Home » Core Prescribing Solutions Blog » Locally commissioned services: Making a Local Enhanced Service Deliverable

Locally commissioned services: Making a Local Enhanced Service Deliverable

11th November 2026
Clinically reviewed by: Adeem Azhar, MPharm, IPres

Getting your Trinity Audio player ready...

Five steps from local offer to live workstream
What are locally commissioned services in general practice?
How do local enhanced services differ from the Network Contract DES?
How can a practice or PCN make a local service deliverable?
What should a PCN monitor in locally commissioned services?

Locally commissioned services turn a local priority into practical care. Leaders must convert an agreement into a measurable workstream. For PCNs and practices, that means defining eligibility, ownership and follow-up before work starts.

Key takeaways

Local is not national: Local enhanced services vary by commissioner, population need, scope and funding.
Mobilise before launch: Capacity planning should match the cohort, data route and staff time before activity starts.
Check payment requirements: Confirm the evidence and deadlines attached to local payment before allocating clinical time.
Make hand-offs clear: Each action needs an owner, escalation route and feedback loop.

Five steps from local offer to live workstream

For local enhanced services, confirm what is additional to core provision. Check local eligibility, payment triggers, deadlines and required evidence before allocating clinical time. Use the agreed NHS service specification as the baseline.
Define the eligible cohort, exclusions, referral route and patient-facing journey.
Capacity planning must test demand, competence and supervision. Where ARRS-funded staff contribute, confirm the activity fits their role, commitments and funding conditions.
Build coding, clinical escalation, hand-offs and reporting into the workflow.
Go live with a short review cycle, named decision-makers and a safe change route. Use service evaluation and key performance indicators.

Five-stage local enhanced-service workflow covering local requirements, cohort definition, capacity planning, workflow design and launch review. — A defined mobilisation process helps teams move from a local offer to a service that can actually be delivered and reviewed.

What are locally commissioned services in general practice?

Local enhanced services meet identified needs beyond core general-practice provision. They should state what is additional, who can use the pathway and how work is reviewed.

The BMA enhanced services guidance confirms that scope and funding vary locally. In England, ICBs exercise delegated responsibility for primary medical services, as NHS England confirms. NHS commissioning should reflect local needs.

Need help turning a local service specification into a workable pharmacy pathway?

Discuss local service delivery support

How do local enhanced services differ from the Network Contract DES?

PCN manager and GP comparing a locally commissioned service pathway with the separate national Network Contract DES framework. — Local and national arrangements may complement each other, but their requirements should not be assumed to be the same.

An LES is locally agreed and optional for practices. The Network Contract DES is a national contractual arrangement with its own requirements. A local offer may complement national work, but leaders should not assume that national rules apply automatically.

This distinction helps teams identify overlapping obligations and check the applicable recording and payment rules.

How can a practice or PCN make a local service deliverable?

Clinical Pharmacist, GP and PCN manager balancing patient demand with protected time, competence, supervision and available staff capacity. — A local pathway needs enough protected, appropriately supervised clinical capacity before referrals begin.

For locally commissioned services, start with the patient pathway. Capacity planning should test demand, protected time, competence, supervision and tasks retained by the practice.

NHS commissioning priorities need a locally owned delivery plan. Clinical Pharmacy can support high-risk medicines reviews, medicines reconciliation or pathway follow-up. A Clinical Pharmacist support service works best when scope, supervision and the Pharmacy Technician contribution are agreed before referrals begin.

Illustrative example: a local high-risk medicines review can allocate searches and record preparation to a Pharmacy Technician. A suitably competent Clinical Pharmacist can assess patients. A named GP receives complex escalations. The plan should state who arranges monitoring, follows up patients and submits evidence. Responsibilities depend on the local specification, governance and scope of practice.

What should a PCN monitor in locally commissioned services?

Pharmacy Technician, Clinical Pharmacist and GP coordinating preparation, patient review, escalation and follow-up within a local service. — Clear role boundaries help turn local commissioning requirements into a workable Clinical Pharmacy pathway.

Use a small dashboard that shows access, completed actions, outstanding risk and patient outcomes. Key performance indicators should describe the work that matters, not create reporting for its own sake.

Align the service level agreement NHS teams use with the operating model. Keep contract monitoring proportionate, and use service evaluation to test the intended result.

Expert insight from Adeem Azhar, qualified Clinical Pharmacist and CEO

A local service becomes reliable when people know the cohort, the decision-maker and the point at which work is complete. Clear ownership protects patients and lets teams improve the pathway without losing sight of daily delivery.

Adeem Azhar, MPharm, IPres
Co-Founder and Chief Executive Officer – Core Prescribing Solutions
Qualified Clinical Pharmacist

PCN and Clinical Pharmacy team reviewing access, completed work, outstanding risk and outcomes on a small local-service dashboard. — A small set of useful measures should support service evaluation and pathway improvement rather than reporting for its own sake.

FAQs

Do local enhanced services apply everywhere in England?

No. They vary by commissioner, population need, scope and funding. Teams should use their own local documentation rather than assume another area’s model applies.

Who decides which locally commissioned services a GP practice provides?

The relevant commissioner and participating provider agree the local arrangement. NHS commissioning decision-makers should record delivery responsibilities. The service level agreement NHS teams use should reflect them before launch.

Can a prescribing incentive scheme become a local workstream?

It can, if the local agreement defines the cohort, clinical ownership, expected action and review method. Use a small number of key performance indicators to support appropriate care, not reward activity without evidence of completion.

How should the workstream be reviewed after launch?

Use service evaluation to compare delivery with the intended patient and operational outcome. Review agreed measures alongside staff feedback and unresolved clinical actions.

Turn a local commissioning opportunity into a governed pharmacy service

Core Prescribing Solutions can support GP practices and PCNs with Clinical Pharmacist and Pharmacy Technician capacity for defined locally commissioned workstreams. We can help align delivery with the agreed cohort, scope, supervision, escalation, reporting and evidence requirements so local services move from specification to practical delivery.

Discuss your locally commissioned service

Adeem Azhar, MPharm, IPres

Co-Founder and Chief Executive Officer
Qualified Clinical Pharmacist

Fervent about healthcare, technology and making a human difference.

Adeem writes about Healthcare, wellness, medicines management, medicines optimisation and workforce planning, drawing on his experience supporting GP practices and NHS organisations across nationally.

Adeem is a thought leader and is passionate about using healthcare and technology to improve patient outcomes, enhances access to healthcare services and to support NHS teams.