For the first time, the new GP contract enables PCOs to commission local services to meet local needs. Previously, the national 1990 GP contract allowed little flexibility in what services were provided locally, and to what specification. New, locally agreed contracts should ensure that patients, particularly those with long-term chronic diseases, have access to specialised services or treatments catering for a specific local need in primary care. These Local Enhanced Services (LESs) are commissioned by local negotiation, using the same structure and principles as NESs as detailed in the previous chapter to meet specific local needs.