Do local enhanced services in primary care improve outcomes? Results from a literature review

Objective: This paper aims to examine the role of local enhanced services (LES) as a financial incentive in improving clinical and process outcomes in primary care with a view to discussing their future in light of the Health and Social Care Act. Methods: A literature review was conducted to identify LES commissioned in the UK in any disease area and to evaluate common themes relating to their impact on outcomes. The literature review consisted of two stages: an initial reference database search (MEDLINE, MEDLINE IN-PROCESS and EMBASE) and a more general internet search. The internet search used free text augmented by a targeted search of key heahh organisations' websites. Data were extracted from the LES to provide information on the background and context of the LES before going on to describe the incentive structure, health and economic outcomes and limitations of the LES. Results: Although a number of LES were identified in the online search, only 14 reported any data on outcomes. These LES programmes related to 10 different disease areas, with cancer, alcohol dependence and chronic obstructive pulmonary disease (COPD) being the most common health needs. Three common factors between the selected LES emerged that appear to influence the extent of the impact on local health or economic outcomes: (1) a national framework supporting the LES, (2) existing service provision, and (3) the size of the financial incentives. Conclusion: The common themes emerging from the literature review suggest that, following the Health and Social Care Act 2012 and newly established national standards, given sufficient attention to planning service specifications, LES could continue to be important in reducing health inequalities and preparing poorly performing general practices for longer term changes directed at improving outcomes and standards in healthcare