Enhanced Services

What is an Advanced Service

The new GMS Contract was introduced in April 2004. As part of the new Contract, GP Practices can opt to provide services over and above the essential/additional services normally provided to patients. These services are known as Enhanced Services and are delivered to a higher specified standard. By providing these services GPs help reduce the burden on secondary care and expand the range of services to meet local need and improve convenience and choice for patients.

There are three types of enhanced service:

  • Directed Enhanced Service (DES) – Health Boards must ensure that this service is provided for the population, e.g. child immunisation programme.
  • National Enhanced Service (NES) – Services commissioned to meet patient needs with national specifications, e.g. specialised services for multiple sclerosis.
  • Local Enhanced Service (LES) – Locally developed services designed to meet local health needs.

Enhanced Services Provided By The Practice

Directed Enhanced Services

  • Influenza Immunisation
  • Minor Surgery (includes joint injections, and excision of skin lesions)
  • Palliative and End of Life Care

National Enhanced Services

  • Child Immunisations
  • Anti-coagulation Monitoring
  • Intra-Uterine Device (Coil) Fittings
  • Multiple Sclerosis
  • Near Patient Testing (screening for patients taking high risk prescribed medication)
  • Extended Hours

Local Enhanced Services

  • Specialist care of patients with Diabetes
  • Alcohol Screening and Brief Interventions
  • Alcohol Users
  • Polypharmacy
  • Anticipatory Care
  • Treatment for patients with suspected Deep Vein Thrombosis 
  • Violence & Aggression (a specialist service provided to patients who are unable to register with a GP due to violent or aggressive behaviour).

Minor Surgery

Problems suitable for minor surgery include the removal of cysts, moles, skin tags and other small growths as well as the treatment of in-growing toenails and warts. For an assessment please see Dr Court or Dr Davis during a normal surgery.

Vaccinations & Immunisations

Childhood vaccinations are carried out by the Practice Nurse (see Child Health). She will also carry out other vaccinations, by appointment.

Flu Vaccinations

Flu vaccinations are administered from early September to March each year. It is recommended that the following groups should be immunised against flu:

  • Over 65 years of age
  • Children (from 2 years up to and including primary school children) see Child Flu Programme
  • Diabetics
  • Respiratory disease, including asthma
  • Stroke
  • Chronic heart, liver or kidney disease
  • Chronic neurological disease, eg multiple sclerosis
  • Poor immune response due to illness or medication including absence of spleen or a dysfunctional spleen
  • Patients in long stay residential care
  • Health care workers
  • Unpaid Carers
  • Pregnant women at any stage of pregnancy

Pneumococcal Vaccination


Pneumococcal disease is the term used to describe a range of illnesses such as pneumonia, septicaemia (blood poisoning) and meningitis (inflammation around the brain), when these are caused by the Streptococcus pneumoniae bug. The bugs are spread by coughing, sneezing or close contact between people. These bugs get into the nose and throat where they may stay without doing any harm but sometimes they can invade the lungs or bloodstream causing pneumonia and septicaemia or they can reach the brain and cause meningitis.  

Vaccination with the pneumococcal jab helps prevent severe forms of pneumococcal disease. The risk of getting the disease increases with age. People over the age of 65 are particularly vulnerable – especially if they have a heart or lung condition, have diabetes, no spleen or have a weakened immune system, eg if they are having treatment for cancer.  

Everyone aged 65 and over is therefore now being offered a routine pneumococcal jab. MOST PEOPLE WILL ONLY NEED THIS VACCINE ONCE. Re-vaccination is recommended for people who have problems with their spleen or kidneys. Your GP or Practice Nurse will be able to advise you accordingly. 


Because Pneumococcal vaccination can be difficult to treat, an effective vaccination programme to prevent pneumococcal disease is the only sensible solution to a problem which has not improved in years despite new antibiotics and advances in treatment. 

Infants and children under 2 years of age are particularly vulnerable to pneumococcal disease. All infants will now receive immunisation against pneumococcal disease at 2, 4 and 13 months of age, along with other routine vaccinations.

About the childhood pneumococcal vaccine

  • Made in the same way as other meningitis vaccines routinely given to infants and young children in the UK
  • Used widely outside the UK, especially in the US, where it has had a dramatic impact on pneumococcal disease
  • Similar safety profile to other childhood vaccines given to infants and young children in the UK. Local reactions, like redness or swelling of the injection site may be seen and could be slightly uncomfortable for a day or so. Children might also get a fever or be irritable, which may be treated with fever lowering medication, such as infant paracetamol. Vomiting, diarrhoea, drowsiness and restless sleep may also occur

If you have any concerns, get in touch with your Health Visitor or Practice Nurse.  Further details on the Child Immunisation Programme can be found here.

Other Vaccinations

We also recommend that all adults should have a tetanus booster at least every ten years until five doses in total have been administered. If you have never been vaccinated against tetanus or polio then you should make an appointment for a full course of vaccinations as soon as possible.

Bowel Screening Programme

Bowel cancer is the third most common cancer in Scotland. During recent years, almost 4,000 people across Scotland have been diagnosed with the disease. The Scottish Bowel Screening Programme invites all men and women in Scotland between the ages of 50 to 74 for screening every two years and is seen as a major step forward in detecting bowel cancer at an early stage. We would encourage all our patients to take part in this important screening when offered. The test is completely painless, takes a few minutes and the results are available in a short space of time. If you are 75 years or over you can request a test kit by contacting the Screening Helpline on 0800 0121 833. If you would like to talk to a GP or Nurse about the programme please make an appointment or call the surgery on your usual number. Alternatively you can find out more about the programme by clicking on the link below:


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