Local enhanced service commissioning through GP contracts


This document sets out how integrated care boards (ICBs) can commission local enhanced services through primary medical care contracts.


When NHS England became responsible for commissioning primary medical services in 2013, it retained the ability of former primary care trusts to commission local enhanced services through general medical services (GMS), personal medical services (PMS) and alternative provider medical services (APMS) contracts.

In this context local enhanced services were defined as the services outside of national GP contracts providing a wider range of higher quality primary medical services to meet local population needs and priorities.

However, with the intention that all local commissioning decisions would sit with clinical commissioning groups (CCGs), NHS England set out in guidance how it would not commission local enhanced services and that it would be for CCGs to commission a wide range of community-based services, including from general practice, using NHS standard contracts.

Additionally, CCGs did not have direct powers to pay for improvements in the quality of services provided under GP contracts, although NHS England introduced through its co-commissioning programme increasing opportunities for CCGs to design and pay for incentives for improvements in the quality of primary medical care services (local incentive schemes).

New commissioning arrangements

Integrated care boards (ICBs) have had delegated responsibility for commissioning primary medical services under GP contracts since 1 July 2022, carrying over many of the delegated responsibilities that applied to clinical commissioning groups.

The new delegation agreement introduced takes account of NHS England’s ambition to delegate more of its direct commissioning functions than simply primary medical care.

However, the delegation agreement has incorporated an amendment that makes clear ICBs delegated primary medical care responsibilities now include decisions on local enhanced services and local incentive schemes.

This change essentially repatriates the GP contracting and local commissioning responsibilities that existed with primary care trusts prior to NHS England.

Integrated care board commissioning of local enhanced services

Integrated care boards (ICBs) will have inherited from clinical commissioning groups (CCGs) a range of local enhanced services commissioned from general practice under NHS standard contracts. ICBs remain free to carry those contracts over in to 2023/24 and to continue to enter into such contracts with GP providers as it requires.

However, ICBs are also now free to make arrangements for the provision of local enhanced services through contractual variation of existing primary medical care contracts (general medical services, personal medical services and alternative provider medical services) [1].

[1] While primary medical services contract regulations do not require an enhanced service schedule to be included in contracts, NHS England’s standard GMS contract and PMS agreement all include an enhanced service section which allows the details of such services and relevant specifications to be included, where the parties agree that the contractor is going to provide such services. APMS contracts can include enhanced services in the main service specification or could equally introduce a new enhanced service schedule.

This should mean a simplification for both ICBs and GP providers in agreeing and incorporating local enhanced services as these will now be provided and governed by GP practices core primary medical services contracts.

Like CCGs, ICBs will still need to decide whether local enhanced services could be delivered by a number of potential providers (which may include GP providers) or whether they could only be provided by GP providers. ICBs will also need to decide how to arrange those services with those providers with regard to relevant rules that may apply. At the time of publication current procurement rules apply and should be followed but a new set of rules (NHS provider selection regime) is expected to be introduced.

For services that can be delivered by a number of potential providers, ICBs will still need to decide whether to undertake a tender exercise to identify a single provider (or limited group of providers) or whether to allow patients to choose from a range of qualified providers.

For local enhanced services for which there are no other possible providers, for instance because they require list-based primary medical care, or for services of a minimal value, ICBs will be able to arrange these services directly via agreed contract variation.


In conclusion integrated care boards (ICBs) may commission local enhanced services from general practice and this may be arranged using the GP contract as the contracting vehicle rather than the NHS standard contract.

The rules around determining whether services are best delivered by practices or other providers have not changed.

ICBs will continue to ensure that the services they commission from general practice deliver the best quality and outcomes for patients, provide value for money, give patients choice wherever appropriate, and adhere to rules as may apply in deciding who should provide those services.