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MPIG-reliant practice faces 25% drop in funding after NHS England backtracks on protection for 'outliers'

Exclusive A GP practice is considering slashing opening hours and cutting staff after it was told by area team managers that there was ‘no money’ to protect it from a 25% drop in income due to the withdrawal of MPIG.

GPs at the Rowhedge and University of Essex Medical Practice in Colchester said that despite initial assurances they would be protected, they had recently been informed by the Essex area team that they were unlikely to have any additional funding allocated to them.

The practice is set to lose a quarter of its funding as one of the 98 ‘outlier’ practices that were given initial assurances by NHS England in December that they would be protected from the swingeing cuts in funding brought about by the withdrawal of MPIG over seven years from April.

However, as Pulse reported earlier this month, NHS England last month revised its initial commitment by refusing to give outlier practices any guarantee they would be protected.

The practice told Pulse it will lose at least 25% of its funding, which could increase to 34% if the practice fails to win contracts to provide enhanced services. This amounts to around £33.90 per patient and the practice is already planning drastic action to survive.

GP leaders have said that the situation was ‘appalling’, with some practices effectively being ‘dumped’ by NHS managers despite facing a huge reduction in resources.

Dr Alan Speers, one of the GPs in the surgery, said their practice was so dependent on MPIG because one of their sites serves students at the University of Essex and the other is in a rural area.

He said: ‘We are looking at a 25% reduction in our practice income, so we are pretty screwed basically. We thought we were going to be given some funding going forward and we have been told there is no funding.’

Dr Speers said that they had been pursuing managers for weeks for reassurance, after they were informed in a letter from NHS England that they may be eligible for additional funding as one of the largest MPIG ‘outliers’ in the country.

He said: ‘We pursued NHS England locally for the past two months and finally got them in [last] Monday to be told that there is no money in the kitty.’

The area team said it would come back in a month, Dr Speers, but they were already considering drastically cutting back their opening hours to half-days, refusing all new patients and potentially the ‘job security’ of some members of staff.

He said: ‘We were thinking that OK, we are probably going to lose some money, but common sense will prevail and no one can survive with a 25% loss in their funding. But actually they seem quite happy for us to potentially fail.’

Essex LMCs chief executive Dr Brian Balmer said Dr Speers’ practice was one of those practices in serious trouble because the promised national agreement to protect practices heavily reliant on MPIG had never materialised.

He said: ‘[NHS England] say “we know this may require funding”, but they know well that the area team there is going to say “there is no funding”. So we are really less than impressed.

‘We think some of our practices have just been dumped, and nobody cares. That practice is not alone, we have several practices in our area which are financially unstable, we just don’t know how many more will be in the next few months. We have a couple already saying that they need exact figures because they are going to be writing redundancy notices. I am not sure that NHS England realises that primary care is about to shrink in some areas.’

GPC deputy chair Dr Richard Vautrey said the situation was ‘appalling’. He added: The letter NHS England sent out to area teams suggested some solutions that they might offer to practices, such as enhanced services, or merging, or working differently. But there was no money to fund this and area teams are left with no realistic options to offer these practices, which is completely unacceptable.

‘It will have a hugely destabilising effect on these practices, and not just the 98. There are other practices as much if not more deserving who are also going to lose large amounts but haven’t figured in the 98 in line with NHS England’s calculations. Managers at NHS England are fully aware [of area teams doing nothing to protect outliers]. We have told them repeatedly that the situation is unacceptable and they are choosing to plough ahead regardless.’

Dr Vautrey said the situation was further complicated because the GPC does not know how many practices will be affected, since NHS England is withholding the names of practices most affected by the MPIG withdrawal.

NHS England Essex director of commissioning Ian Stidston said: ‘As part of the GP contract settlement in 2013, MPIG top up payments are to be phased out over a seven year period. A national audit of practices receiving MPIG payments has been carried out and based on the calculations around how the resources will be equitably allocated it showed that of 98 outliers nationally only four practices in Essex are significantly affected.

‘We are working with those practices to help them make a smooth transition to the new funding arrangements, including reviewing the full range of services they are providing to highlight any opportunities they have to generate additional income.’


Readers' comments (24)

  • Surely this is a simple issue, you provide what is funded for. if there is no money you provide the absolute minimum as required by the contract. If that means increased referrals to A&E etc so be it. You must get patient groups involves so they know the situation.
    It'll hurt your professional pride but its not as if there is a choice.
    On the other hand you could just be a martyr and carry on as you are and work for free.

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  • Peter Swinyard

    In my 25 years in medical politics, I have become increasingly cynical about any long term "deal" as our contracting authority seems to be able to rip up a bipartite deal with no consequences to it at all.

    I remember when on GPC in 2002-5, the MPIG deal was heralded as protecting outlying practices "in perpetuity" until the global sum rose to remove it, allowing the intended redistributive effects of the contract deal to take place. GS/GSE has not risen enough and a practice like mine stands to lose funding equivalent to the profit share of one of my part time partners (we have me on 8 sessions and two partners on 6 sessions). We are not an exceptional practice in anything other than having a young patient profile.
    The other "long term" deal was the pensions agreement under which doctors, especially GPs, agreed to pay a larger percentage of their income to protect low paid NHS workers was also torn up last year and swingeing rises in the contribution rates to the NHS Pension are demoralising my younger partners and will inevitably lead to an exodus from NHS General Practice.
    Who will still be there to look after me in my dotage (which some say is forecast for next year....)?

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  • I hesitate to ask but will their funding be less per patient than other practices in the area?
    What truly exceptional costs do they have and what are their profits or are they running a Rolls-Royce Service?

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  • There are some populations that no longer make business sense to serve - it time get out of those areas. It's up to NHSE then to find someone else who will do it for the monies available.
    GP's don't have automatic right of protection but NHSE must provide the NHS health care as a statutory responsibility. Its their problem not the practice's. This is a seven year plan so plenty of time to restructure.

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  • Practices with young populations are weighted low by Carr-Hill formula and so it is probable that a University practice may receive 40% less funding per patient than other practices.

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  • re anonymous : 1134am - you are right - CHF very biased against young practices. Regrettably young people also consult lots- may not have multisystem morbidity like the elderly but also have stoicism-failure at times from which the elderly do not suffer

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  • Carr-Hill formula is based on decade old consultation patterns and even then only a relatively small number of practices were looked at. Even the method of deciding workload was more pragmatic than truely accurate.
    That is one reason that it did not work well then, and little has changed now.

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  • MPIG reliance maybe due to variosu factors.
    1) Atypical population (as mentioned by Dr.Speers)
    2) Abnormal workload requiring more staff- ? due to area served, type of population-deprived, inner city, socio-cultural factors.i.e. historically needed more funding
    3) rarely organizational factors.
    If the government imposes MPIG loss without reason , practices will have to find savings.Given the nGMS in 2004 was negotiated when average consultation was 2.5 consultations per patient per GP the practice can impose a maximum appts based on same figure and anyone who can`t get in can go to A&E. This will cause problems to local economy and CCG but will make others take notice.

    The best alternative which is fair would be based on actual consultations and be paid a HRG tariff for GP consultations per 10 min, per 5 min, nurse consultations, telephone consultations, cost for form filling, reviewing reportsand lttrs from hospital etc.
    GPC needs to work out a tarrif for primary care please

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  • Keith Taylor

    This will be highly damaging for the practices concerned and their sustainability will need to be closely monitored. Hopefully the proposed revision to the Carr-Hill Formula will soften the blow.

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  • Vinci Ho

    This is no longer about how much GP earns into pocket , it is about the money to look after patients , in a way 'their money' . Get this across to your patients.
    Pure oppression !

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  • the current reality is that the funding per patient does not get anywhere near covering cost for patients. hence why QOF and enhanced services have become a part of core income for the practice.
    If you're lucky to be in an area which has a tolerable workload then great, but this will change.
    It is rather perverse that the most efficient part of the NHS is being run into the ground.
    But we still need to focus on cutting our cloth, if it means no admin and doing everything your self , then so be it. Of course each consult would need 1/2 hr to ensure all necessary admin is done for each patient

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  • You'll want to FOI the MPIG data from your LAT for your area. Here 1/7th of practices have over 10% of their income from MPIG. If one in 7 practices fall over or really struggle as a result, how will the local economy manage with A&E and referral rates soaring. What impact will there be on neighbouring practices? This is really dangerous.

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  • Essex seems to be suffering disproportionately: first only one GP left in Frinton-on-Sea and now the imminent demise of a University practice in Colchester.

    If the problem is the miniscule funding for young populations expected to have minimal health requirements, will any practice be able to afford to take on students anywhere?

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  • When we were given a vote about whether to accept the new contract we were promised MPIG in perpetuity. Had we not been given this promise, I for one wouldn't have voted to accept. I wonder how many others wouldn't have agreed either?
    What is the point of having ANY consultation, ANY votes, ANY 'promises' if the DH/NHSE simply rips up any agreement it can't be bothered with?

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  • Why is it only the DOH can rip up contracts and decide when they will back out of negotiated promises on pay and pensions etc.

    Practices which tried to have a reduced service to Xmas had the book thrown at them, anyone opting out of dangerous service at risk of problems.

    Time whole profession said no to things - and they can't sack the entire GP cohort without political suicide.

    Time for the BMA to - Stand up for our profession and GP pay and pensions, stop the tendering out of core work, and forcing us to essentially subsidise the NHS with pay cuts to continue funding the practice and staff.

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  • Took Early Retirement

    BMA stand up?? Can't ever see that happening. Peter S, I was one of the 20% who voted "No" as I saw all this type of thing coming, though not in its finest details, of course, and I remember your brief appearance on DNUK, telling us off for daring to go against the wisdom of the GPC!

    Actually, the BMA should have torn it all up on the day Carr-Hill numbers were published, then there would have been no need for MPIG at all.

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  • The DOH can back track on anything. Do we need to stay ? Can we not follow the dentists ? What is stopping us ? Either we stay and soak up this utter claptrap or we leave. At what point in time will the GPC ballot on leaving. That is the only thing the BMA can do, unfortunately. There can never be an agreement with the DOH as they always go back on any contract.

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  • Took Early Retirement

    5.28- Quite right. I'm going. 100 days now, and some of that holidays.

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  • If the government wishes to provide health care to area where there is less financial insentive to do so (i.e. rural, high student, etc) then it must be prepared to subsidise the cost, rather then expecting the GPs in these area to simply earn less. It doesn't really matter what formular they use as the funding is adequate.

    If they wish not to do so, DoH will have to be prepared for black pockets of health care where no GP surgery exists.

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  • can never trust nhse ever again..i am usually against industrial action but it is well past time for us all to reconsider...or at least else to deal with an amoral bunch of bullies

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  • As a practice who stands to lose 25% of its funding as well, I do remember that the DOH promised the MPIG 'in perpetuity'.
    As a result
    1. Is there a legal challenge against the change possible from the 98 practices acting together?
    2. Have the BMA looked into this?

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  • Drachula

    What I find staggeringly incompetent is that we still don't actually know what we will be paid next year. CCGs and practices have to be registered and approved. I would like to see the same system for NHSE and the DoH....

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  • Drachula

    Fee for service does sound attractive as feb 17 12.19pm. Perhaps the true cost of GP services might then be demonstrated.

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  • Can I suggest this is an opportunity for those practices (or areas) to make drastic changes to the way they operate and place the blame squarely at the door of NHSE.

    I do feel sorry for those GPs who it affects the most (and their patients) but I think that the government will continue to act the way they do until they get some blame for what is happening.

    If I were a partner in those -practices I would consider the following:

    a - 25% reduction in funding means 25% reduction in appointments available - any extras are diverted to ambulance or A+E. Any complaints diverted to NHSE.

    b - All unnecessary hospital work gets diverted back to the hospital department - at the bottom mark please consider this another referral if needed - so that it costs the NHS money overall for new appointment. Things like stitches removed/ follow up blood test/ etc/ etc. - It might help sure up the local hospital funds as well.

    c - a re-evaluation of all the extras (LES/ DES/ etc) to ensure all of them are value for money to the practice and stopping those that provide more work than money.

    If I was being treated this unfairly I would have no problems in practising in a way that reduces my practice's burden to an absolute minimum, even if it meant that the NHS budget as a whole is screwed over.

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