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A faulty production line

MPIG set to be phased out within seven years in sweeping overhaul of GP funding

GP practices are facing a radical reshaping of practice funding after the Government laid out plans to phase out the minimum practice income guarantee (MPIG) over the next seven years in order to achieve ‘equitable core funding’.

The plans, disclosed today by the Department of Health, would move all practices to a common capitation price, based on current average expenditure on the global sum, correction factor payments under MPIG, and basic elements of PMS funding, from April 2014.

The plan was initially drawn up by the BMA and NHS Employers, but the GPC said the DH’s controversial announcement that it could impose a series of radical changes to the GP contract for 2013/14 had ‘overturned’ any prior agreement to pursue the phase out.

Today’s announcement on the MPIG applies to GMS practices, but the DH said the NHS Commissioning Board, which it has tasked with taking forward the plans, was likely to follow the same approach for PMS agreements, subject to consultation with practices.

The MPIG was originally agreed by the GPC and the Labour Government in 2004 to ensure financial stability and continuity of care when the new GMS contract came in, but successive governments have for a long time tried to phase out the payment on the grounds that it is inequitable to some practices. The Doctors’ and Dentists’ Remuneration Body (DDRB) estimates that around 61% of GP practices currently receive an MPIG payment alongside their core funding.

The details of the plans are set out in a letter to PCT and SHA chief executives from the DH’s national managing director of commissioning development Dame Barbara Hakin, which outlines in detail proposed changes to the GP contract for 2013/14, including plans to retire organisational QOF indicators and offer GPs a 1.5% practice funding uplift.

But Dame Barbara said the phasing out of the MPIG would not kick in until 2014/15 because of the scale of the work needed to implement the changes.

She wrote: ‘[The plans] would mean moving in a controlled and phased way towards equitable funding for all GP practices, based on the numbers of patients they serve with an appropriate weighting for demographic factors that affect relative patient needs and practice workload. Given the work needed to prepare for these changes, these changes would begin from April 2014 and would not affect the 2013/14 contract.

‘The department intends that these changes should include appropriate adjustments to the capitation formula to ensure that sufficient weight is given to deprivation factors.’

But GPC deputy chair Dr Richard Vautrey told Pulse: ‘We haven’t agreed anything, as the imposition [of the 2013/14 changes] has overturned everything we were working on. The DH wanted to reduce funding differences between PMS and GMS over a very short timescale. We said it would cause significant destabilisation and pushed them to a seven year timescale but in addition this had to be agreed by the profession once they had seen modelling at practice level. We would therefore only proceed if the majority of GPs agreed.’



Readers' comments (8)

  • Hang on a minute, wasn't that how it worked when I started in parctice 17 years ago ??
    Or am I going senile ? Think of all the money they could have saved if they had just left it alone for the past 2 decades.....

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  • The government have won on the pensions issue and know that they can screw us any way they like confident that any backlash will be toothless.

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  • This "one size fits all" approach seems to contradict the rhetoric about about encouraging local innovation and clinical leadership in the "commissioning excellence" paper published only four months ago.
    The last funding formula wasn't fair, what make the next one any different?
    This move will do nothing but disenfranchise and destabilise innovative GP's who will be too busy trying to look after their pennies to even consider helping CCG's look after their pounds!
    Well done DH..................................Not!!

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  • What is 'an appropriate weighting for demographic factors that affect relative patient needs and practice workload' ? Hopefully any formula will be made public in contrast to the Carr-Hill (Benny Hill) formula which was, and remains, secret. From the list of published correction factors for the global sum it was probably based on: Labour MP = x 3, Tory MP = x 0.5. Top of the list, if I remember rightly, was Sedgefield.

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  • Regardless of any rationale behind this, the destabilisation efect needs to be taken into acount.
    2013/14 - removal of all the organisational QOF points and replacement of that funding by Enhanced Services (NES? DES? LES?) requiring totally different criteria (btw, who will be administering these?)
    So at a time when HMG and DH are requiring GP practices to take on massive aditional organisational and clinical work, the same practices are being told they will face major cuts (don't forget the raising of upper thresholds as well) in QOF, and a planned reduction in practice income - especially, if I read this correctly, for practices where the increased need does not relate to densley populated deprived inner cities - already heavily weighted.

    Will the leafy suburbs and Shires still vote for either party in this Coalition?

    And, if turkeys *do* vote for Christmas, do they deserve the consequences?

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  • Hey guys and girls the DH have finally hosted you, on your own patards! The day they could purchase a GP for 50-60k via the salaried option - you lost your power!! If you do not tow the line you will be made salaried with a contract and YOu WILL do what you are told...via the contract. Greed of the bankersand now they have lost and now greed of the Partners - they will be the next to loose. General Practice is a franchise with the Government and that is all.

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  • I've got an original idea....
    Why don't we get paid for the ACTUAL work we do (consultations), ACTUAL services we provide and ACTUAL quality we deliver!
    After all it IS the way every other small business in the world is resourced.
    Why the GPC insist on flogging a flawed formula based of the POTENTIAL workload POSSIBLY generated by a VIRTUAL weighted patient, is beyond me.
    The GP's posting above are concerned about spiraling demand and workload.
    Would any other small business moan about having too much work?
    NO, because they'd get paid for doing it!!!
    The insistence on funding a core contract based on potential rather than actual workload is ludicrous in the extreme, and actually creates perverse incentives which have the potential to drive down quality and access. Even QoF rewards the achievement of targets, no matter who does the work.
    If the government want GP's to do more, they have a funny way of showing it!
    Primary care is the most cost effective way of delivering health services, the DH know it (Commissioning excellence in Primary Care) and so do we. Even the Kings Fund have recognized the benefits of enhancing Quality in primary Care and suggests government pay special attention to incentivizing this.
    Why not then, facilitate growth, innovation and leadership by ensuring GP’s can rest assured they’ll be paid for the work they (or their staff) do.
    Dame Barbara Hakin’s recent letter charts the destruction of all the above objectives.
    General Practice will be in decline and the NHS and, more importantly, our patients will be worse off for it!
    I use the NHS income my practice receives to deliver ACTUAL services not to compensate me for POTENTIAL demand.

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  • Dear BMA,
    There was me thinking that 90% of consultation occur in General Practice and our gate keeping role is invaluable. The DoH should be grovelling to us not shafting us. DO SOMETHING BMA......

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