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At the heart of general practice since 1960

New plan may snatch away GP pay choice

The choice of pay systems dangled in front of GPs may be snatched away under a new plan set to be considered at the emergency LMC conference next month.

GPs would lose the chance to opt for the deal that paid their practice most.

Instead, every practice would be pushed into the minimum practice income guarantee (MPIG) in the first year of the contract and forced to switch to an improved Carr-Hill formula in the second.

Prominent GPC members have thrown their weight behind the controversial NHS Alliance proposal, claiming it offers the only hope of salvaging a Yes vote in the ballot.

They say it would also offer the chance to collect more accurate practice-level morbidity data as the quality framework and enhanced services would operate during the year when all practices were paid via MPIG.

But the plan ­ backed in a unanimous vote last week by the influential GPC primary care development sub-committee ­ has drawn ire from GP negotiators and the NHS Confederation.

Their irritation was heightened by its emergence just as GPC chair Dr John Chisholm and NHS Confederation chair Mike Farrar wrote to all GPs hailing MPIG as a mechanism to ensure every single practice could gain under the contract.

Dr Julian Neal, chair of the primary care development sub-committee and chair of the emergency LMC conference on May 14, said: 'If you mention Carr-Hill this year people will vote No. It's completely dead in the water.'

Dr David Jenner, NHS Alliance contract spokesman, said: 'It would be complete folly to have two formulae running at once ­ never mind one that is fundamentally flawed.'

GPC member Dr Kailash Chand said a No vote was a 'grave danger' because of GPs' 'abhorrence' of Carr-Hill. He added: 'MPIG will protect losers but there is already growing anger towards the gainers.'

Dr Clare Highton, a GP in Hackney, east London, and co-chair of City and Hackney PCT professional executive committee, said: 'It would be very divisive to put those who gain on Carr-Hill and the rest of us on MPIG.'

But GPC joint-deputy chair Dr Simon Fradd branded the plan 'barking mad'. He said: 'Why should people who can gain lose in the short-term? By waiting a year, the MPIG doctors are not going to do any better, they're just going to make the winners do worse.'

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