Helpdesk query response – medical

Query

I’m looking for advice on whether a GMS contract needs to list each enhanced service the GP practice agrees to provide. I am looking at using some general wording to populate Parts 4 and 12 to limit the need to contract variations for regular changes.

I would like your view on the following general wording the ICB is considering using:

Part 4 ‘the duration of any enhanced services provided by the contractor is specified in each service specification.’

Part 12 ‘the contractor may sign up to provide enhanced services as will be periodically offered out to practices.’

At present, the ICB are only considering national enhanced services as we do not include local enhanced services in GMS and APMS contracts at this point.

PCC response

Thank you for submitting this inclusion of enhanced services in a GMS contract query to the helpdesk.

Firstly, I must stress that this is only a personal view and may not be relied upon in the event of challenge to the ICB – if in doubt please seek legal advice.

The intention of the GMS Contract is to contain all primary medical services provided by the Contractor under that contract, including enhanced services (services other than essential services, minor surgery or out of hours services). As you identify that requirement can be found in Part 4 and Part 12.

Part 4 relates to the commencement and duration of the contract – you are looking at duration of any enhanced services included in clause 4.2.2 onwards. The NHS England template GMS Contract at 4.2.2 provides consideration on how to complete each sub-clause for the provision of each enhanced service period after negotiation/agreement with the Contractor. However, in my view, the template is only suggestive/advisory in saying a duration ‘should be inserted here’ and while should is an expectation it is of itself not an obligation/mandatory to use a phrase such as ‘enhanced service X will be for a period on one year (01/04/xx to 31/03/xx)’ – arguably, as you appear to suggest, it may suffice to direct the reader/contractor to the specification for duration (amongst other matters). However, if you are not going to list each enhanced service in Part 4 and seek to use an such overarching phrase, I suggest you consider rephrasing along the following lines:
4.2.2 The parties agree the inclusion of enhanced services in this contract as provided in Part 12 from time to time varied. The duration of any enhanced services provided by the contractor:
4.2.2.1 where those enhanced service are pursuant to Primary Medical Services (Directed Enhanced Services) Directions (as from time to time amended), will be for the duration as contained in those Directions or associated specification unless specified otherwise within this contract.
4.2.2.2 other than enhanced services in 4.2.2.1 and 4.2.2.3, where enhanced services are required to be offered by the Commissioner from time to time and the Contractor has agreed to provide, will be for the duration as contained in those specifications unless specified otherwise within this contract.
4.2.2.3 other than services in 4.2.2.1 and 4.2.2.2, where the Commissioner commissions locally enhanced services and the Contractor agrees to provide, will be for the duration as contained within a local specification provided to the Contractor from time to time unless specified otherwise within this contract.
Part 12: in my view, even if you take an overarching approach to Part 4 (as above) and arguably more so if you do, I consider you must list each enhanced service covered by the GMS contract under Part 12 – otherwise, arguably, it is not contained within the GMS contract. I appreciate the NHS England template GMS Contract at clause 12.1 again only uses the word ‘should’ however not to list each enhanced service and thereby apply the overall provisions of the GMS Contract, for example dispute resolution, risks the question of good governance including audit trail if there is no other formal contract covering that service.

While I appreciate you are seeking a way to reduce contract variations, and such maybe achievable to some extent with overarching wording such as that I offer for Part 4 and a clear audit trail evidencing sending specifications, I would caution about not listing each current enhanced service under the GMS Contract within that contract albeit Part 12 listing maybe to the effect:
12.1 The Contractor shall provide ‘ABC enhanced service’ in accordance with Primary Medical Services (Directed Enhanced Services) Directions (as from time to time amended) to its registered patients {and registered patients of [name other contractors not agreeing to provide]} in accordance with the specification provided at ‘X’.
12.2 The Contractor shall provide ‘XYZ enhanced service’ to its registered patients {and registered patients of [name other contractors not agreeing to provide]} in accordance with the national specification provided at ‘B’ [insert hyperlink to NHS England webpage].
12.3 The Contractor shall provide ‘LMN local enhanced service’ to its registered patients {and registered patients of [name other contractors not agreeing to provide]} in accordance with the local specification provided at ‘W’.

Where not a national specification, which you direct the contractor to, you may wish to consider including local versions as an Annex to the contract – of course, don’t forget to include the ‘tariff’ for each enhanced service somewhere or reference accordingly if a national tariff.


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