Network contract directed enhanced service – guidance for 2024/25 in England – part A: clinical and support services (section 8)

Network contract directed enhanced service – guidance for 2024/25 in England – part A: clinical and support services (section 8)

The NHS England document this support article relates to was published on 28th March 2024

What do I need to know?

This document is described as being part of a "guidance package" which describes best practice in support of the delivery of the Section 8 "Service Requirements" in the DES

Improving health outcomes and reducing health inequalities

Population health management

The DES specification states that a PCN must seek to improve health outcomes for its population using a data-driven approach and population health management techniques in line with guidance and the CORE20PLUS5 approach.  PCNs are expected to engage proactively with wider delivery partners and agree formal data sharing arrangements with ICBs to support local integration of data in line with the What Good Looks Like Framework

Health inequalities

The DES states that a PCN should actively seek to reduce health inequalities across its Core Network Practices in line with guidance and the CORE20PLUS5 approach

CVD prevention and diagnosis

There are a number of outcomes that are described in this section:
  1. Improve detection and management of CVD risk factors
  2. Improve the detection of hypertension
  3. Improve the detection of atrial fibrillation
  4. Identify and manage raised lipids
    1. Primary prevention
    2. Target potential familial hypercholesterolaemia
  5. Earlier identification of heart failure

Early cancer diagnosis

The DES states that PCNs should support early diagnosis by reviewing cancer referral practice in collaboration with partners making efforts to improve support of early diagnosis and work with partners to improve screening uptake especially with breast, bowel and cervical cancer.

Targeting resource and efforts

Proactive care for frailty

To achieve this a PCN should refer to the proactive care guidance to identify and code the target cohort, develop a personalised care and support plan, and deliver co-ordinated multi-professional interventions and provide a clear plan for continuity of care.

Structured medication reviews

These should be targeted at those:
  1. in care homes
  2. with learning disabilities
  3. with complex and problematic polypharmacy, specifically those on 10 or more medications
  4. on medicines commonly associated with medication errors and risk of harm
  5. with severe frailty, who are particularly isolated or housebound or who have had recent hospital admissions and/or falls
  6. using one or more potentially addictive medications from the following groups: opioids; gabapentinoids; benzodiazepines; and Z-drugs
PCNS should also be alert to populations particularly at risk of health inequalities.

Collaboration on wider medicines optimisation

PCNs should take into account the National Medicines Optimisation Opportunities (only those relevant to primary care included below):
  1. Addressing problematic polypharmacy
  2. Addressing low priority prescribing
  3. Improving update of the most clinically and cost-effective medicines (guidance is secondary care focussed - biosimilars for antiTNF)
  4. Addressing inappropriate antidepressant prescribing
  5. Appropriate prescribing and supply of blood glucose and ketone monitors and testing strips
  6. Identifying patients with atrial fibrillation adn using best value DOACs
  7. Identifying patients with hypertension and starting medication where appropriate 
  8. Improving respiratory outcomes while reducing the carbon emissions from inhalers
  9. Improving valproate safety
  10. Optimising lipid managment for cardiovascular disease prevention
  11. Reducing course length of antimicrobial prescribing
  12. Reducing opioid use in chronic non-cancer pain
PCNs should also look to implement the guidance on items which should not be routinely prescribed in primary care.

Social Prescribing

PCNs should provide access to a social prescribing service to those who may benefit.  It is suggested to use targeted approaches to find those most in need (CORE20PLUS5).

Enhanced health in care homes

The requirements for this are unchanged from previous years:
  1. Agree which care homes the PCN is responsible for
  2. Have a lead GP (or other senior clinician) for the implementation of the EHCH framework and provide continuity of care
  3. Co-ordinate an MDT meeting and associated actions, including the lead GP or clinician and care home staff
  4. deliver a weekly care home round
  5. ensure accurate coding of care
To deliver this PCNs should follow the Enhanced Health in Care Homes framework

Enhanced access

This is unchanged from previous years.