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DH set to accelerate phase-out of MPIG

By Gareth Iacobucci

The Government is planning to fast-track plans to phase out the MPIG with a tough new pay deal that would cut GP income sharply in real terms at more than half of practices.

Ministers have abandoned the complex ratio agreed last year for uplifts to different parts of the GP contract after talks broke down with the GPC.

Instead, the Department of Health is proposing to put all the 0.5% gross uplift it has promised for general practice into the global sum, meaning the MPIG, QOF and enhanced services would all be completely frozen.

Under the deal, revealed in supplementary evidence to the Doctors and Dentists Review Body, the 32% of GMS practices that do not receive an MPIG would gain a sizeable 2.6% increase in global sum payments.

But the remaining 68% of practices would receive in most cases nothing at all, although 8% of practices would receive some additional income as a result of coming off the MPIG.

Accountants told Pulse expenses were rising by 3-5% a year, which could mean a fall in income of 4-7% for practices that receive no uplift at all. For a practice bringing in £1m in income a year, that could amount to losses of up to £70,000.

‘We regret it has not been possible, as hoped, to reach agreement with the GPC,' says the DH evidence. ‘In the absence of an agreed settlement we invite the review body to follow its determination [in 2008/9] to uplift global sum only.'

The proposals would cut the proportion of practices receiving correction factors from 68% to 60%, with savings on the MPIG reinvested in the global sum.

‘The overall effect would be a 2.6% increase in global sum payments, increasing the sum per patient from £63.21 to £64.85, and reducing MPIG payments by £26m, from £131m to £105m.'

GPC chair Dr Laurence Buckman attacked the plans, warning: ‘The DH's proposals would mean a big pay cut for most practices, including mine.'

The BMA had called for a 2.05% gross uplift and had refused to consider using this year's 7:5:5:2 phase-out ratio again unless GPs were guaranteed a minimum award of 1.4% to meet rising expenses.

Mike Gilbert, partner at RMT chartered accountants, said his clients were seeing a 3-5% annual increase in expenses.

And Bob Senior, director of medical services at accountancy firm Tenon, said he expected the number of practices coming off the MPIG to be ‘much less' than the DH was predicting, which would mean more practices facing big losses.

Dr Buckman said the GPC was furious the DH was suggesting in its evidence to the review body that there was no need for an award to take into account practice expenses: ‘Expenses are going up. This is nonsense and smacks of desperation.'

But the DH said the review body's recommendation ‘does not need to cover expenses, given previous increases in income have far exceeded increases in expenses'.

Dr Laurence Buckman is furious the DH is ignoring rising practice expenses The DH's MPIG phase-out plan

- Put entire 0.5% gross uplift into global sum, freezing MPIG, QOF and enhanced-service payments

- Proportion of practices receiving an MPIG to be reduced from 68% to 60%, cutting correction factor payments by £26m (from £131m to £105m)

- 2.6% increase in global sum payments for the 32% of GMS practices that do not receive an MPIG

- Effective pay cut for the 60% of practices still on the MPIG after implementation of the deal

Source: DH supplementary evidence to the Doctors' and Dentists' Review Body

DH supplementary evidence to DDRB

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