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PCTs will let QOF losers go to the wall

By Steve Nowottny

Scrapping the QOF square root formula will trigger the closure of dozens or even hundreds of practices, the GPC has admitted.

Negotiators warned that PCTs were failing in their duty to agree local deals to prop up practices penalised by the changes, plunging some into financial crisis.

The dramatic admission over the impact of changes to the formula linking QOF pay with disease prevalence comes just weeks after negotiators pledged that no practice would go to the wall.

It has fuelled concern among grassroots GPs over how the GPC has handled recent contract negotiations, after its admission that this year's stage of the MPIG phase-out may also be ‘unfair' to many practices.

The embattled GP negotiators are now to enter crisis talks with health minister Ben Bradshaw in a desperate attempt to keep afloat the big losers from the abolition of the square root formula.

Some are set to lose up to £100,000 a year in funding, and negotiators had agreed with the Department of Health that primary care organisations would bail out the most extreme losers with local deals.

But Dr Laurence Buckman said: ‘Some SHAs and PCOs have made no attempt to contact practices.'

Practices in London alone are set to lose £11m, and so far not a single PCT in the capital has begun talks on a rescue package.

Dr Buckman warned the crisis left ‘tens, maybe hundreds' of practices at risk of closure: ‘It's a small number, but for their patients it's 100%. There are university practices facing a serious drop in income where they will have to question their viability or sack people. We're not talking about a few quid, we're talking huge sums.'

Dr Michelle Drage, joint chief executive of Londonwide LMCs, said: ‘Practices do feel let down. You're not going to see a practice suddenly destroyed by it, but you will see them severely unsettled and possibly destabilised.'

Some GPs are furious that their only lifeline is the DH's non-binding request for PCTs to support practices.

Dr Richard Van Mellaerts, a GP in Bethnal Green, east London, whose practice covers Queen Mary, University of London, will lose a ‘five-figure sum' from April. He said: ‘Unless there's a written contract, there's no obligation on PCTs to do anything. It's really worrying the GPC is negotiating things like this.'

A picture of utter confusion is also emerging over plans agreed by the GPC and Government to begin phasing out the MPIG, with Dr Buckman admitting the proposals negotiators signed up to may lead to an ‘unfair' redistribution of resources.

The GPC and NHS Employers conceded the temporary for-mula brought in to begin the phasing out of the MPIG, due to be applied to any pay uplift this April, fails to reflect extra services some practices may provide to earn their correction factors.

The two bodies have launched a survey of GPs, ending this week, effectively asking them to justify their payments, as they seek to come up with a new phase-out formula.

GPC chair Dr Laurence Buckman GPC chair Dr Laurence Buckman QOF and MPIG changes on the table

QOF prevalence shake-up
• Square root formula to be scrapped from April, with true prevalence used to determine QOF payments from April 2010
• Practices in deprived areas likely to benefit, whereas those with low chronic disease rates will lose out
• PCTs were told to discuss with LMCs how best to support losing practices – but many, including all 31 PCTs in London, are yet to begin talks

MPIG phase-out
• Negotiators agreed a ‘differential uplift' of different parts of GMS contract as first step towards phasing out
• But GPC and NHS Employers now admit some practices may have ‘historic reasons' for high correction factors
• Survey of 500 practices with highest correction factors due to conclude this week

How GPC has changed its tune

'No practice will go under as a result of these changes'
Dr Richard Vautrey, GPC deputy chair – November 2008

'Some practices [are at risk of folding] – tens, maybe hundreds.'
Dr Laurence Buckman, GPC chair – February 2009

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