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Independents' Day

Why is our funding being cut when we serve the most needy patients?

Practices in deprived areas are having their funding cut at the time they need it most, says Dr Graham Pettinger

This year is still full of uncertainty for our city centre practice. Losing MPIG means we remain under serious threat of closure unless NHS England agrees to halt its decision to withdraw the income guarantee without any commitment to replace it with an alternative funding stream.

Jeremy Hunt’s insistence that all practices should be funded on the same basis, without recognition of the marked differences of population needs and thus practice resource needs, is as divisive as it is wrong.

Andy Burnham has stated that he would stop MPIG being withdrawn, at least for the time being, so perhaps a change of government may bring a glimmer of hope.

The Government’s ‘Five Year Forward View’ may have some interesting ideas for general practice organisation and financing as a whole, and offers some possible increase in funding, but still does not seem to recognise the particular needs of disadvantaged or complex populations, and how resources could address health inequalities. Something like a pledge to protect MPIG for five years would help practices plan for the long-term.

Bring back MPIG, or replace it

There seems to be no clear decision about any successor to the badly flawed Carr-Hill formula, which has led to us and many other practices letting down populations in need.

We are now at least in regular discussion with the local area team, the CCG and Public Health England in Sheffield, all of whom have accepted in principle the figures for our practice economics, workload, and population complexity and needs. They understand that we are not a failing practice, but have survived until now in a difficult financial situation by dedication and careful use of resources. They also accept that they would face very difficult decisions about providing care to our patients if the practice were to close.

However, at present the area teams have no power to make locally flexible decisions, and the CCGs do not have a remit to vary our contracts.

All three organisations have agreed to contribute to fund a short-term independent study designed to look in detail at our workload and our patients’ needs so that they can understand why we are so dependent on MPIG.

We hope that the study will inform NHS England or CCG in their decision-making about future commissioning, and that some of our more complex work may be able to be recognised by alternative funding, but as yet there is no guarantee or clarity about this.

We are confident that we meet the criteria for the two-year reprieve, but we are awaiting a decision on this from the higher levels of NHS England, as the area team don’t have the authority to make this decision themselves. At present, our MPIG payments continue to be reduced.

We are supported by the LMC chair, and by our local Labour MP Paul Blomfield, who discussed the issue in the House of Commons. The chair of our Patient Participation Group also wrote to Nick Clegg, whose constituency covers a significant part of our practice area, but when Clegg raised the concern with Jeremy Hunt, he also received the same response as our MP: ‘the money released by withdrawing MPIG will be used to increase the basic funding that all practices receive.’

In an ideal world, NHS England should immediately stop MPIG withdrawal pending the development of a fairer and more considered alternative, in order to ensure the survival of practices that care to the UK’s most in-need patients.

But at the very least, the Government must acknowledge that high levels of mental illness, social deprivation, drug and alcohol dependency, homelessness and language barriers all increase resource needs. It is time to end the inverse care law for good.

Dr Graham Pettinger is a GP in Sheffield.

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Readers' comments (5)

  • I completely agree with the above. MPIG cuts have disproportionately hit deprived (and rural) areas.

    Medical evidence is very clear - depravation is linked with poorer health outcomes and the inverse care law is always talked about but nothing done!!

    Unfortunately most new DESs and CCG schemes seem geared towards the elderly population and does not take into account the vastly reduced life expectancy with depravation and hence this population does not benefit from enhanced care.

    A national solution to this is needed as area teams are not capable of dealing with this.

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  • Mass resignation from this crazy system is what is needed, when you can see 40+ patients each day and still go bankrupt or shut your practice because of some arcane mathematical principle. How can we work so hard in a system that is so short of doctors and still be losing money. GPC, either do something or resign forthwith; you are killing General Practice by letting GPs go to the wall.
    It has to be like the Musketeers - all for one, one for all. Please ballot for resignation.

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  • I always thought it was deprivation that was linked with poor outcomes, however if depravity is bad for health outcomes we should have it banned for the public by statute and not just for Doctors by the GMC.

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  • Good article.

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  • This is one story that appears to have passed the national news media by, though it has been covered widely by regional TV news & politics programmes here in the North East. I went to London to lobby Hunt about this. I may as well have saved the 90-odd pound train fare & a lost working day. I fully intend to make this issue rise up & bite the Tories in the arse in the run-up to May 7th. If all GPs resigned their contracts a fortnight this Friday, the plywood curtains would be going across the windows of all surgeries the week before the election. That would focus minds.

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