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Gold, incentives and meh

Funding changes could lead to practices closing, NHS England chief admits

Exclusive A senior NHS England official has told Pulse practices could close as a result of ongoing GP funding redistribution such as the withdrawal of the minimum price income guarantee.

In an exclusive interview with Pulse, Dr David Geddes, who is head of primary care commissioning and a GP in York, said that support provided by NHS England to MPIG-affected practices did not necessarily relate to financial support and said he wasn’t expecting ‘cheque books to come out and just create another small MPIG’.

Dr Geddes also said that he expected practices to ‘merge’ or ‘move’ as a result of the changes to MPIG.

His comments come after Pulse revealed that no area team in England has committed to offer financial support to practices despite NHS England’s previous promises to protect ‘outliers’ through measures such as commissioning extra services from them.

NHS England has continued to claim that area teams will support practices but, when asked whether he could guarantee no practices will close, Dr Geddes said: ‘Well, I can’t say that. Because obviously what you are implying there is that we will be focusing on all practices and saying that “none of them will ever close”. Some of them may decide to, some of them may merge, some of them move.’

‘We do know that there are some practices that will actually see themselves and say that actually this doesn’t really fit, this doesn’t really work.’

Dr Geddes said that actually area teams are providing support although it was not financial.

He said: ‘I can understand the anxiety and there is a lot of focus on what are the financial solutions that might be presented by NHS England area teams [but] what we need to do is to actually ensure area teams are supporting discussions at practice level. Now, I don’t think that means that we will immediately be coming along with a cheque book and say here, let’s buy another new service from you.’

Asked if the cheque book might come out eventually, he said: ‘Well I think what we aren’t expecting is for the cheque books to come out and just create another small MPIG. In other words, provide some backfill with no purpose, no attached sort of quality issue, or no attached service development.

‘So it is not like we want to replace like for like, we want to move away from that. But it is about recognising that if we have got practices who will need some transitional support, who have identified an additional service they provide, or quality they can deliver, then actually we want to work with the CCGs in establishing better ways of managing that.’

Some practices, such as the Jubilee Street Practice in Tower Hamlets, have already set a ‘red button closure date’ just months away if no funding materialises.

Related images

  • Dr David Geddes May 2014

Readers' comments (17)

  • I think we should embrace this. Ultimately the MPs won't take problems within general practice seriously until we see some closures., particularly if wealthy areas become unviable communities due to lack of medical provision . This may be for the good in places with inefficiency and will redistribute resources more equitably. In other areas it will rapidly become apparent that primary care is struggling and the voters will express their concerns at the ballot box when they realize they have been lied to. The left over GPs will be snapped up soon enough but the governments hand will be forced by economic reality.

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  • Who is going to merge with a failing practice?

    I would like to see the GPC offer guidance on how to wind up a practice with minimal fuss and redundancy cost to the partners - eg can you switch to a limited liability partnership and then close things down.

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  • NHS England gets more sinister with time.

    I suspect NHS England may have been told unless they introduce radical changes they may cease to exist.

    There are many career dr's who could not survive otherwise!

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  • It isn't Dr Geddes' practice which is under threat is it ???.

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  • We came back from PMS. We never experienced the joys of MPIG. Whats it like?
    If the government do relent, do we get some extra money too, I mean it would be unfair otherwise!

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  • PMS was the labour gravy train for all their constituencies the Tories are correcting an injustice that we in the shires had to endure as poorly performing inner city practices were rewarded regardless of their poor health outcomes

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  • Behave yourself 1105pm - 'shires' & 'endure' should not be in the same paragraph re GP issues. Your irony though maybe appreciated!!!!!! Humour lives on!

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  • Vinci Ho

    A human recording machine playing the same message over and over again. Well done NHSE or Ministry of Plenty(rf. 1984)
    Mind you , a machine is cold hearted anyway.....

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  • Nothing will improve until the whole system falls over . By desperately trying to prop things up we prolong the agony . The tipping point is near .

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  • Practice failure/closure is part of the overall government policy of destabilising the NHS and giving it to the private sector. First the community services then secondary care now general practice.
    Join the fight for practices starting in East London. What the GP press

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  • I agree with Ron that destabilisation and closure are seen as good outcomes by the Dept of Privatisation (previously Health). Federation is a way of closing small practices and bigger ones are better for takeover.

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  • If your neighbouring practice closes - NHS england will just allocate the patients to you - so we all suffer as even efficient well run practices, who are already feeling over stretched as list sizes are growing because all the new housing being pushed up on every spare bit of land.
    In our area you cannot move for building sites building new homes, homes but no additional infrastructure ie health, education or any other social provision.
    There is no additional funding to support expanding premises or workforce. And no one is fighting our corner. There is a general election next year now is the time to mobilise and let Joe Public really understand what is happening to the very good local GP practices and who is responsible. Campaign now and very hard..

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  • Is he the same Dr Geddes who on bbc radio file on 4 called for more efficency savings in the wasteful NHS:

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  • Trying to recruit more GPs while letting those you have go to the wall. How ironic is this. It is insane. The system is so bad because these GPs are working so hard, seeing 40+ patients a day and still going under. The real problem is the GPC who lie back and let this happen with no answers.

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  • The fact that NHSE is prepared to let practices go bust and the partners face personal financial disaster through no fault of their own changes the relationship between GPs and the NHS.
    If the NHS has no sense of responsibility or loyalty to its workforce, there is absolutely no reason why we should show any loyalty or responsibility to the NHS.
    Who in their right mind would be prepared to take on this risk without any safeguards?

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  • 1106 Absolutely right. I belong to a generation that did 80 hour weekends with 3-4 hours sleep [ over 700 of those],168 hour weeks etc. The NHS exists purely on the the dedication of it's staff. Now, as workloads increase for the same money or even less and a patient consultation is only worth £ 3.00, it is time to let the NHS go.
    How can it be right that our Contract has an arcane formula where a GP can go bust seeing 40+ patients and working 12-13 hour days because of a bizarre calculation called MPIG. ? And, worst of all, we, the colleagues and the GPC, their representative, speak fine words at conferences but let the GPs they look after go to the wall. The whole lot should fall on their swords and let someone else do the negotiating.

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  • Negotiation requires someone who is able/willing to negotiate. The current bunch want the death of general practice without having the balls to pull the trigger. The GPC do the best they can with no real weapons. We will not resign en-masse and we will not strike. We won't refer all long term care to hospitals and we won't even prescribe everything as brands. In short we care too much about the NHS and our patients to be able to look after ourselves.

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