Local Enhanced Services (Services specifically commissioned across Herefordshire & Worcestershire)

Local Enhanced Services are services outside of the national GP contract providing a wider range of primary medical services to meet local population needs and priorities. Local Enhanced Services are included as an appendix to each Practice's GMS Contract.

NHS Herefordshire and Worcestershire Integrated Care Board directly awarded contracts for Local Enhanced Services pursuant to Regulation 8 (Direct Award Process B) under the NHS Provider Selection Regime for the period of 1st April 2024 to 31st March 2025 to 78 GP Practices across the Herefordshire and Worcestershire geographical area at a total cost of £6,957,822.

These Local Enhanced Services (LES) are commissioned on a rolling basis and reviewed annually. PSR supplementary guidance for arranging primary care services confirms that "where all GP practices provide a wider range of services or provide their core services at an enhanced level, these services may be carried out under a contract modification." The original contract award for these services was for a 12-month period from 1st April 2024 to 31st March 2025. During this period, the ICB commenced a comprehensive Clinical Review in December 2024, with the aim to complete this (and for the ICB to issue new contracts) for 1st April 2025. However, the time period required to undertake the comprehensive Clinical Review has been considerably longer than was originally estimated. Therefore, the contracts were extended (initially until June 2025, and then) for a further period until 31st March 2026 to enable the Clinical Review to take place. During this period, there has not been any material changes to the character of the existing contracts; the contract end date was extended to allow for the comprehensive Clinical Review. The contract extensions were formally approved in accordance with the ICB's formal corporate governance procedures at its Strategic Commissioning Committee (i.e., the extension for 1st April 2025 to 30th June 2025 was formally approved at the NHS Herefordshire and Worcestershire Strategic Commissioning Committee meeting on 15th January 2025; the further extension to 31st March 2026 was approved at the above committee on 4th June 2025). The total cost of the contracts including the extensions to allow for the Clinical Review was £13,915,644.

This modification is put in place to commence from 1st April 2026 at a value of £1,880,000. The test for considerable change has not been met as the modification does not materially alter the character of the contracts.

The comprehensive Clinical Review is continuing for these services for 2026/27. The high priority services have been reviewed and combined into a Universal Enhanced Service (UES) Specification which include the adoption of a full evaluation and costing model for each included service.

This will ensure a standardised, equitable and sustainable LES framework ensuring all patients have access to the same level of service regardless of location. The remaining services will be rolled forward into 2026/27 where the Clinical Review will continue to prioritise and evaluate each service.

At this meeting, the voting members:

• Approved the commissioning of the Universal Enhanced Services Specification.
• Approved the roll forward of the remaining Local Enhanced Services
• Noted the planned review of the rolled forward Local Enhanced Services in 2026/27