Locally Commissioned Services Review
NHS Norfolk and Waveney Clinical Commissioning Group (CCG) commissions a significant number of Locally Commissioned Services (LCS) from its 105 General Practices. These LCS include services often provided in general practice but which are not part of the General Medical Services contract, such as phlebotomy, minor injuries and treatment room services.
An LCS review has taken place to make sure that services offered to patients via practices are consistent, equitable, sustainable and, most importantly, help achieve good health outcomes for the people of Norfolk and Waveney. The review also aimed to support the resilience of general practice by funding fairly and extending contract lengths where possible.
Following the review, a number of services have been identified that should either stop being provided by general practice, start being provided by general practice or delivered in a different way. An FAQ document has been developed to help answer any questions and concerns you may have.
The service review committed to being open and transparent and was subject to a formal approval process, which included sign off by the CCG Clinical Executive Committee, consultation with the Norfolk and Waveney Local Medical Committee and approval by the Primary Care Commissioning Committee. Service specifications and contracts will be issued to practices to enable services to commence from April 1, 2022.
Six Key Principles
The core driver for the LCS review was to achieve six key principles, which were developed and approved by the CCG’s Primary Care Commissioning Committee to ensure:
- A consistent range of services for patients, no matter where they live in Norfolk and Waveney
- The level of overall investment in general practice services is maintained
- Provide stability and reduce unnecessary bureaucracy
- The review to be transparent and clinically led
- The funding to be fair and reflect the cost-of-service delivery
- The transitional period to be managed sensitively
The review will not change the way in which most patients access services, but in some cases, there will be change in the way people access services which could mean they have to go to a different location. Ultimately, this is about making best use of public money and ensure NHS services can provide the care needed to the people of Norfolk and Waveney.
The review has helped to streamline services to make them operate more effectively, as well as ensuring services are equitably available to people, regardless of where they live in Norfolk and Waveney.
From April 2022 there will be changes to these services:
Removal of ear wax
GP practices will no longer be commissioned to remove ear wax and this decision has been made on the basis of clinical priority.
Patients should self-care where possible to manage ear wax. For patients who can’t self-care and where self-care has not worked and the patient remains symptomatic (e.g. hearing loss, earache, tinnitus, vertigo, cough suspected to be due to earwax) or where the patient has a hearing aid or needs one fitted, the CCG commissions aural micro-suction services in the community which the patient can be referred, via the GP, for treatment.
Deep Vein Thrombosis (DVT) D-Dimers – Hospital Provision
Historically, West and North Norfolk practices provided DVT assessment (D-Dimer). As this service is available from all three hospital trusts in Norfolk, it is not an appropriate use of resources to also commission the service from all Norfolk practices. Patients will continue to receive appropriate care for DVTs from their local acute hospital trust.
24-hour ECG services
Historically, only North Norfolk practices were commissioned to provide 24-hour ECGs and the test was often repeated when patients were referred to hospital. This service is available from all three acute hospital trusts in Norfolk, it is therefore not an appropriate use of resources to also commission the service from all Norfolk practices. Patients will continue to receive appropriate care for 24-hour ECGs from their local acute hospital trust.
Feedback about these changes
If you wish to provide feedback to the CCG about these changes, please go to www.norfolkandwaveneyccg.nhs.uk/contact for details of how to get in touch.