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Over 200 GP practices to lose more than £2 per patient from MPIG withdrawal

A further 131 practices are set to lose out on more than £2 a patient from the withdrawal of the minimum practice income guarantee, in addition to the 98 practices already identified as losing more than £3 per patient, the Government has admitted.

Responding to a written parliamentary question earlier this week, Dr Dan Poulter revealed that the total number of practices losing more than £2 a patient was 229 practices, of which 36 are rural.

The new figures give weight to the GPC’s claims that the number of practices being destabilised by the withdrawal of MPIG will grow after NHS England withdrew guarantees that the affected practices would be financially supported in order to secure patient services.

Dr Poulter said: ‘NHS England undertook provisional analysis at the end of 2013 to identify “outlier” practices, those that will lose £3 or more per weighted patient per year from 2014-15, as a result of the phasing out of the Minimum Practice Income Guarantee (MPIG). This initial modelling identified 98 outliers and, of these, 15 were rural practices. Details of these practices were sent to NHS England area teams. In the small number of cases where there are exceptional underlying factors that necessitate additional funding, teams were asked to meet with the practices to discuss and agree arrangements to ensure that appropriate services for patients continue to be available.’

He added: ‘The provisional analysis suggested that a further 131 practices might lose between £2 and £3 per weighted patient per year from 2014-15 as a result of phasing out MPIG. Of these 21 were rural practices. Further analytical work will be undertaken shortly to confirm the final figures.’

The written question to the health secretary, posed by Liberal Democrat MP for Westmorland and Lonsdale Tim Farron, sought additional statistics on MPIG outliers alongside a request for the Government’s analysis of the effect on rural practices.

However, the new figures released appeared to support NHS England’s premise that rural practices were not disproportionately affected, with rural practices making up only 16% of the 229 most affected practices, compared with 18% of all English practices.

GP leaders remain concerned about the viability of MPIG practices, and last week Pulse could reveal that the third-highest practice on NHS England’s anonymised list of 98 outlier practices has been told there is ‘no money’ to invest in extra services to keep it viable. NHS England initially said area teams would be commissioning extra services from MPIG-outlier practices to ensure they could retain patient services. However, it later emerged that this was far from guaranteed, as decisions are left entirely to the discretion of area teams, regardless of their financial position.

Asked whether NHS England might reassess that decision, a spokesperson said: ‘Area teams are best placed to make these decisions based on the circumstances of individual practices within their localities and this remains the case. There are no plans to reassess guidance to area teams on this issue.’

In its latest guidance to area teams on the matter, NHS England said: ‘There have been some suggestions that the phasing out of MPIG payments has a disproportionate impact on practices in rural areas. This is not the case. Rural practices make up less than 15% of the 98 ‘outliers’, whilst they make up 18% of all GMS practices in England. The majority of practices in both urban and rural areas will gain from the redistribution of MPIG resources.’

A DH spokesperson added: ‘We want to ensure that patients have access to high quality GP services, no matter where they live. The system needs to be equitable so GP practices are paid fairly according to the number of patients and the services they need.’

‘The MPIG was introduced in 2004 to support practices moving to a new GP contract, and was never intended to be in place for the long term. The NHS will be supporting the most affected practices to adjust as these payments are gradually phased out over seven years, but it’s important to note that most practices will be better-off as a result of a package of changes.’

Readers' comments (12)

  • £2 per patient = £4000 for a typical GP. But this is only the projection for next year, which is the first phase of a 7-year withdrawal plan. Therefore the total loss will be closer to £28000 per year, per GP, in those practices.

    We will see practices close.

    PS Since the DH insist that this money will be 'reinvested in the global sum' there will presumably be GP's who will be £28k richer per annum.
    Why do I not believe that?

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  • Re above
    It's not that simple as the practices losing MPIG will also gain a percentage of the reinvested money via global sum, so the losses will be less. It's still terrible!

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  • We GP`s are scrabbling for £2 hand-backs when we could be paid per consultation!
    The cost of OPD appointment in hospital is £200 approx - which is similar to private consultation with consultant. We should ask for similar HRG tariff as private GP`s and walk out of NHS.
    We won`t earn much more but our workload will be much less and can devote more time to patients.
    How the government rations the number of consultations is up to them.
    The average consultation rate has gone up exponentially over last decade while the take home pay per consultation has tanked.

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  • It's simple - some practice in certain area will be non viable and will close. If the partnership are in financial difficulty, existing partners will end up with debt - despite working 50+ hours/week.

    If I were them, I'd quit now and look for a salaried post or even better, do locum. Sadly, all enjoyable thing in primary care such as continuity of care will also disappear.

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  • this is an absolute disaster. what are the BMA RCGP and GP negotiating team doing about this. why are they letting this happen?

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  • BMA/GPC are no longer effective representatives for GP partners and it's high time we woke up to this.The removal of Mpig over 7 years is devastating enough for those affected but the reduction in income to Pms practices with immediate effect is vicious and will render a good number of practices financially unviable .Practices who reluctantly decide for the first time ever that their only option is to make some staff redundant may have to think again when they discover the reality of the ridiculous BMA contracts for salaried doctors and Agenda for Change nursing staff and the 'continuous service' rule meaning a salaried doctor in his 40's who may only have been employed by you for 3-4 years is entitled to redundancy pay dating back to their initial nhs service ...a sum of probably £90,000 .
    Laurence Buckman at a roadshow prior to the 2004 contract was asked by an audience member whether the BMA had considered as a back up plan GP's opting out of the NHS and contracting services back to it. or going private as the dentist did,his response was that the BMA had no interest other than negotiating contracts for our services with the government within the NHS and I suspect little has changed in this regard.
    The government of course knows this and also knows with the current BMA mindset they can bulldoze through anything they want without an effective opposition.The minor concessions that the BMA harp on about after 'negotiations' are peripheral to the elephant in the room that this government want to destroy GP partnerships and they will..very soon.
    Unless a tangible alternative to the BMA arises that represents GP partners specificically with all options on the table we have only ourselves to blame when our demise slams us in the face.

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  • Sadly, I agree 100% with 0.13.
    Every decision made in the last 2 years has been about destroying the partnership model of general practice. The government / NHSE say that the current model is unsustainable and CG is advocating a salaried service. This is only true because the government have made it true and want to sell off general practice to private provider friends. All they need to do to save the current model is reinvest some of the money removed, but they will not do this. The BMA do not care and support the salaried doctors, not partners.
    I have got out as I saw this coming, but I feel desperately sorry for those left behind and only hope that somehow the government support them when it all implodes, which it surely will. I can only assume that they don't want to see lots of bankrupted ex GPs. Hmmm......

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  • 7.14 am: what makes you think that the the government dose *not* want to see lots of bankrupted ex-GPs?
    Unless, of course, you think they are too stupid to realise that if a small business is unsustainable financially, the only option is closure which may mean bancrupcy for the owners?
    After all, the support for this government from those likely to be affected has already been lost...

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  • I have absolutely no faith that the government care about bankrupted GPs....hence my decision to leave and my cynical Hmmmmm......

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  • Also BMA/RCGP cabal represent large urban practices who can afford to let partners attend BMA meetings far removed from their practices at the expense of any rural practice representation. One cheer for democracy.

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