A new year & a new DES: is this a chance to regain control?

James Bennett is a salaried GP in North Yorkshire and an NIHR In Practice Fellow

Another week in general practice and another change. My inbox has been slowly filling with the steady stream of emails updating our team on the new contract Directed Enhanced Services (DES) we as a practice are choosing to fulfil to best meet the needs of our patients within our local NHS. For international and new-to-UK general practice readers,  DES is a nationally agreed menu of healthcare services that English general practices can opt to offer to patients. These result in additional fundinf to the practice (to cover those services). DES can cover a wide range of areas, including cancer screening, cardiovascular disease prevention, enhanced health in care homes, and vaccination and immunisation.¹

The introduction of the new DES from April 2025 has again been heralded as an opportunity for primary care to take control and lead on improving the range of services available to patients. Hopefully also giving a sense of empowerment to a workforce that has often been left feeling that managing the ever-changing landscape is beyond their individual or collective control.

Reflecting on the emailed lists of new updates to practice, new coding templates, and recall systems to ensure payment, I am reminded of Andah et al’s article from BJGP Open a few years ago.² It is well worth the read but in summary describes the link between workforce motivation and retention of staff within that workforce. Findings from this rapid review of the literature were analysed against a framework from Rosabeth Moss Kanter’s work around workforce motivation explaining that meaning, membership and mastery are fundamental pillars in supporting staff to stay within any given workforce. Perhaps most relevant to the recent DES changes are the clear descriptions of how a perceived lack of control can have a negative impact on workforce motivation and ultimately whether people stay or leave.

Any period of adjustment causes a degree of stress and increased administrative work. Being forced to adapt and develop new ways of working erodes our sense of ‘mastery’, no longer feeling that we are experts in a role that has once again changed. The sense of ‘meaning’ changes too; why are we changing? What does this all mean on a local/regional/national scale about the role of a GP in the NHS? Importantly is it worth it? Finally a change in our sense of ‘membership’, an increased need for community and support within our work as we evolve into new systems of work, visibly being part of a team trying to achieve this together. My growing list of emails would suggest that locally at least people are trying to support each other through this. However without clearly defined mechanisms to discuss ways of working, address emerging concerns or worries, and importantly guide each other though periods of change we can quickly be left feeling confused or isolated in our work and subsequently demotivated.

Time will tell what the longer-term impact of these changes will be on an already overstretched workforce. Will we see a resurgence of energetic motivated practice teams, or will it prove to be yet another heavy yoke? Despite this I am optimistic and hopeful that DES will help to deliver what we want it to; a more effective and bespoke service for local patient populations and a workforce that feels empowered and more in control of the work it does. Maybe this increased sense of control will even go so far as to start to positively affect the motivation and retention of GPs in primary care. After all, a change is as good as a rest … Isn’t it?

References

1. https://www.bma.org.uk/advice-and-support/gp-practices/gp-service-provision/enhanced-services-gp-practices-can-seek-funding-for [accessed 4/4/25]
2. Andah E, Essang B, Friend C, Greenley S, Harvey K, Spears M, Reeve J. Understanding the impact of professional motivation on the workforce crisis in medicine: a rapid review. BJGP Open. 2021 Apr 26;5(2):BJGPO.2021.0005. doi: 10.3399/BJGPO.2021.0005. PMID: 33653705; PMCID: PMC8170605.

Featured Photo by Glenn Carstens-Peters on Unsplash