify any patients with one of these unsuitable diagnostic codes on their record. Where a patient has one of these codes, the practice should re-assess the patient and re-code using one of the other available clinical codes.

• profound mental retardation (IQ below 20)
• severe mental retardation (IQ 20-34)
• mental handicap
• moderate mental retardation (IQ 35-49)
• borderline mental retardation (IQ 70-85)
• mild mental retardation (IQ 50-70)
• mental retardation
• educationally subnormal
• severely educationally subnormal.

For a full list of the acceptable clinical codes, see the Business Rules.

Due to this change, the indicator ID in QOF has been renamed as LD004 from 1 April 2018.

Learning disability clinical coding changes questions






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