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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)

  • 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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