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A faulty production line

Small practices set for contractual changes over MPIG withdrawal

Excusive: Small practices are set for contractual changes to protect their viability following the withdrawal of MPIG, says NHS England after it promised to protect ‘outlier’ practices where MPIG payments make up a significant proportion of their income.

The committment comes after lobbying from rural GPs and their members of parliament, who are more likely to be reliant on MPIG, with one MP saying that health secretary Jeremy Hunt was ‘sympathetic’ to GPs’ problems.

The governing body of the NHS told Pulse that it was prepared to negotitate different contractual arrangements with the GPC for the ‘very small’ number of practices that heavily reliant on MPIG, although it stopped short of one proposal to grant practices in rural areas ‘specialist centre’ status.

DH officials confirmed earlier this year that around 100 practices are currently heavily reliant on the MPIG, and said that NHS England may have to consider different ways of funding their services.

The GPC has demanded that practices in England are informed in advance about how the MPIG will be withdrawn, and then surveyed to approve the process before it begins.

In contrast, the Scottish Government has put the abolition of MPIG on hold and the Welsh Government has guaranteed it will protect the practices that will be hardest hit, such as single-handed or rural practices.

The exact arrangements will now rely on negotiations with the GPC, but rural practices have been mounting a campaign to get their local MPs to highlight the drastic impact the withdrawal of MPIG would have on their viability.

Dr Karen Massey, a GP in Lancashire, has started an petition titled ‘Save our rural GP surgeries’ on the Government’s e-petitions website. It has nearly 400 signatures.

She told Pulse that after lobbying from her and her MP, Nigel Evans, the health secretary has promised to arrange an audience for with NHS England senior officials to discuss her concerns.

Dr Massey said: ‘There will be a large number of practices that will have no choice but to shut their doors. We need the Government to recognise rurality in its calculations – so that little practices like ours will be able to survive.’

Nigel Evans, MP for Ribble Valley in Lancashire, has already met with Mr Hunt to discuss the cash crisis, which will cost some small surgeries almost £100,000 a year by 2020. Mr Evans said Mr Hunt was ‘sympathetic’ to GPs’ problems.

Mr Evans told Pulse he wants the Government to give ‘specialist centre’ status for practices in remote areas with low patient numbers, leading to extra funding.

Other prominent MPs are also pressing the case for rural practices. William Hague, MP for Richmond in Yorkshire and former Conservative party leader, and Scarborough and Whitby MP Robert Goodwill are pushing for a joint meeting with Mr Hunt in October to raise GPs’ concerns.

National Parks England, which represents 15 areas of mountains, meadows and moorlands across England, is also campaigning on GPs’ behalf. Chair Jim Bailey said in a letter to Sara Eppel, head of rural policy at the Department for Environment, Food and Rural Affairs that older people will be disproportionately affected if surgeries shut. ‘Closure of any of the few remaining GP surgeries in our remote rural areas would have a significant detrimental impact.’

Dr Giles Horner, a GP at Egton Surgery in Whitby, said he would lose £70,000 a year and they would have to lose a GP.

He said: ‘We are stuffed. There are only two of us. You couldn’t cover the workload with just one GP. The funding formula doesn’t work for us – we are in the North Yorkshire Moors in a national park and we can’t just go out and get extra patients.’

An NHS England spokesperson told Pulse that it was ‘committed’ to ensuring that patients in rural areas can continue to access appropriate GP services.

She said: ‘We want to ensure that there is a fairer system of funding for all GP practices, with money for GPs shared more equitably depending on the numbers of patients they serve and the health needs of those patients (with funding per patient weighted to reflect factors such as age and rurality).

‘As part of the contract settlement in 2013, it was therefore decided to phase out the MPIG top-up payment.  Only some GMS practices benefit from an MPIG payment and this will be reduced by a seventh over a seven year period, starting in April 2014.

‘The money that this releases will then be used to increase the basic funding that all practices receive for the number of patients they serve.  In this way, the money released from MPIG will be distributed in a more equitable way that reflects needs of practices’ registered populations.

‘NHS England is also committed to working with the GPC and other stakeholders over how to handle the very small number of “outlier” practices where MPIG payments make up a significant proportion of their income.

‘Different contracting arrangements may need to be considered to ensure appropriate services for their local populations.’


Readers' comments (8)

  • How about those practices who are not rural that depend on their MPIG for survival?

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  • According to NHS England, it will apply to the very small number of “outlier” practices where MPIG payments make up a significant proportion of their income, so would not just mean rural practices. I have changed the headline to reflect this.

  • Peter Swinyard

    Many smaller urban practices also depend on MPIG - mine for example would have to lose a doctor for the loss of MPIG - due to the Carr-Hill formula which may (arguably) reflect morbidity but certainly does not relect demand. At the least, we need to return to a Basic Practice Allowance which provides for the opening-the-doors costs which are not proportional to morbidity and mortality across a population.

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  • Bornjovial

    Many reorganizations on funding seem to muddy waters and increase complexity rather than solve the problem. MPIG is far from perfect but rather than to have abolished they should have found(?already have) different models which seem to reflect demand/disease burden more accurately. As completely fair funding scheme is impossible as asking Waitrose to open branches in deprived populations. Equality of healthcare is different from open market forces. If the government wants exactly the same funding for everyone then it has to admit that deprived/very rural and high demand areas will be bereft of GP cover.
    Alternate is a small token charge of £5 per consultation and £10 per home visit and A&E attendence which can be repaid to the patient at the end of financial year. That way patient health cost is still FREE but people will think before booking an appointment. Of course some deserving people may ignore health needs rather than go to GP but the alternative is a complete system meltdown with no alternate private provider in place.

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  • Its strange how the most productive and efficient area of the NHS is being squeezed more and more. We're being set up to fight with secondary care over diminishing resources yet the PFI projects and other similar white elephant projects are not even examined.

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  • And many University practices are also very heavily reliant on MPIG.

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  • I am shocked that only 'around 100' practices are heavily reliant on MPIG. I wonder what they mean by that? 16% of our Total NHS income is MPIG which is more alarmingly 36% of our profits. We are small at 4800 list but sub-urban not rural. It looks like we have big problems ahead for our practice but I will take early retirement by then.

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  • most gms practices rely on mpig. in 2004 practices took more staff to fund practice needs .ruraL, suburban or city practice all reply on MPIG.
    mpig reduction will lead to redundancies and it will affect services. "SOME RURAL PRACTICES" will be spared sounds like saving huge amount of money but plan to look generous for needy in public eye. it is total nonsense.

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  • Until MPIG disappears and premises funding and everything else becomes part of "Global sums" General practice will remain unattractive to our chums in the private sector. Once all GP funding is in the global sum and payments based purely on a weighted formula then the flood gates will open to the soon to become multi-national health maintenance organisations and those few GP entrepreneurs amongst us who see themselves as millionniare landlords/employers of the rest of us. Federalisation, mergers its just the beginning. When you think of it me working as a single handed GP with 2,950 patients in Southampton with a bit of hired help - its a joke? Self employed business man to pretty much a single employer - we will look back in the years to come and laugh at ourselves - why did we make such a fuss? Because we deliver personal quality patient centred care that our patients appreciate - its nice to know your own GP and see "your GP" each time as the years go by. Ringing the "healthcentre" and bring triaged by the nurses' healthcare assistant before being allowed to see the nurse practitioner - will it really matter?

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