DH phase-out of MPIG falls victim to cuts

By Gareth Iacobucci

The Government is to abandon plans to take thousands of GP practices off the MPIG over the next four years, after the strategy became a victim of its own primary care spending cuts.

Ministers are instead set to leave it to the GPC and NHS Employers to come up with alternative proposals for more equitable funding of practices.

The U-turn comes after the Doctors' and Dentists' Review Body called for a rethink of the Government plan for nearly 700 practices to come off the MPIG in 2010/11, because the recent pay award was too small to pay for it.

It follows the Department of Health's controversial decision to ignore the pay body's recommendation to increase GPs' payments by 1.34% - designed merely to cover rising expenses – and instead award an uplift of just 0.8%.

The DH had indicated it would press ahead with the rapid MPIG phase out anyway. But a letter circulated last week to SHAs indicated it might instead be prepared to accept the review body's recommendations for a slower timescale.

DH director of primary care Ben Dyson wrote: ‘The Government continues to believe we should move to an equitable system of GP funding as quickly as possible.'

But he admitted: ‘If no agreement can be reached [between the GPC and NHS Employers], we would anticipate accepting the DDRB's recommendations for distribution of the uplift.'

The admission has left accountants forecasting it will now be many years before the MPIG could be scrapped altogether.

Under the DH's plans, all the uplift would have been placed into the global sum, with the MPIG, QOF and enhanced services frozen entirely.

The Government had estimated 8% of practices would be taken off correction factors in 2010/11 and that just 27% of GMS practices would remain on the MPIG by 2013/14. It then planned to buy out remaining correction factors to remove the MPIG completely.

But the GPC – which is set for imminent talks with NHS Employers to decide how to carve up the 0.8% award - said ‘very few' practices would be removed from the MPIG this year because of the ‘derisory' uplift, and said the Government had fundamentally undermined its own policy by overruling the DDRB.

The DDRB is recommending half of the overall gross uplift should be invested into a combination of global sum, correction factor, QOF, enhanced services and locum payments, with the other half applied to global sum payments only with no corresponding increase to correction factor. Any released correction factor payments would then be reinvested back into the global sum.

Accountants are forecasting this approach would take only around 2% of practices off the MPIG in 2010/11.

GPC negotiator Dr Chaand Nagpaul said: ‘We will need to discuss with employers how we best ensure this rather derisory sum is spread across all practices. It will depend on exactly how the 0.8% is applied, but we are looking at very tiny numbers. The Government's interference has undermined its own policy of getting practices off the MPIG.'

Bob Senior, head of medical services at accountant Tenon, said: ‘At this rate it is going to take a long-time for the MPIG to disappear.'

'We invite the Review Body to uplift global sum only. We consider that we should be pushing harder to erode MPIG.' December 2009

'If no agreement can be reached, we would anticipate acccepting the DDRB's recommenations for distribution of the uplift.' March 2010