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The waiting game

MPIG payments to be reduced by average £1,700 a year

The DH has announced MPIG payments will be reduced by an average of £1,700 a year from March 2014 until it is completely phased out in 2021, with GP leaders warning it could spell ‘absolute disaster’ for some practices. 

The money gained from the seven-year MPIG phase out will reinvested partly into global sum payments and partly to other payments in an effort to close the funding gap between practices, the DH said. This would provide ‘some uplift across the board’, it added.

The correction factor payments are received by 61% of practices and the average sum received by these practices is £12,000, the DH confirmed. Previously the Government had said they expect 50% of practices to gain from changes to MPIG, and the other 50% of practices to lose.

DH figures obtained by Pulse last month found that the average practices receives £12,000 a year from MPIG, though the figure varies hugely, with one unnamed practice receiving £370,000 a year - a correction factor payment worth more than nine times its global sum.

Bob Senior, head of medical services at RSM Tenon previously told Pulse that the phasing our of MPIG could lead to a ‘bloodbath’ in practice funding, resulting in surgeries with a list size of less than 4,000 patients closing.

Phasing out MPIG in seven years could lead to a change in the landscape of general practice in England, with a gradual disappearance of small and single-hander practices and a shift towards larger practices, he said. 

Mike Gilbert, a medical accountancy specialist at RMT accountants said: ‘The DH aren’t qualified to say that 50% practices will lose and 50% of practices will gain. They don’t have access to practice accounts. It’s the practices which most heavily rely on MPIG that will lose out, but until we see the mechanics of it we won’t know by how much.’

He added that this raised questions about the funding of out-of-hours services: ‘We should also be asking what the impact is on out-of-hours. Will it be out-of-hours based on 6% of the global sum.’

Dr Nigel Watson, chair of the GPC’s commissioning subcommittee, said that that 60% of practices in Wessex rely on payments through MPIG, and that the changes will prove to be an ‘absolute disaster’ for some.

He said: ‘For some it’s under £30,000, but a small number still get 30% of their income through correction factor payments. They might be a rural practice, have a very young population or split sites. Removing correction factor payments would leave these practices unviable.’

He agreed the MPIG phase-out could change the landscape of general practice in England. He said: ‘Small practices are going to need to federate and practices with split sites are going to have to close branches. This will ultimately affect patients because practices won’t be able to provide the same quality services. Already practices are thinking about what services they can drop because unless people continue to work for less they’re just not sustainable.’

Dr Watson added that he is ‘not reassured’ by the DH’s pledge to reinvest the funds partly into global sum payments. He said: ‘The question is whether a formula is sufficiently sensitive to take account of different workloads and different populations, which of course it can’t. A formula can’t adequately reflect the difference. It’s going to be challenging, a tough time for practices.’

Readers' comments (6)

  • As a single handed City GP all this doom and gloom makes one wonder why does the NHS management and HMG hate small/single handed practices so much? Patients seem to like the personalised flexible care available in single handed practice - I had my 2,600 list closed until the beginning of this year when I was told I had to open it again and as a consequence my list has increased to 2,850 - far to many for a single hander. I suppose the idea is if single handers have open lists they'll become so large they'll be a group practice? And when they are they won't be and patients will get the supermarket different nurse maybe Dr each time - that lots of folk who come and sign on with single handers/small practices want. Don't get me wrong I think there is still a place for big supermarket style practices for fit well youngsters - its ideal if you hardly ever need to see the GP - but NHS bureaucrats and Politicians need to come out of their comfort zones in London and see what small practices provide elsewhere in the country - before consigning us all to the dustbin with yet more kicks in the teeth

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  • When mpig was proposed we were encouraged to have more staff as dhhs washed their hands to fund staff. my practice which is a small practice but have 3600 patients took more staff and correction factor was over 69k. staff are still there. if we keep then i will not earn money for work and would have no choice but to close down. i think this applies to all small practices. mpig is more then 33% of our profit.
    global some is irrelevant to us as we have young people mostly not by choice. our practice can not afford a partner even now. whole thing is ridiculous

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  • Patients have a right to be registered with a practice, and practices have obligations to registered patients.
    If-and-when rural practices are forced into receivership, who wil be allocating their patients - and on what basis?
    Some years ago, in a neighbouring locality, a practice foldered unexpectedly - but there *were* a number of other local practices and there *was* a PCT able to manage the transfer of the practice list.
    What does the Coalition expect to happen when there are no neighbouring practices available/able (willing or not) to accept the patients and no organisation responsible for ensuring that such patients are allocated to a practice?

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  • Thomas Craig

    This is good news for the 50% of practices that do not receive MPIG. Our practice never received MPIG and when it was reduced we benefited financially grately. Hence I look forwrd to MPIG being phased out.
    Practices that got MPIG had high expenses cost, which was mainly staff. Staff costs mushroomed further when the contract was introduced. Practices have to have a look at these costs.

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  • its fine to say all opractices should be funded the same...but some practices are providing more services historically and therefore the MPIG covered this cost somewhat. Are all providing phelbotomy (i think not)....if all are funded the same all must provide the same or the inequality will still remain,.

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  • Hazel Drury

    I run a single handed rural practice with 2300 patients. As we only opened in 2005 we never had an MPIG. We've nearly closed a few times and lately had some legal problems when local LHB (Wales) tried to claw some cash back, but I still keep going. Granted I have no cash to pay into a pension nor am able to take any annual leave but we cope. Rubbing my hands in anticipation of getting some extra funding from bloated unfairly funded practices so I can take a day or 2 off at some point over the next 7 years.

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