{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,6]],"date-time":"2026-05-06T18:59:44Z","timestamp":1778093984417,"version":"3.51.4"},"reference-count":22,"publisher":"Royal College of General Practitioners","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["BJGP Open"],"published-print":{"date-parts":[[2021,1]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Primary care in England is contracted to provide essential services. Many practices also provide additional services, termed \u2018directed enhanced services\u2019 (DES), for extra income. The optional nature of DES may result in inequitable service delivery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim<\/jats:title><jats:p>To determine the range of DES activity and equity of service provision.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design &amp; setting<\/jats:title><jats:p>A cross-sectional analysis of data from general practices in England took place from 2018\u20132019.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>DES were defined in terms of activity level and measured as total DES funding per registered patient. Linear regression modelling was used to explore the relationship between DES activity, practice, and population characteristics.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Data were available for 6873 practices providing up to 10 DES in the initial sample. Due to negative funding amounts and a list size of \u2264750 registered patients, 24 practices were excluded. Of the final sample (<jats:italic>n<\/jats:italic> = 6849), highest DES provision was for influenza and pneumococcal immunisation (99.9%), pertussis immunisation (97.9%), rotavirus and shingles immunisation (99.9%), meningitis immunisation (99.7%), and childhood immunisation (99.6%); lowest provision was for extended hours access (72.4%), violent patient services (2.0%), and out-of-area urgent care (1.3%). Mean DES funding was \u00a36.25 per patient. In deprived areas, DES funding was \u00a30.35 lower (95% confidence interval [CI] = \u00a30.60 to \u00a30.10) per patient (most versus least deprived quintiles); ethnic group-related differences were not significant. DES funding was higher in practices with more GPs or practice nurses per patient. In deprived communities, there was less immunisation activity (including influenza, pneumococcal, meningitis, childhood, and rotavirus and shingles immunisation) and provision of extended hours access; however, learning disability checks provision was greater in these communities.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>DES provision is lower in deprived areas (notably for immunisations and some aspects of access) but higher in better staffed practices. Voluntary quality schemes may contribute to widening health inequalities.<\/jats:p><\/jats:sec>","DOI":"10.3399\/bjgpopen20x101141","type":"journal-article","created":{"date-parts":[[2020,11,17]],"date-time":"2020-11-17T05:50:17Z","timestamp":1605592217000},"page":"bjgpopen20X101141","source":"Crossref","is-referenced-by-count":5,"title":["The provision of additional services in primary care: a cross-sectional study of incentivised additional services, social deprivation, and ethnic group"],"prefix":"10.3399","volume":"5","author":[{"given":"Veline","family":"L'Esperance","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter","family":"Schofield","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark","family":"Ashworth","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1987","published-online":{"date-parts":[[2020,11,16]]},"reference":[{"key":"2021022317501737000_5.1.bjgpopen20X101141.1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMhpr041294"},{"key":"2021022317501737000_5.1.bjgpopen20X101141.2","unstructured":"NHS Employers (2020) Investing in general practice. The new General Medical Services contract. https:\/\/www.nhsemployers.org\/~\/media\/Employers\/Documents\/SiteCollectionDocuments\/gms_contract_cd_130209.pdf. 11 Dec 2020."},{"key":"2021022317501737000_5.1.bjgpopen20X101141.3","unstructured":"The King\u2019s Fund (2006) Access to health care and minority ethnic groups. https:\/\/www.kingsfund.org.uk\/sites\/default\/files\/field\/field_publication_file\/access-to-health-care-minority-ethnic-groups-briefing-kings-fund-february-2006.pdf. 11 Dec 2020."},{"key":"2021022317501737000_5.1.bjgpopen20X101141.4","unstructured":"NHS England (2018) GP contract 2018\/19: enhanced service specifications. https:\/\/www.england.nhs.uk\/publication\/gp-contract-2017-18-enhanced-service-specifications. 11 Dec 2020."},{"key":"2021022317501737000_5.1.bjgpopen20X101141.5","unstructured":"NHS England, NHS Improvement (2020) Network contract directed enhanced service (DES). Guidance for 2020\/21 in England. https:\/\/www.england.nhs.uk\/wp-content\/uploads\/2020\/03\/network-contract-des-guidance-2020-21.pdf. 11 Dec 2020."},{"issue":"3","key":"2021022317501737000_5.1.bjgpopen20X101141.6","first-page":"157","article-title":"Do local enhanced services in primary care improve outcomes? Results from a literature review","volume":"22","author":"Kumar","year":"2014","journal-title":"Qual Prim Care"},{"key":"2021022317501737000_5.1.bjgpopen20X101141.7","doi-asserted-by":"publisher","DOI":"10.3399\/bjgp15X687829"},{"key":"2021022317501737000_5.1.bjgpopen20X101141.8","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(08)61123-X"},{"key":"2021022317501737000_5.1.bjgpopen20X101141.9","doi-asserted-by":"publisher","DOI":"10.1016\/S2468-2667(18)30177-4"},{"key":"2021022317501737000_5.1.bjgpopen20X101141.10","doi-asserted-by":"publisher","DOI":"10.3399\/bjgp16X688345"},{"key":"2021022317501737000_5.1.bjgpopen20X101141.11","unstructured":"NHS Digital (2019) NHS payments to general practice \u2014 England, 2018\/19. https:\/\/digital.nhs.uk\/data-and-information\/publications\/statistical\/nhs-payments-to-general-practice\/england-2018-19. 11 Dec 2020."},{"key":"2021022317501737000_5.1.bjgpopen20X101141.12","unstructured":"NHS Digital (2015) General and personal medical services (NHS Digital, London)."},{"key":"2021022317501737000_5.1.bjgpopen20X101141.13","unstructured":"Office for National Statistics (2011) 2011 census. https:\/\/www.ons.gov.uk\/census\/2011census. 11 Dec 2020."},{"key":"2021022317501737000_5.1.bjgpopen20X101141.14","unstructured":"Department for Communities and Local Government (2015) The English Indices of Deprivation 2015. https:\/\/assets.publishing.service.gov.uk\/government\/uploads\/system\/uploads\/attachment_data\/file\/465791\/English_Indices_of_Deprivation_2015_-_Statistical_Release.pdf. 11 Dec 2020."},{"key":"2021022317501737000_5.1.bjgpopen20X101141.15","doi-asserted-by":"publisher","DOI":"10.3399\/bjgp14X677545"},{"issue":"3-4","key":"2021022317501737000_5.1.bjgpopen20X101141.16","first-page":"371","article-title":"Socio\u2010economic inequalities in health care in England","volume":"37","author":"Cookson","year":"2016","journal-title":"The Journal of Applied Public Economics"},{"key":"2021022317501737000_5.1.bjgpopen20X101141.17","doi-asserted-by":"publisher","DOI":"10.1136\/jech-2016-207572"},{"key":"2021022317501737000_5.1.bjgpopen20X101141.18","doi-asserted-by":"publisher","DOI":"10.3399\/bjgp18X694397"},{"key":"2021022317501737000_5.1.bjgpopen20X101141.19","doi-asserted-by":"publisher","DOI":"10.3399\/bjgp14X680533"},{"key":"2021022317501737000_5.1.bjgpopen20X101141.20","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2019-030624"},{"key":"2021022317501737000_5.1.bjgpopen20X101141.21","doi-asserted-by":"publisher","DOI":"10.3399\/bjgp19X704549"},{"key":"2021022317501737000_5.1.bjgpopen20X101141.22","doi-asserted-by":"publisher","DOI":"10.3399\/bjgp13X671803"}],"container-title":["BJGP Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.3399\/bjgpopen20X101141","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,2,24]],"date-time":"2021-02-24T01:50:39Z","timestamp":1614131439000},"score":1,"resource":{"primary":{"URL":"http:\/\/bjgpopen.org\/lookup\/doi\/10.3399\/bjgpopen20X101141"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,11,16]]},"references-count":22,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2021,2,23]]},"published-print":{"date-parts":[[2021,1]]}},"alternative-id":["10.3399\/bjgpopen20X101141"],"URL":"https:\/\/doi.org\/10.3399\/bjgpopen20x101141","relation":{},"ISSN":["2398-3795"],"issn-type":[{"value":"2398-3795","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,11,16]]}}}