Frequently asked questions
Enhanced services vary across Wales, and there is no single resource describing them. Morgannwg LMC has created a summary spreadsheet (in both excel and pdf format) describing the services available in every Healthboard in Wales. The information was obtained by making freedom of information requests to each Healthboard and also to Welsh government. All information in the spreadsheet comes directly from these public sources.
Please use it to support your business planning and negotiations.
This project was made possible through a generous grant from GPDF. If you have any questions or suggestions please contact Morgannwg LMC.
The information is available as an Excel spreadsheet or PDF and the source information is available here.
Budgeting and forecasting
To help practices to calculate costs incurred in providing supplementary services, Gwent LMC have developed a useful calculator which has been included below. It is necessary to factor in human resource expenses (salary, oncosts and mandatory training) , building expenses (including insurance) and materials and fixed costs. This means including proportionally the number of clinical and admin staff involved and all the running costs such as fridges, beds, lights in minor surgery room, extra cleaning etc.
Enhanced Service Financial Calculator
Gwent LMC have developed a calculator to aid business decisions about the viability of enhanced services for practices. It will allow additional costs such as pension, NI contributions etc to be automatically included. Just input hourly staff rates and time spent by differing members of the practice team to get an overall estimate of practice costs to complete an activity.
Gwent LMC Enhanced Service Calculator
Recent Uplift from SBUHB
Please note that MLMC were unable to reach a mutually agreeable position regarding an uplift with SBUHB. SBUHB felt that their offer of a 5% uplift was reasonable considering their financial position, but MLMC did not feel that they could endorse the offer based upon the information contained in the comparative spreadsheet.
If practices would like a further discussion about supplementary services please do not hesitate to get in touch with MLMC.
The letter from SBUHB can be downloaded for reference here.
Work out the cost of the service
Look at current level of remuneration and cost to deliver service.
Have a chat amongst clinical team and with practice manager to decide next steps.
If you wish to continue then read no further
Payment not covering costs and / or impacting on GMS care?
You can withdraw from the service
How to withdraw:
Give 3/12 notice in writing to the Health Board of your intention and reasons.
Ask for them to inform you of where to redirect patients once notice period has ended. Put a time date on response to this and put a diary marker in your diary to check this has been responded too.
Copy in the other services affected by the decision
Top tip – make sure you get confirmation of receipt – email route perfect for this
Continue to provide the service for 3/12
Start updating your staff that service is no longer going to be provided and ensure all know where to refer patients once service has ended. Consider giving them a “script” to use when faced with such requests
Start to inform your patients via posters / screen messages / during consultations of when this service will no longer be available and why (if appropriate)
The LMC will be developing patient information materials for you to use in some cases
Consider how you can best utilise the freed up resource/ time to provide additional capacity within your clinical team
Keep track
Make a note on your systems when service is due to end
Remind all staff after that date that you no longer provide these services and where they should send patients.
What if the HB don’t tell you what to do with patients after notice period?
Contact the LMC Office
Morgannwg LMC is here to support you!
It is not unusual to feel concerned at stopping work OR to think that you are the only practice considering taking this action. YOU ARE NOT. Practices can no longer continue providing services at financial or clinical capacity costs to themselves. Follow the checklist above, discuss as a practice and reach your own conclusion.
A Home Office License is NOT required by a GP who keeps opiates in their bag which they have requisitioned themselves directly from the Pharmacist
A License is required in those surgeries that order a “central “ supply from which the GPs draw what they need.
It is recommended that surgeries which currently or intend to hold drugs in surgery should apply for a Home Office License if they do not have one already.
Contractual Requirements and Data Entry
A new flu vaccination delivery model has resulted in some operational challenges.
All provider practices must adhere to the National Primary Care Contractual Instruments (PCCIs) Schedule 2025 ( attached), which is the same for both general practices and community pharmacy to ensure equity of service.
The specification requires that vaccine administration and stock checks must be data entered onto the WIS system by the end of the working day.
Due to significant and sporadic outages of the WIS system, practices were previously authorized to input data on the following working day, a situation which may have caused confusion.
Practices must log any data upload concerns with the primary care team and immunisations team via the general primary care email (even on weekends) to maintain an audit trail. A DHCW service point call is also recommended for evidence.
The Health Board (HB) agreed to send out a communication to clarify contractual data entry requirements and address any confusion.
Functionality and Use of WIS
Practices reported that WIS flu invites were being sent too late, causing patients to miss appointments.
WIS is sending generic blanket text messages that invite patients to a session rather than a specific time.
It was agreed that the specification allows practices to use their in-house appointment systems or "established booking system including GP Clinical systems" to invite patients for flu vaccination; the specification does not mandate using WIS for flu invites.
Opportunistic administration of the flu vaccine is encouraged.
There is confusion because the requirement is to ONLY use WIS to invite patients for the COVID-19 vaccine, which is difficult to manage alongside the separate rules for flu, especially given changes to the eligible age ranges.
The HB confirmed the technical ability to use WIS for both flu and COVID-19 invites, but noted "teething problems."
The HB agreed to issue a clarification immediately to address misinformation regarding invitation methods.
WIS Write-Back Delays
Significant WIS write-back delays were reported (up to four days), which creates a clinical governance risk as patients could receive the vaccine from another provider (e.g., a pharmacy) during the delay period.
A national update was shared indicating the WIS platform had been down from 6-9 October to address duplicate entries. Duplications were found from both clinical systems (EMIS/Vision) and WIS, as well as some unexplained duplicates.
The impact of these delays on the practice's ability to call and recall patients will need to be monitored.
HB Vaccination Assurance
The HB has not started any general 'mop-up' programme and plans to begin administering to the general population only on December 1st, 2025, as per the national specification.
Requests to vaccinate housebound patients have been declined, with a request made for those practices signed up to the supplementary service to administer.
The HB has agreed to a request to vaccinate care home residents for flu. This area needs greater clarity and coordination for future years, as the HB administers COVID-19 in care homes while practices are asked to do the flu vaccine.
A national Task and Finish Group has been set up to specifically resolve care home vaccination challenges.
Other groups who may have been vaccinated by the HB include pregnant women at HB clinics and NHS staff, which may have caused confusion.
Due to responding to specific practice-based requests, the HB is currently unable to issue an assurance that no flu vaccines have been administered.
Uptake Targets
Practices still have a 75% target rate for vaccination.
The HB is confident there is enough stock for all eligible over 65s.
Uptake for 2-3 year olds and at-risk groups remains low, consistent with previous years.
A representative noted that recent negative discussions in the media have affected this year's uptake, and asked the HB to update the website with more guidance to help patients research vaccine safety.
The HB agreed to look into ways to disseminate patient information.
Patient Booking Phone Line
Patient delays were reported when using the immunisation service booking line.
The HB confirmed a phone outage on one specific day in October. Outside of this, the average call waiting time was 3 minutes, with the longest reported wait being 10 minutes.