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NHS England to commission new services from practices hit by MPIG withdrawal

Exclusive: NHS England has instructed its area teams to commission additional services from the 100 GP practices in England worst affected by the withdrawal of the minimum income guarantee, Pulse can reveal.

In draft guidance prepared for area teams, which has been shared with the GPC, NHS England has told its regional teams to investigate the reasons why the practices are heavily affected by the withdrawal of the minimum price income guarantee (MPIG), looking at factors such as rurality and atypical populations.

The guidance – which will also list the 100 worst-affected practices when it is sent to area teams – instructs local area teams to commission new services based on their findings to ensure the needs of patients continue to be covered.

The Government initially announced the withdrawal of the MPIG over seven years when it imposed the current contract on GPs this year, with payments being reduced by one-seventh every year and the money being put back into the global sum.

It initially said it would not protect outliers – those practices that are most badly affected – but made a u-turn earlier this year following a backlash from GPs and politicians when it emerged that some practices in more rural areas would need to close once the payments start being reduced.

This guidance followed talks with the GPC and has ended the uncertainty that led to some practices making contingency plans to reduce staffing levels before April.

GPC negotiator Dr Beth McCarron-Nash said that NHS England has identified 100 practices that will be particularly badly affected by the withdrawal.

She added: ‘The top 100 will be treated as, obviously, special cases but [area teams are asked to] identify “whether there are some exceptional factors not captured by the Carr-Hill formula which means that these practices cannot reasonably be expected to provide the services within these adjusting funding mechanisms”. For instance, many of these outlier practices are providing services for an atypical population – they might be very rural, they might have a very small list for a very good reason, due to geography.’

Dr McCarron-Nash added: ‘LMCs will have to play a vital role during this process to ensure that these practices are treated in a fair and transparent way.’

GPC chair Dr Chaand Nagpaul welcomed the Government’s acknowledgement that some practices would need protection, but said it was important to note that removing the MPIG was part of last year’s contract imposition and not something agreed with the profession. He added that there was likely to be fallout following the ‘arbitrary’ cut-off set by the Government at 100 practices.

He said: ‘It is important to note that this forms part of last year’s imposed changes so it is not something that we support or agree with. But we have always argued that there should be special consideration for when practices are covering special population needs. It is an arbitrary issue as to where the cut-off is, NHS England has chosen this cut-off, and obviously there will be debate about this, and who falls under this threshold because it is arbitrary after all.

‘What we are doing is we are trying to mitigate the worst effects of this.’

Dr Nagpaul also questioned the decision by NHS England to handle the MPIG withdrawal separately from its review of PMS contracts, after the GPC had called for PMS money to be redistributed within general practice.

He said: ‘The changes to GMS are being made without consideration to redistribution from the PMS budget. If money ends up being taken out of PMS budgets and out of general practice, that will be detrimental to the profession.’

NHS England confirmed that it will be sending out a guidance document to area teams but declined to comment on the content.

Readers' comments (3)

  • How did they decide who the 100 worst affected practice are? Is it isimply based on £'s per patient or was it based on profitability? A highly profitable practice could be less affected by a higher £'s per patient drop than a practice with a low profitability by a low £'s per patient drop!

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  • It does seem arbitrary and therefore unfair, particularly if you happen to be the 101st worst affected practice! The basic issue is that Carr hill (and any formula) is imperfect and does not truly reward workload or more importantly activity. If the government want GP's to rise to meet the ever increasing demand for access to core services, then we need to be paid for the actual work we do (not the potential demand on services, which may or may not be met). The current formula based funding straight-jackets the necessary investment/expansion in Primary care workforce and premises. The time has come to redress the balance by incentivising the most cost efficient part of the NHS by allowing GP's to be paid by PBR!

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  • careful what you wish for 12.22pm. PBR in the modern era might be connected to outcomes (non-exception coded) rather than activity. This is the way commissioning is moving. The partners would take the financial risk if the outcomes were not achieved.

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