BGS responds to NHSE’s Network Contract Directed Enhanced Service Specifications

16 January 2020

The NHS Long Term Plan identifies the care of older people living with frailty as one of its priorities, something that the BGS advocated for prior to its publication. This further aligns to the Government’s Industrial Strategy and the 2019 Public Health England-led Consensus Statement on Healthy Ageing. We know that failure to appropriately meet the needs of our ageing population is a major contributor to the problems that the NHS faces.

As part of the five-year GP contract introduced in April last year, it was agreed that the new primary care networks (PCNs) would deliver seven national service specifications – five of which come into effect in April 2020. In December 2019, NHS England and NHS Improvement launched a consultation on these five draft service specifications which form part of the Network Contract Direct Enhanced Service (DES). All practices signed up to the DES in 2020/21 will be required to deliver these services.

The BGS has long-held that primary care service design and planning must reflect the increasing number of people living with frailty and multiple long-term conditions. We have therefore submitted feedback on the draft Outline Service Specifications for a new Network Contract Direct Enhanced Service (DES). We focused on three of the five specifications that had particular relevance for the care of older people: Structured Medication Reviews, Enhanced Health in Care Homes and Anticipatory Care.

We believe there is much to be welcomed in these draft service specifications and they represent a positive direction of travel for the care of older people in England. The specifications provide a key opportunity to build on existing NHS work focused on meeting the burgeoning health and care needs of older people, especially the most vulnerable who are known to live with frailty and multiple long-term conditions.

However, we do have concerns about the specifications as written, since it appears that the focus on older people and healthy ageing that was such a crucial element of the NHS Long Term Plan has been diluted. This is particularly concerning at a time when Primary Care Networks are taking on responsibility for the healthcare of their local populations and would benefit from clear support from a dynamic Ageing Well programme. Much of the content of these specifications falls directly under the Ageing Well workstream of the Long Term Plan. However, there is currently no clear line of sight from the aspirations of the NHS Long Term Plan through the Ageing Well programme and these specifications to improved health outcomes for the people they aim to serve.

We have provided what we hope is constructive feedback and suggested ways in which these specifications could be amended to make them more achievable and ensure that they work towards improving healthcare for older people. We see the national consultation as a positive step in creating a shared vision and hope to play a part in revising and re-shaping these specifications over the coming weeks.