Directed enhanced service

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During the rule of PCTs in England, and until the rule of CCGs comes into place, there are broadly two forms of "enhanced service", comprising:[1][2]

  • Local enhanced services (LESs) – schemes agreed by PCTs in response to local needs and priorities, sometimes adopting national service specifications. *Directed enhanced services (DESs) - schemes that PCTs are required to establish or to offer contractors the opportunity to provide, linked to national priorities and agreements.

When the Department of Health (England) agrees that a service must be provided, it may introduce a "Directed Enhanced Service" (DES - note not "Directly Enhanced Service"), requiring Primary Care Trusts to pay a specified fee to e.g. GPs for the service.

In contrast a Local Enhanced Service (LES) has to be paid for out of PCT funds.

Prior to the introudction of the NHS Commissioning Board national directions currently cover eight DES schemes:

  • childhood immunisation
  • influenza and pneumococcal
  • violent patients
  • minor surgery
  • extended access
  • alcohol reduction
  • health checks for people with learning disabilities
  • patient participation.

This will all change when the NHS Commissioning Board comes into existence.[3] The guidance about the 2012 UK antenatal pertussis vaccination campaign, for example, refers to a "National Enhanced Service" (NES).


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