DoH £50m U-turn on clinical areas

The DoH has agreed to pay practices in England to carry out the clinical services the GPC fought to have included in the 2008/9 quality framework.

Richard Vautrey
Richard Vautrey
But instead of being included in the contract, they have been packaged as five clinical directed enhanced services (DESs) worth £50 million, the DoH announced this week.

These include using beta-blockers for heart failure, treatment of osteoporosis, annual health checks for people with learning disabilities and increased support to overcome harmful drinking.

GPC chairman Dr Laurence Buckman said all five clinical areas were discussed in contract negotiations and that there was evidence for their inclusion in the quality framework.

But details of how what targets will be included in the new DESs and how they will be costed have yet to be thrashed out, due to the dispute over the Doctors' and Dentists' Review Body (DDRB) pay decision, which is likely to see most practices receive no global sum increase.

'We need to talk to the government about how this will work,' said Dr Buckman. 'Whether or how (the new services) can happen is not clear. It has made its announcement and now we've got to work out what it means on the ground.'

Heart failure and osteoporosis were two of the three key areas the GPC pushed for inclusion in the 2008/9 quality framework. But the DoH decided to reassign 75 points to a new patient survey and 60 to access.

GPC deputy chairman Dr Richard Vautrey, said: 'It's completely topsy turvy.

'It's a shame the government didn't accept our offer in November to put these things in the quality framework, which is where they should be.

'Access would have been better served as a DES.'

Once the £50 million is split between the five clinical DESs, practices may find it will cost them more than they will earn to provide any one of the services, added Dr Vautrey.

It is part of the 1.5 per cent extra investment - worth £105 million - pledged by the DoH in January when contract negotiations were at crisis point.

At the time, a Whitehall official told GP that the DoH had plans for improved clinical care in general practice, but refused to give details (GP, 11 January).

A spokeswoman for NHS Employers said discussions were ongoing. However, given that the financial year began in April, she said the agreement would be made 'as soon as possible'.

The rest of the £105 million is being given to PCTs to push for extended hours and improvements to surgery premises and to implement the DDRB pay recommendations.


  • New measures to tackle heart failure.
  • Best practice for osteoporosis treatment.
  • Annual health checks for patients with severe learning disabilities.
  • Better data recording for black and ethnic minority patients.
  • Support to beat harmful drinking.

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