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Should the MPIG be scrapped?

The MPIG is disadvantaging most GPs as well as their most vulnerable patients, and action must be taken to phase it out, argues leading NHS manager Alastair Henderson. But the GPC's Dr Kailash Chand disagrees, arguing that getting rid of the MPIG would destabilise general practice and hit forward-thinking GPs hardest of all.

The MPIG is disadvantaging most GPs as well as their most vulnerable patients, and action must be taken to phase it out, argues leading NHS manager Alastair Henderson. But the GPC's Dr Kailash Chand disagrees, arguing that getting rid of the MPIG would destabilise general practice and hit forward-thinking GPs hardest of all.

Yes

The chances are, if you're a GP reading this, your practice receives a degree of correction factor funding to support your minimum practice income guarantee (MPIG).

But some of your neighbouring practices probably receive a lot more for providing exactly the same level of service.

Practices at the high end may get twice the amount per patient – in global sum and correction factor payments – as others.

That's not fair on you, it's not fair on your staff and, most importantly, it's not fair on your patients who, in areas of lower MPIG funding, are known to generally have a poorer quality of life, poorer health and are dying younger.

GPs often believe that if their practice received some level of MPIG protection, they would be disadvantaged by the ending of the MPIG. In most cases, that is not true.

The majority of MPIG protection funding is being paid to a minority of practices. Many of those receive more than £120 per weighted patient from their combined global sum and correction factor payments.

If a practice's combined funding is less than about £70 per weighted patient, it is receiving less than the average and would probably be immediately better off if agreement was reached to end MPIG protection and reinvest that funding across all general practice based on the global sum formula.

Robust and accurate

This formula has recently been proven to robustly and accurately share out funding by an independent review board jointly led by the GPC and NHS Employers.

Regardless of a practice's current level of MPIG protection, its future competitive position is being restricted through the current MPIG arrangements.

New patients registering with GMS practices will automatically trigger the weighted patient global sum payment, which is currently £54.72 per year.

If the MPIG were ended and the associated funding reinvested across general practice, it is possible practice funding per patient would be considerably higher.

The current GMS and MPIG rules will ultimately be preventing many practices from maximising their future profitability.

Yet new providers entering, or waiting to enter, the market are not subject to such artificial MPIG barriers and can therefore exploit the purchasing power of commissioners at your expense.

This should not be a debate about private or non-private providers – it should be about ensuring GPs have a level playing field upon which to compete in the future.

There has been much debate about the need to ensure practice stability. Nobody has, or is, disputing that need.

The MPIG was agreed by GPC negotiators and the Government on the introduction of the new GMS contract to ensure continuity of care.

All practices have since benefited considerably from that contract and the associated protection arrangements. But time has moved on and we should focus on future practice stability.

If you were responsible for buying your weekly groceries and paid £100 because of a price protection scheme at that supermarket, but the same trolley of branded groceries cost £50 in the next supermarket, it wouldn't be long before you realised you were paying over the odds and you would switch your provider – particularly if you knew the choice of supermarkets was much greater than it used to be and there seemed to be an endless line of potential new providers waiting to build even more.

The debate should not be about why, but about how we can reduce the reliance on the MPIG and phase it out over a reasonable timescale.

The MPIG scheme is disadvantaging patients most in need and even if it is not disadvantaging your practice now, it certainly will in the longer term.

GPs should ask their local and national representative organisations what they are doing now to help end this gross unfairness and protect their continued stability as established and trusted providers of NHS care.

Alastair Henderson is acting director of NHS Employers


No

The Government now wants to abolish the MPIG as part of what appears to be a deliberate and vindictive campaign against GPs.

The MPIG was introduced because the formula used to calculate the global sum was woefully inadequate. It was paid to avoid destabilising practices without having to admit publicly that the Carr-Hill formula was an expensive white elephant.

Without the MPIG my practice would be in danger of being insolvent. I am not alone; almost 90% of practices would be affected.

The Carr-Hill formula in the GMS contract was intended to distribute general practice funding more equitably.

GPs supported distribution of funds based on equity and population needs. The problem was the total global sum was too small so the formula was unworkable – with 90% of practices losing out and needing an MPIG.

The letters between the GPC's Dr John Chisholm and Mike Farrar at the NHS Confederation clearly state the MPIG will be there as long as it is needed.

All sides agree it would be best if there were no need for the MPIG, which does cause some problems. PMS practices don't get one, making it difficult to switch back to GMS, and the MPIG does fossilise any historic inequalities.

But the GPC rightly disagrees with the Government on the means of getting to that point.

We argue it can only be removed when sufficient funding is in the global sum for the MPIG to be no longer needed. We talk of using the ‘rising tide' effect to remove the need for impact – but the tide isn't currently rising.

There is also no evidence whatsoever that the MPIG is, as claimed, a source of inequalities. Many of the practices that rely on it work in areas of deprivation.

The majority of inner-city practices under the Red Book invested heavily in staff and premises, under arrangements reimbursing them for 70% of costs. When the new contract came in, almost all qualified for an MPIG as their staff bills, which included 30% of the new costs, were high.

A real issue

If the MPIG were now to be abolished or downgraded, it would be a very real issue for these practices, which would suddenly find the funding that has paid ancillary staff is withdrawn.

Rather ironically, it would be the more forward-looking practices that would be the most hard hit – rather a disincentive to invest in the future.

I asked GPs at my local practices how they would survive without an MPIG.

One said: ‘A significant correction factor was added to our global sum to maintain our level of provision and commitment; otherwise it would have necessitated a service reduction.

Poor socioeconomic demographics are reflected in the global sum, but not by enough to meet the needs of a population with 50% to 100% more morbidity and mortality, or to reduce the health inequalities gap.'

Another added: ‘The MPIG for us is 20% above our global sum payments. With no recognition of inflation or increased overheads to maintain quality of care, removing the MPIG almost places the practice back into the pre-contract era of poor return on a high workload.'

The attenuating of correction factors will have an impact on practices and if the MPIG were to be abolished, many would be destabilised.

Some practices are thinking of reducing staff hours or doctor input, which would compromise quality of care and is not how they would wish to proceed.

The GPC agrees on the need to end the reliance on MPIG, but there needs to be a significant uplift in the global sum, or differential uplifts to underfunded practices over a long period of time.

Any sudden attempt to remove the MPIG would seriously destabilise general practice.

Dr Kailash Chand is a GPC member and a GP in Ashton-under-Lyne, Lancashire

The MPIG Alastair Henderson

If the MPIG were ended, practice funding per patient might be higher

Dr Kailash Chand

Without the MPIG, my practice would be in danger of being insolvent

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