Directed Enhanced Services (DES) Uplifts a CONFIDENTIAL Note for Lmcs

Directed Enhanced Services (DES) uplifts – A CONFIDENTIAL note for LMCs

In 2009/10 some PCTs chose not to apply the 1.74% uplift to all directed enhanced services (DESs). This note gives some background to this decision.

There are two types of DES:

1)DESs that PCTs must offer to each contractor. The remuneration for these DESs is set out in the SFE. The DESs in England in this group are:

1. Extended hours access
2. Childhood immunisation
3. Alcohol related risk reduction
4. Ethnicity and first language
5. Learning disabilities health check
6. Osteoporosis diagnosis and prevention

2)DESs that the PCT must commission, but not necessarily from GMS contractors. There is no nationally prescribed remuneration for these DESs (and they are not set out in the SFE). Remuneration is determined by the PCT and set out in subsequent agreements with the provider (in the case of GMS practices, this is incorporated into the GMS contract). The Department of Health says that at no point since 2004 has it directed PCTs to increase the remuneration payable to GMS contractors in respect of these services. The DESs in England in this group are:

1. Influenza and pneumococcal
2. Violent patients
3. Minor surgery

Following the 2009/10 negotiated agreement, the prices for DESs in the SFE were increased by 1.74%. PCTs were not explicitly directed to increase the remuneration for other enhanced services. Ben Dyson’s letter of 3 April 2009said:

“18. The Department of Health will increase DES payments in the Statement of Financial Entitlements by 1.74%. It is for PCTs to consider the implications of the DDRB recommendations for the LESs they commission and payments made under NESs which they administer locally on a case by case basis. In principle, we would expect PCTs to honour the spirit of the negotiated agreement and, other things being equal, increase contract prices in line with the 1.74% increase for DESs. However, PCTs are responsible for ensuring value for money from the services they commission and will need to consider with local practices the prices of individual commissioned services.”

Choosing not to apply the DDRB’s uplift to the non-SFE DESs does seem to be PCTs’ prerogative, as they have discretion in their application of public monies. As some DESs are not covered by the SFE, nothing can force PCTs to increase the price paid for them, regardless of any agreement between the BMA and the DH.

For 2010/11, we will ask the Department to tell PCTs it expects all DESs to receive the agreed uplift. This may help but unfortunately does not override local discretion.

Earlier this year we asked LMCs to tell us about the commissioning arrangements for non-SFE DESs in their localities. LMCs told us that a variety of different frameworks were being used to commission these services. Although both LESs and non-SFE DESs are subject to PCT discretion in pricing, we found that those using a local DES framework were more likely to have received the 1.74% uplift than those using a LES framework. Those LMCs representing practices using DES frameworks for these services had not on the whole negotiated prices with the PCT.

It is quite possible that some PCTs were not aware that they have the discretion not to uplift the non-SFE DESs. Please therefore ensure that this information is kept confidential. For 2010/11 we would encourage LMCs, where necessary, to continue to ask PCTs to uplift LESs and non-SFE DESs in line with the uplift applied to DESs in the SFE.