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GPs face evening work to keep MPIG

GPs may have to open up surgeries in the evening or at weekends to preserve their current income, Pulse can reveal.

Ministers want to stop propping up practices through the MPIG and use the cash for incentives to offer more flexible opening hours.

News of the plan comes as the Department of Health analyses two million responses to its patient survey, which is expected to intensify the pressure for flexible opening.

A Pulse investigation has also reopened the debate over access to GPs out of hours, after finding many PCTs are cutting the number of GPs on call.

But the department sees the MPIG cash as an ideal source of funding for a new system of incentives to improve access, health minister Andy Burnham told Pulse in an exclusive interview last week. 'Improving access is a key issue for us and brings us back to the MPIG. What you do with one area leads to flexibility with another. I'm keen to switch the emphasis to incentives and use the money that way.'

He added: 'It's a helpful pressure if a GP practice puts in place opening hours that suit people and improve standards. That's why the emphasis should be away from minimum income and towards rewards for people who provide services the public want.'

Mr Burnham's comments echo those of his predecessor Lord Warner, who last month told Pulse: 'You cannot go on giving a guarantee of more than £300m to general practice with nothing in return. I think this is an issue that will be driven very hard in future.'

Professor Alan Maynard, who has advised ministers on the productivity of doctors, believes docking pay for missing targets acts as a better incentive than offering additional money, and said redirecting MPIG money might be effective at improving access.

Professor Maynard, who is professor of health economics at the University of York, said: 'Mr Burnham's comments are all about trying to find a way that is revenue-neutral, because a huge amount of money has been poured into GP revenues. Now the Government has realised the quid pro quo hasn't been great in terms of access.'

But GPC chair Dr Hamish Meldrum made clear the idea of axing the MPIG in favour of

incentives was a 'non-runner'

as far as the GPC was con-cerned. 'That's part of the

basic funding to practices,

because the Government didn't put enough funding into that in the first place,' he said.

'It wasn't agreed that it would always be under review. It was a guarantee in perpetuity. Either he's been wrongly advised or he's choosing not to look at what was agreed.'

Dr Harry Yoxall, secretary of Somerset LMC, said Mr Burnham's comments were 'comparing oranges and lemons'.

'Trying to cut resources out of part of the way primary care is funded to improve access just doesn't make sense.'

Plans to link GP pay to extended opening hours would cause problems for those juggling work and family commitments, GPs have warned.

'I would be very much against it,' said Dr Claire Bailey, a locum

GP in Devon. 'There's no provision, especially for GPs that have families.

'Nobody's going to provide me with a nanny or someone to look after my children, so it would make it impossible.'

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