Network Contract Directed Enhanced Service 2020/21 and updates

Network Contract Directed Enhanced Service 2020/21
NHS England 31 March 2020 updated 17 September 2020

• Updated Network Contract DES for 2020/21.
• The amended DES introduces three substantive changes to the 2020/21 Network Contract DES: flexibility for the clinical lead under the Enhanced Health in Care Homes service requirements to be a non-GP; the introduction of two new reimbursable roles under the Additional Roles Reimbursement Scheme (ARRS); and the introduction of an Investment and Impact Fund worth £24.25m. For details see the covering letter.

Network Contract Directed Enhanced Service (DES) Contract Specification 2020/21 – Primary Care Network Entitlements and Requirements

NHS England 31 March 2020 updated 17 September 2020

• This document sets out how commissioners must offer to primary medical services contractors the opportunity to participate in the Network Contract DES; the eligibility requirements and process for primary medical services contractors to participate in the Network Contract DES; and in relation to the Network Contract DES, the rights and obligations.  The document has been updated to include the introduction of two new reimbursable roles and the introduction of the Investment and Impact Fund (IIF) from October 2020.

Briefing: Amendments to the network contract DES 2020/21
NHS Confederation 22 September 2020

• A summary of the amendments made to the primary care network contract directed enhanced service (DES) for 2020/21. The amendments apply from 1 October 2020.

Is Bigger Better? Lessons for large scale general practice

Is Bigger Better? Lessons for large scale general practice
Nuffield Trust 19 July 2016

• According to  research drawn from a 15-month study of large-scale general practice organisations in England, three quarters of English practices have now joined large-scale GP organisations, formed to help cope with rising pressure and policies demanding longer hours and new services. This report discusses the factors influencing collaboration in general practice.
•  While these organisations can help to sustain general practice in the face of intense financial pressure and shortages of doctors and nurses, they have so far made limited progress in expanding into new services, and taking on a strategic role in redesigning care.
• Key findings are as follows:
• This agenda is well underway across the country, with almost three-quarters of general practices already in some form of collaboration with others, almost half of which formed during 2014/15. The major reasons for forming were to ‘achieve efficiencies’ and ‘offer extended services in primary care’. 
• Larger scale has the potential to sustain general practice through operational efficiency and standardised processes, maximising income, strengthening the workforce and deploying technology. 
• However, scaling up will take a lot of hard work and cannot just be left to a few heroic leaders. All GPs will need to play a part in making these new organisations successful.
• The evidence that these organisations can improve quality is mixed. Patients had differing views about the benefits of large-scale organisations. Some appreciated increased access, while others were concerned about losing the close relationship with their trusted GP.
• The case study organisations had established high-quality specialist services in the community which were popular with patients, but were delivered at relatively small scale. Trust and close engagement between practitioners and commissioners were very important for successful implementation. CCGs had to manage the tension between supporting large-scale organisations to develop while also managing conflicts of interest.
• The report offers a series of practical insights and lessons for general practitioners as well as important lessons for policy-makers, national leaders and commissioners.

GMS contract 2015/16

GMS contract 2015/16
NHS Employers, 30 September 2014

• NHS Employers and the General Practitioners Committee of the BMA has announced changes to the GMS contract in England for 2015/16. The changes include the following:
• A named, accountable GP for all patients (including children) who will take lead responsibility for the co-ordination of all appropriate services required under the contract. (see the press release from Jeremy Hunt Personalised GP care for everyone 30 Sept 2014)
• Publication of GP net earnings - practices will publish average net earnings (to include contractor and salaried GPs) relating to 2014/15, as well as the number of full and part time GPs associated with the published figure. 
• Further commitment to expand and improve the provision of online services for patients, including extending online access to medical records and the availability of online appointments. 
• Changes to the QOF : adjustment of point value for 2015/16 taking account of population growth and relative changes in practice list size for one year from 1 January 2014 to 1 January 2015; deferment for one year of changes in thresholds planned for April 2015. 
• The avoiding unplanned admissions (AUA) enhanced service will be extended for a further year from 1 April 2015
• The patient participation enhanced service will end and associated funding will be reinvested into global sum. From 1 April 2015, it will be a contractual requirement for all practices to have a patient participation group (PPG) and to make reasonable efforts for this to be representative of the practice population. 
• The alcohol enhanced service will end and associated funding will be reinvested into global sum. From 1 April 2015 it will be a contractual requirement for all practices to identify newly registered patients aged 16 or over who are drinking alcohol at increased or higher risk levels. 
• GPC, NHS England and NHS Employers will work together to develop more consistent guidance for the provision of enhanced minor surgery services. 
• The extended hours and learning disabilities enhanced services will be extended and unchanged for a further year. 
• Assurance on out of hours provision has been agreed to ensure that all service providers are delivering out of hours care in line with the National Quality Requirements (or any successor quality standards). 
• GPC, NHS Employers and NHS England will have a broader strategic discussion about the primary care estate, especially to support the transfer of care into a community setting. 
• NHS England and GPC will re-examine the Carr-Hill formula with the aim of adapting the formula to better reflect deprivation.

CCGs delegated to provide GP IT and OOH services

Primary medical care functions delegated to clinical commissioning groups: Guidance
NHS England 28 March 2014, Clarification 11 August 2014

• NHS England has the power to direct a CCG to exercise any of its functions relating to the provision of  primary medical care services. 
• NHS England is directing CCGs to exercise the following functions on behalf of NHS England in 2014/15:
• 1. Arrange GP Information Technology services in their area 
• 2. Commission out-of-hours primary medical care services for their area
• This document sets out guidance on how CCGs should exercise and report on Delegated functions to area teams.
• A letter of clarification of CCG responsibilities was issued on 11 August 20104

Proactive care programme enhanced service specification and implementation guidance

Enhanced Service Specification: Avoiding unplanned admissions: proactive case finding and patient review for vulnerable people

NHS England, June 2014

• The specification and revised guidance for the 2014/15 enhanced service has been published.
• The service is now referred to as the “Proactive Care Programme”
• Proactive care programme: CCG support for implementation (NHS England May 2014)
• This guidance note sets out the key role that CCGs can play, working with member practices, to help make sure that these services deliver the maximum benefits for patients. This includes making sure that GP practices are able to use risk stratification tools to identify those patients who should be offered the new service.
• See all GP contract documents here

Avoiding unplanned admissions - Service Specification and related documents

Avoiding unplanned admissions - enhanced service specification
NHS England June 2014

• All documents relating to this enhanced service, including the service specification, payments and validation, templates and guidance for CCGs 

GMS contract 2014/15

General Medical Services Contract 2014/15: Guidance and audit requirements
NHS Employers March 2014

• This document provides guidance for NHS England area teams and also for practices that hold a GMS contract and for all practices subject to the new contractual requirements or which are offering enhanced services nationally, commissioned by NHS England.
• Includes:
• Technical requirements
• Quality and outcomes framework (QOF) and contractual changes
• Enhanced services - alcohol-related risk reduction scheme learning disabilities health check scheme, facilitating timely diagnosis and support for people with dementia, patient participation, extended hours access

Implementation guidance for 2014/15 GP contract

Implementation guidance for 2014/15 GP contract
NHS Employers 2 April 2014

• NHS Employers and the General Practitioners Committee of the BMA have agreed changes to the General Medical Services contract for 2014/15 for England. 
• Includes documents been published to support GP practices and NHS England area teams in the implementation of the 2014/15 contract changes and an outline of the contents of the contract as below.
• Enhanced Service (ES) on avoiding unplanned admissions and proactive case management 
• Quality and outcomes framework (England) 
• Seniority 
• Named GP for patients aged 75 and over 
• Quality of out of hours services 
• Publication of GP earnings 
• Friends and family test 
• Choice of GP practice 
• Patients needing access to a practice clinician after assessment 
• CQC inspections 
• Deprivation 
• Patients and information 
• Enhanced services 
• GP pay and expenses

Accountable GP - guidance for GPs

A programme of action for General Practice
NHS England, April 2014

• NHS England has published a 5-page guide to support GPs in their role of ‘accountable GP’ which describes the role and responsibilities of GPs and CCGs in carrying out this significant new enhanced service that came into effect on 1 April 2014. The guide complements the specification and guidance for the enhanced service. 
• The guide sets out what this means for general practice, CCGs and patients and carers.
• What this means for CCGs:
• CCGs should CCGs to identify an overall lead for this new programme and to work with GPs and the practices – to support implementation.
• CCGs should identify at least £5 per patient from their budgets for 2014/15 and use this to support GP plans for improving services for older people and those with more complex needs. This broadly equates to £50 per head for patients who are aged 75 and over.
• CCGs should be using this funding to commission additional primary care services or community health services (over and above those provided under the new enhanced service) that GPs and practices have prioritised.
• Any practice plans should complement the initiatives planned through the Better Care Fund for 2015/16, for which one of the criteria is an accountable professional for integrated packages of care.
• Suggestions for additional services based in general practice or the community
• NHS England will provide benchmarked information on a range of measures of success for this programme to help to identify the impact on quality of care. 
• NHS England have worked with the BMA General Practitioners Committee to develop the guidance and detailed specification for this service, available here. 

Avoiding unplanned admissions

Providing proactive care and avoiding unplanned admissions for vulnerable people: a programme of action for general practice
NHS England, 1 April 2014

• The new enhanced service about to be introduced in general practice – together with new opportunities for CCGs to shift funding into primary care services and community health services – are designed to bring about a step change in the quality of care for frail older people and other patients with complex needs.

Primary care functions delegated to CCGs

Primary medical care functions delegated to clinical commissioning groups: Guidance
NHS England, 26 April 2013

• NHS England has the power to direct a CCG to exercise any of its functions relating to the provision of primary medical care services. 
• This guidance sets out the arrangements for CCGs to manage, on a transitional basis, local enhanced services for primary medical care and primary ophthalmic services that were commissioned by PCTs, and commission out-of-hours primary medical services for their area.
• Includes a flowchart for CCGs to commission primary care services

UPDATED by Primary medical care functions delegated to clinical commissioning groups: Guidance, 

NHS England 28 March 2014

GMS contract 2013/14 including enhanced services

2013/14 general medical services (GMS) contract - Guidance and audit requirements for new and amended services
NHS Employers and NHS England, 3 April 2013

• Guidance on Enhanced Services (ES) in 2013/14 that will make use of the General Practice Extraction Service (GPES) and Calculating Quality Reporting Service (CQRS) to provide primary care organisations with information to help support the continuation or introduction of these services.
• Guidance includes the two extended Clinical Directed Enhanced Services (DES) and other new/existing ESs. There is a description of the new services here
•  Clinical Directed Enhanced Services  are
• Alcohol-related risk reduction scheme 
• Learning disabilities health check scheme
• New immunisations 
• Rotavirus (childhood immunisation) 
• Shingles (routine aged 70 immunisation) 
• New Enhanced Services 
• Risk profiling and care management scheme 
• Facilitating timely diagnosis and support for people with dementia scheme 
• Remote care monitoring (preparation) scheme 
• Improving patient online access scheme 

Enhanced services under the NHS Commissiong Board

Local commissioning arrangements for enhanced services
NHS Commissioning Board, 16 August 2012

• A description of the new local commissioning arrangements via the NHS Commissioning Board  for enhanced services from April 2013.