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GPs to be paid to battle for patients

By Steve Nowottny

GPs are to be paid to battle each other for patients as part of a Government drive to intensify competition and widen patients' choice of practice.

The MPIG will be scrapped to encourage GPs ‘to attract more patients' and specific incentives will be handed to expanding practices, ministers have announced.

The Government set out the plans in its primary and community care strategy, released last week as part of Lord Darzi's NHS Next Stage Review.

Under the proposals, PCTs would pay practices ‘allowances' to open up closed lists and expand practice boundaries. Payments for expanding practices are already in place in a number of areas, including Tower Hamlets PCT in east London.

The Department of Health remained tightlipped over whether GPs would eventually lose the right to set their own practice boundaries altogether.

But the measures prompted a ratcheting-up of hostilities between the DH and the BMA, with health minister Ben Bradshaw accusing GPs of operating ‘gentlemen's agreements' not to compete for patients.

GPC chair Dr Laurence Buckman described the claims as ‘absolute nonsense'.

‘We are specialists in family medicine,' he said. ‘We're not running shops.'

Ministers believe scrapping the MPIG, upon which 90% of practices are reliant, will force practices to become more competitive. They also intend to scrap the QOF square root formula so payments are more closely related to disease prevalence – encouraging recruitment of patients and case-finding.

Officials also admitted for the first time there was no guarantee MPIG funding would all be reinvested in the global sum, with money set to be diverted to incentives for new work. Primary care tsar Dr David Colin-Thome told Pulse: ‘It would either go into LESs or DESs, or into the global sum – that's for negotiation.'

The admission means practices could have to take on extra work just to remain viable, and sets the stage for a major battle with the BMA in the next round of negotiations.

GPC leaders refused to comment on the detail of the Government's proposals, which are now subject to ‘active negotiation', but warned they would continue to insist on an overall uplift to the global sum before agreeing to phase out the MPIG.

Lord Darzi's review placed patient choice of services – and competition among providers – at the core of the Government's vision for the NHS.

Detailed practice information will now be published on NHS Choices to help patients choose a practice. And, as revealed in Pulse in April, PCTs have been told to give the new wave of polyclinics sweeping catchment areas, in many cases stretching right across a PCT.

But Dr Vijoy Singh, chair of Leicestershire and Rutland LMC, warned the plans to boost competition would lead to private-sector companies ‘cherry-picking' young healthy patients. ‘They will create such turmoil in general practice that it will probably lead to the meltdown of the NHS,' he said.

Lord Darzi Lord Darzi How the Government plans to put GPs against each other

• Axing the MPIG to make practices chase patients
• Launching local incentives for extending practice boundaries
or keeping lists open
• Overhauling the QOF square root prevalence formula
• Publishing detailed practice data and patient feedback on NHS Choices
• Giving new wave of polyclinics PCT-wide practice boundaries

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