DIRECTIONS

NATIONAL HEALTH SERVICE, ENGLAND

The Primary Medical Services (Directed Enhanced Services) Directions 2026

The Secretary of State for Health and Social Care, in exercise of the powers conferred by sections 98A(3), 272(7) and 8 and 273(1) of the National Health Service Act 2006(a), gives the following Directions.

Citation, commencement, extent and application

These Directions may be cited as the Primary Medical Services (Directed Enhanced Services) Directions 2026 and come into force on 1st April 2026.
These Directions are given to NHS England(b).
These Directions extend to England and Wales.
These Directions apply in relation to England only.

Interpretation

In these Directions—

the Act: means the National Health Service Act 2006
financial year: means a twelve month period ending on 31st March
general practitioner: means a medical practitioner whose name is included in the medical performers list prepared and maintained by NHS England in accordance with regulation 3(1)(a) of the National Health Service (Performers Lists) (England) Regulations 2013(c )
GMS contract: means a general medical services contract
GMS contractor: means a person with whom NHS England is entering, or has entered into, a GMS contract
health care professional: means a person who is a member of a profession regulated by a body mentioned in section 25(3) of the National Health Service Reform and Health Care Professions Act 2002(d) (the Professional Standards Authority for Health and Social Care)

2006 c. 41. Section 98A of the National Health Service Act 2006 (“the Act”) was inserted by section 49(1) of the Health and Social Care Act 2012 c. 7. By virtue of section 271(1) of the Act, the powers conferred by these sections are exercisable by the Secretary of State only in relation to England.

NHS England (formerly known as the National Health Service Commissioning Board) was established by section 1H(1) of the National Health Service Act 2006 c. 41 (“the Act”). Section 1H was inserted into the Act by section 9(1) of the Health and Social Care Act 2012 c. 7. The National Health Service Commissioning Board was renamed “NHS England” by section 1 of the Health and Care Act 2022 c. 31.

S.I. 2013/335. Regulation 3(1) was amended by paragraph 1(3) of Schedule 1 to the Health and Care Act 2022 (Further Consequential Amendments) (No. 2) Regulations 2023/1071.

2002 c. 17. Section 25(3) was amended by paragraph 17 of Schedule 10 to the Health and Social Care Act 2008 c. 14, paragraph 10(1) and (2) of Schedule 4 to S.I. 2010/231, paragraph 56(b) of Schedule 15 to the Health and Social Care Act 2012 and paragraph 2 of Schedule 4 to the Children and Social Work Act 2017 c. 16.

“local medical committee” means a committee recognised by NHS England under section 97 of the Act(a);

“PMS agreement” means a section 92 arrangement(b) with a person which requires the provision by that person of primary medical services;

“PMS contractor” means a person with whom NHS England is entering, or has entered, into a PMS agreement;

“practice” means the business operated by a primary medical services contractor for the purpose of delivering services under the primary medical services contract;

“primary care network” means a network of primary medical services contractors and other providers of services which has been approved by NHS England, serving an identified geographical area;

primary medical services: means medical services to which the provisions of Part 4 of the Act (medical services) apply

a person recorded by NHS England as being on a primary medical services contractor’s list of patients; or
a person whom a primary medical services contractor has accepted for inclusion on its list of patients whether or not notification of that acceptance has been received by NHS England and who has not been notified by NHS England as having ceased to be on that list; and

“Statement of Financial Entitlements” means the General Medical Services Statement of Financial Entitlements Directions 2026(d).

Establishment etc. of directed enhanced services schemes

NHS England must, in exercising its functions under section 83(1) of the Act, establish, operate and, as appropriate, revise the following schemes—

Section 97 was amended by paragraph 41 of Schedule 4 to the Health and Social Care Act 2012.

For the definition of “section 92 arrangement” see section 92(8) of the National Health Service Act 2006. Section 92 was amended by section 55(1) of, and paragraph 36 of Schedule 4 to, the Health and Social Care Act 2012.

Section 83 was amended by section 55(1) of, and paragraph 30 of Schedule 4 to, the Health and Social Care Act 2012.

The General Medical Services Statement of Financial Entitlements Directions 2026 were signed on 30th March 2026.

These Directions are available at: General Medical Services Statement of Financial Entitlements Directions (opens in a new tab)ncial-entitlements-directions or a hard copy from the Primary Care Team, Department of Health and Social Care, 4th Floor, 39 Victoria Street, London SW1H 0EU.

a Network Contract Directed Enhanced Service Scheme, to integrate care by the formation and continued operation of primary care networks in order to deliver care in a more personalised way,
a Learning Disabilities Health Check Scheme, to encourage primary medical services contractors to—
identify registered patients aged 14 or over who are known to the local authority social services department primarily because of their learning disabilities, and

(ii) offer and provide an annual health check to such patients,

a Violent Patients Scheme, to ensure that there are sufficient arrangements in place to provide primary medical services to patients who have been subject to immediate removal from a patient list of a primary medical services contractor because of an act or threat of violence, and
a Minor Surgery Scheme, to ensure that a wide range of minor surgical procedures is made available as part of the primary medical services provided in England.
NHS England must not enter into arrangements with a primary medical services contractor as part of any of the schemes mentioned in paragraph (1) unless NHS England is satisfied that the contractor—
is capable of meeting its obligations under those arrangements (including under any agreed plan), and
has the necessary facilities, equipment and properly trained and qualified general practitioners, health care professionals and other staff to perform those obligations.

Network Contract Directed Enhanced Service Scheme

As part of the Network Contract Directed Enhanced Service Scheme (“the Network Contract Scheme”), NHS England must—
offer to each primary medical services contractor (the “contractor”) an opportunity to enter into arrangements under the Network Contract Scheme, during the relevant period, in accordance with NHS England’s Network Contract Directed Enhanced Service Specification(a) (the “Specification”);
offer to contractors who wish to enter into arrangements under the Network Contract Scheme but who are not part of a Previously Approved primary care network, an opportunity to apply to register, during the relevant period, a new primary care network, and
allow contractors to apply to alter the membership of a new primary care network or Previously Approved primary care network during the relevant period.
NHS England may only approve the registration of a new primary care network, or approve the continued registration of a Previously Approved primary care network, where each contractor forming part of the primary care network has—
signed a Network Agreement in accordance with the Specification(b),
agreed upon and nominated one contractor to receive payments from NHS England on their behalf, to be known as “the nominated payee”,

The Network Contract Directed Enhanced Service Contract Specification was published on [26 March 2026]. The current version is available at Network Contract Directed Enhanced Service Contract Specification 2025-26 (opens in a new tab)quirements-and-entitlements-26-27/ and hard copies are available from NHS England, Wellington House, 133-155 Waterloo Road, London SE1 8UG.

See paragraph 2.2.7 of the Specification.

put in place suitable arrangements to enable the sharing of data to support the delivery

of services and business administration, prior to the start of any service delivery under the Network Contract Scheme, in accordance with the Network Agreement and the Specification, and

complied with any additional applicable requirement in the Specification.
Where NHS England is satisfied there are exceptional circumstances it may allow—
a contractor to enter into arrangements under the Network Contract Scheme outside the relevant period
contractors to apply to NHS England to approve the registration of a new primary care network outside the relevant period;
contractors to apply to NHS England to alter the membership of a new primary care network or Previously Approved primary care network outside the relevant period.
The arrangements that NHS England enters into with a contractor under the Network Contract Scheme must include—
a requirement that, following notification by NHS England, contractor A agrees to alter the membership of the primary care network, of which it is a member, to include contractor B in circumstances where NHS England has first sought to engage with a local medical committee;
details of the contractor’s obligations under the Network Contract Scheme in accordance with the Specification;
a requirement that the contractor is accountable, on a collective basis with the other contractors that are members of the same primary care network, for complying with any obligations which are specified to be those of the primary care network in the Specification;
details of the consequences of any breach of the contractor’s obligations under the Network Contract Scheme and of any obligations specified to be those of the primary care network in the Specification;
details as to the monitoring of the arrangements by NHS England;
a requirement that the contractor provides NHS England with such information as NHS England may reasonably request for the purposes of monitoring the contractor’s performance of its obligations under the arrangements;
details of the arrangements for the provision of information to NHS England by the contractor and
arrangements in relation to the making of payments to the contractor.
NHS England must, if necessary, vary the contractor’s primary medical services contract so that the Network Contract Scheme comprises part of the contractor’s contract or agreement and the arrangements under the Network Contract Scheme are conditions of the contract or agreement.
In this direction—
“member” or “membership” refers to Core Network Practice(a) members which are contractors with responsibility for meeting the obligations specified to be those of the primary care network in the Specification;
“Network Agreement” means the agreement between the members of a primary care network that sets out how the primary care network will operate;

See paragraph 2.2.8 of the Specification.

“Previously Approved primary care network” means a primary care network approved in the period beginning with 1st July 2019 and ending with 31st March 2026;
“relevant period” means the period beginning with 1st April 2026 and ending with 30th April 2026.

Learning Disabilities Health Check Scheme

As part of its Learning Disabilities Health Check Scheme (“the LDHC Scheme”), NHS England must before 30th April 2026 offer an opportunity to enter into arrangements under the LDHC Scheme in respect of the financial year ending on 31st March 2027 to—
each GMS contractor which entered into a GMS contract before 1st April 2025 and which subsisted on 1st April 2026;
each PMS contractor for which NHS England holds a list of registered patients, which entered into a PMS agreement before 1st April 2025 and which subsisted on 1st April
Subject to paragraph (3), NHS England must offer to—
each GMS contractor which enters into a GMS contract on or after 1st April 2026;
each PMS contractor for which it holds a list of registered patients and which enters into a PMS agreement on or after 1st April 2026,

an opportunity, after that date, to enter into arrangements under the LDHC Scheme for the remainder of the financial year.

NHS England must only enter into an arrangement under the LDHC Scheme after 31st December 2026 if—
two or more GMS contracts or PMS agreements (under at least one of which arrangements under the LDHC Scheme referred to in paragraph (1) had previously been entered into) merge and—
as a result, two or more patient lists are combined, resulting in either a new or varied GMS contract or PMS agreement, and

(ii) the contractor who is a party to such a new or varied contract or agreement wishes to enter into new arrangements referred to in paragraph (1), or,

a GMS contract or PMS agreement (under which arrangements under the LDHC Scheme referred to in paragraph (1) had previously been entered into) splits and—
as a result, the contractor’s patient list is divided between two or more GMS or PMS contractors, resulting in either new or varied GMS contracts or PMS agreements, or a combination of both, and

(ii) a contractor who is a party to such a new or varied contract or agreement wishes to enter into new arrangements referred to in paragraph (1).

If NHS England enters into a new arrangement under the LDHC Scheme, it must do so before the expiry of the period of 28 days beginning with the date of the merger or the split as the case may be.
NHS England must—
consider any proposals put forward by a GMS or PMS contractor which wishes to enter into arrangements under the LDHC Scheme referred to in paragraphs (1) and (2) with a view to agreeing them;
not delay any such consideration unreasonably;
not withhold its agreement unreasonably.

NHS England may consider and reach a decision in respect of entering into any arrangements under the LDHC Scheme if a GMS or PMS contractor has failed to provide written proposals in response to NHS England’s offer to enter into such arrangements within a period of 42 days beginning with the date of the offer.
The arrangements that NHS England enters into with a GMS or PMS contractor as part of the LDHC Scheme must include—
a requirement that the contractor has in place a register (“learning disabilities register”) which identifies registered patients who have learning disabilities and includes age data;
a requirement that the contractor has in place arrangements to enable the sharing of data with NHS England to support the administration of the LDHC Scheme and payments made under it;
a requirement that the contractor takes reasonable steps to keep the learning disabilities register up to date throughout the period of the arrangement by removing and adding registered patients as appropriate;
a requirement that the contractor provides NHS England with such information as NHS England may reasonably require to demonstrate that it has robust systems in place to maintain the learning disabilities register accurately;
a requirement that the contractor offers an annual health check to each registered patient aged 14 years or over on the learning disabilities register;
a requirement that, if the patient consents, or if a person consents on the patient’s behalf, the health check provided under the arrangement is to involve any carer, support worker or other person considered appropriate by either the patient, the person consenting on behalf of the patient or the contractor;
a requirement that any health check provided under the arrangement includes—
a review of the patient’s physical and mental health that includes—(aa) provision of relevant health promotion advice, (bb) a chronic illness and system enquiry, (cc) a physical examination, (dd) a consideration of whether the patient suffers from epilepsy, (ee) a consideration of the patient’s behaviour and mental health, and (ff) a specific syndrome check;

(ii) the production of a health action plan for each patient with a learning disability who is aged 14 years or over;

(iii) a check on the appropriateness of any prescribed medicines;

(iv) a review of coordination arrangements with secondary care;

where appropriate, a review of any transitional arrangements which took place on the patient attaining the age of 18;
a requirement that in carrying out any health check provided under the arrangements the contractor must use—
the “Cardiff” health check protocol(a) or a similar protocol agreed with NHS England, or

This is also known as the Welsh health check and can be found at Learning Disability Health Check Forms (opens in a new tab)gdisability-health-check-forms/. Hard copies of the protocol are available from the Primary Care team, Department of Health and Social Care, 4th Floor, 39 Victoria Street, SW1H 0EU.

(ii) the “National Electronic Health Check (Learning Disabilities) Template”(a);

a requirement that, before undertaking any health check under the arrangements, the contractor must arrange a training session, if it has not already done so, for its staff which meets the following requirements—
the training session must be attended by such members of the contractor’s staff as are agreed between the contractor and NHS England, which must include— (aa) the lead general practitioner and the lead practice nurse, and (bb) either the practice manager or the senior receptionist, if the contractor’s staff include staff with those designations, or where the contractor’s staff does not include staff with those designations, either of the members of the contractor’s staff who have analogous roles;

(ii) the training session must consist of a multi-professional education session approved by NHS England;

(iii) the training session must include instruction on overcoming any attitudinal barriers with a view to improving staff communication with patients with learning disabilities;

a requirement that the contractor makes relevant entries in the registered patient’s medical record, including any refusal to take up the offer of a health check;
details of the arrangements for the provision of information by NHS England and by the contractor;
details as to the monitoring of the arrangements by NHS England;
in the case of PMS contractors, the amount of the payments to be made to the contractor for meeting its obligations under the arrangements, and in determining the appropriate level of those payments NHS England must have regard to the amounts of payments under Section 8 (Learning Disabilities Health Check Scheme for the period 1st April 2026 to 31st March 2027) of the Statement of Financial Entitlements.
NHS England must, if necessary, vary the contractor’s GMS contract or PMS agreement so that the LDHC Scheme comprises part of the contractor’s contract or agreement and the arrangements under the LDHC Scheme are conditions of the contract or agreement.
In this direction—
“chronic illness and system enquiry” means a check of respiratory, cardiovascular and other functions in the body which may not currently present as being subject to chronic illness or disease;
“specific syndrome check” means a bodily check for certain syndromes known to cause learning disabilities which are associated with increased morbidity.

The “National Electronic Health Check (Learning Disabilities) Template” is an interactive code-based tool which has been available on GP IT systems from 1st April 2017. The purpose of the tool is to help GPs assess the health needs of those with learning disabilities in a systematic way and to generate a Health Check Action Plan which is tailored towards the needs of individual patients. Further information with respect to the template can be found at NHS Learning Disabilities Annual Health Checks (opens in a new tab)

england.nhs.uk/learningdisabilities/improving-health/annual-health-checks/ and obtained from NHS England, PO Box (opens in a new tab)16738, Redditch, B97 9PT.

Violent Patients Scheme

Where a primary medical services contractor wishes to enter into arrangements in respect of a Violent Patients Scheme, NHS England must consult the relevant local medical committee (if any) about any proposals it has to establish or revise that Scheme.
Where NHS England enters into arrangements under the Violent Patients Scheme, NHS England must—
as part of those arrangements, make provision for arrangements in relation to the making of payments to the contractor in respect of the contractor agreeing and meeting its obligations under the Violent Patients Scheme in respect of each financial year to which those arrangements relate;
if necessary, vary the contractor’s primary medical services contract or agreement so that the Violent Patients Scheme comprises part of the contractor’s contract or agreement and the arrangements under the Violent Patients Scheme are conditions of the contract or agreement.
In this direction “relevant local medical committee” means the local medical committee for the area in which the primary medical services contractor provides primary medical services.

Minor Surgery Scheme

As part of its Minor Surgery Scheme, NHS England may enter into arrangements with any primary medical services contractor.
Where NHS England enters into arrangements under the Minor Surgery Scheme, those arrangements must, in respect of each financial year to which those arrangements relate, include—
which minor surgical procedures are to be undertaken by the contractor and for which category of patients, and for these purposes, the minor surgical procedures that may be undertaken are any minor surgical procedures that NHS England considers the contractor competent to provide, which may include—
injections for muscles, tendons and joints; (ii) invasive procedures, including incisions and excisions; (iii) injections for varicose veins and piles;
a requirement that the contractor takes all reasonable steps to provide suitable information to patients, in respect of whom they are contracted to provide minor surgical procedures, about those procedures;
a requirement that the contractor—
obtains written consent to the surgical procedure before it is carried out (where a person consents on a patient’s behalf, that person’s relationship to the patient must be recorded on the consent form), and

(ii) takes all reasonable steps to ensure that the consent form is included in the lifelong medical records held by the patient’s general practitioner;

a requirement that the contractor ensures that all tissue removed by surgical procedures is sent for histological examination, unless the contractor considers there are clinically acceptable reasons for not doing so;
a requirement that the contractor ensures that any health care professional who is involved in performing or assisting in any surgical procedure has—
any necessary experience, skills and training with regard to that procedure, and (ii) resuscitation skills;

a requirement that the contractor ensures that it has appropriate arrangements for infection control and decontamination in premises where surgical procedures are undertaken, and for these purposes, NHS England may stipulate—
the use of sterile packs from the local Central Sterile Service Department(a), disposable sterile instruments, or approved sterilisation procedures;

(ii) the use of particular infection control policies in relation to, for example, the handling of used instruments and excised specimens, and the disposal of clinical waste;

a requirement that the contractor ensures that all records relating to all surgical procedures are maintained in such a way—
that aggregated data and details of individual patients are readily accessible for lawful purposes;

(ii) as to facilitate regular audit and peer review by the contractor of the performance of surgical procedures under the Minor Surgery Scheme;

a requirement that the contractor provides NHS England with such information as it may reasonably request for the purposes of monitoring the contractor’s performance of its obligations under the Minor Surgery Scheme;
the arrangements in relation to the making of payments to the contractor.
NHS England must, where necessary, vary the contractor’s primary medical services contract or agreement so that the Minor Surgery Scheme comprises part of the contractor’s contract or agreement and the arrangements under that Scheme are conditions of the contract or agreement.

Revocation and savings

Subject to paragraph (2), the Primary Medical Services (Directed Enhanced Services) Directions 2025 are revoked.
Despite the revocation provided for in paragraph (1), the Primary Medical Services (Directed Enhanced Services) Directions 2025 as in force immediately before 1st April 2026 are to continue to apply to the extent necessary to assess any entitlement to payment in respect of services provided under arrangements made in accordance with those Directions.

Signed by authority of the Secretary of State for Health and Social Care

Claire Amal Department of Health and Social Care

Member of the Senior Civil Service 39 Victoria Street, London SW1H 0EH

Department of Health and Social Care 30th March 2026

The local Central Sterile Services Department is the provider of equipment sterilisation facilities in the local health economy.

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