NHS GP SERVICES - What can you expect?
General practice services are more complex than many people realise.
Below is an overview of how general practice functions, focusing on the key aspects of services provided to patients.
GPs are required to offer certain essential services, referred to as 'commissioned services', to the population. Some of these services are standard across England and are known as General Medical Services (GMS). Every GP practice is obligated to provide these services.
In addition to the essential services, there are also additional services included in the GMS contract, and it is expected that most GPs will provide them. However, practices have the option to 'opt-out' if they choose.
GPs may also choose to offer enhanced services (ES), which can be either national (Directed Enhanced Services, DES) or local (Local Enhanced Services, LES). Practices can opt into these services, which come with benefits such as more services for patients and extra funding. However, the downside is that they require additional work, which can be difficult to manage in an already busy practice. Unlike additional services, offering enhanced services is entirely voluntary.
Some tasks that GPs are asked to perform fall outside the scope of any NHS contract and are therefore considered non-NHS work. As these are essentially private services, practices are not obligated to provide them and can charge fees for the work, much like a solicitor would.
The following is a brief overview of key points. For more detailed information about what is and isn't covered under contracts, you can refer to the Department of Health and Social Care website, which publishes statutory guidance on Primary Medical Services, including the GMS contract and Directed Enhanced Services.
Frequently Asked Questions
What are Essential Services?
Essential services are those described in the NHS GMS contract. These services are provided to manage patients within core hours (08:00-18:30) and tailored to meet the reasonable needs of patients. These services are for those who are, or believe they are, unwell. They may include consultations (in-person, online, phone), as well as examinations, tests, treatments, or referrals if appropriate. GP practices also offer health advice and promotion. Essential services also include contraceptive services (excluding sexual health) and a maternal 6-8 week check-up.
What are Additional Services?
Additional services include cervical screening, NHS vaccinations and immunisations, child health surveillance (e.g., baby checks), and antenatal care. Some practices may opt-out of providing these services for various reasons.
What are Enhanced Services?
Enhanced services vary significantly across England, as many are determined locally by the Integrated Care Board (ICB). In Emsworth, the ICB is the Hampshire and Isle of Wight ICB. These services are optional, and practices must sign up individually, unlike Additional Services, which have an opt-out option.
Examples of patient-facing Enhanced Services in Hampshire include ECGs, blood tests, spirometry (breathing tests), health checks for learning disabilities, minor surgery, joint injections, treatment for leg ulcers, post-operative wound care, and shared-care prescribing for certain medications.
Why doesn’t every practice offer every service?
There are various reasons for this. The most common reason is that practices may be too busy to take on additional services. Other reasons include a lack of local demand, insufficient funding to cover the costs, or a lack of necessary staff training (particularly for services like minor surgery or joint injections). Implementing new services can be costly and time-consuming, so practices must carefully weigh these factors.
GPs strive to provide as many services as possible, but they must ensure that essential services remain their primary focus.
What happens if my practice doesn’t offer a certain service?
If a practice does not offer a particular enhanced service, an alternative service will be provided, usually by secondary care (such as hospital trusts or private companies). Your practice will refer you to the appropriate provider. The decision about who provides the alternative service is made by the government or the ICB, not the practice.
What is non-NHS work?
Non-NHS work refers to services not covered by any NHS contract. Common examples include medical reports and examinations for driving, adoption, or insurance purposes. These services are typically charged for, as they are considered private work.
Other non-NHS work may include writing letters, completing certificates, or preparing reports, though the practice may not always be able to accommodate such requests.
Why do I have to pay?
The contracts define the services that are funded by the NHS. Any services beyond the scope of these contracts must be funded separately. Though some requests may seem quick or minor, the volume of requests, combined with the need to cover the time and costs involved, necessitates charging. Fees are set to reflect the responsibility and potential legal risks, similar to those of other qualified professionals, such as solicitors.
For some non-NHS services, you may also opt for a private GP, though they won’t have access to your medical records.
Why can’t you do what I’ve asked?
Your GP practice is not obligated to provide non-NHS work. While they will assist when possible, certain requests may not be feasible due to time constraints or because the work is not covered by their medical insurance. In such cases, you may seek a private GP for assistance.
Are there other services that cannot be provided?
The NHS is complex, and funding only exists for services outlined in contracts. If a service is not covered by a contract, it cannot be provided. For example, some procedures that were once routinely offered, such as non-cancerous skin lesion removal, may no longer be covered. If you encounter such issues, contact your ICB for further information.
There are also specific situations where no NHS provider is contracted to offer a service. For instance, aftercare for procedures done abroad may not be provided by your GP practice. You may need to seek private care for such services.
What about ADHD medication and the Right to Choose?
Due to long waiting times for ADHD assessments, patients may request a referral under the 'Right to Choose' scheme, which allows them to choose their provider. However, they must ensure that the provider can prescribe medication, as your GP cannot do so if the provider does not fall under the scheme.
If a private assessment is chosen outside the Right to Choose programme, your GP will not be able to prescribe ADHD medication. In such cases, your GP can refer you to the NHS system, though you will join the back of the waiting list, even if you already have an ADHD diagnosis.
What about Weight loss injections?
We are not allowed to issue NHS prescriptions for weight loss injections. This is not negotiable.
Who should I contact if I disagree with your decision?
If you are unhappy with the services provided or the decision made by your GP practice, contact the practice first. Complaints will be addressed according to the NHS Complaints Policy. If the issue pertains to a service not covered by the practice's contract, you should contact the ICB.
For complaints about private services provided by the practice, reach out to the practice directly, as the NHS Complaints Policy does not apply in this case.
For concerns regarding other NHS or private providers, contact the respective organizations directly. Your practice cannot address complaints about services or waiting times provided by other providers.
Where can I find more information?
For more details on contractual obligations, visit the NHS England website. This site also offers information on shared care guidelines and other relevant topics.