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100 MPIG-reliant GP practices face possible closure after DH rules out additional support

GP practices in England that are heavily reliant on the MPIG will have to get by without any special measures to protect their viability when the phasing out of the correction factor begins next year, the Department of Health has ruled.

DH officials have confirmed that around 100 practices are currently heavily reliant on the MPIG - but said they will not receive any form of protection when the funding is gradually removed over seven years from April 2014.

The DH told Pulse that it had taken the decision because the affected practices were typically those catering specifically for unusual patient populations, such as homeless clinics or practices that serve only care homes. The DH said it would be up to the NHS Commissioning Board to assess whether the practices should be commissioned under different contracting arrangements to ensure their services continued.

The DH also confirmed that by the time the phase-out ends in 2021, the full £110m currently handed out as MPIG payments to GMS practices will be redistributed evenly across GMS practices.

The income of practices in England which are dependent on a correction factor will be reduced by an average of £1,700 a year from April 2014, although there is wide variation in how reliant practices are on the MPIG.

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The GPC has demanded that practices in England are informed in advance about how the MPIG will be withdrawn, and then surveyed to approve the process before it begins.

However a DH spokesperson refused to confirm if the GPC’s demands would be met, saying this would be up to the NHS Commissioning Board, which assumes responsibility for managing GP contracts from 1 April.

He said: ‘The NHS Commissioning Board will need to look at practices which serve more unusual populations and which will be affected by the phasing-out of MPIG.’

‘The board may in future need to commission services differently for these practices, for instance services for care homes or for homeless populations, rather than seek to pay for these services through the general funding formula.’

Dr Peter Swinyard, chair of the Family Doctor Association, said: ‘I’m all in favour of equitable funding, but it is quite a risk to some of those practices which are reliant on an MPIG system.’

‘If you were to do it more imaginatively and have a practice allowance which was aimed at the administrative costs, in other words the demand of patient care, then I think you would have a much more acceptable way of redistributing the money.’

Dr Mark McCartney, a GPC member and GP in Pensilva, Cornwall, said the 100 practices would have to start negotiating in different ways to ensure their survival, and warned that rural practices could also be hit hard.

He said: ‘It’s a real worry. I think particularly for the small or rural practices that are heavily dependent on it. The model contracts the Government seem to be moving towards don’t seem to leave any particular allowance for rurality.’

‘They’re talking about renewing the Carr-Hill formula but I can’t see how that is going to replace what will be lost with MPIG.’

GPC deputy chair Dr Richard Vautrey said there was concern the changes would affect the viability of many practices.

He said: ‘There will be some outliers that will need support to enable them to remain viable. This could be homeless practices or other practices with particular specialist patient populations.’

‘But the vast majority of practices, they will be tied up to the plan that the Government has put in place. We have concerns because the Government has not spelt out how it is going to change funding for GMS as a result of the changes they are doing to PMS. That is the key to the survival of practices long term.’

‘The essential point on which the Government has to be absolutely clear is that all money is going to be retained within general practice. We had asked that all affected practices should be consulted on changes but that is clearly not going to happen now.’


Pulse Live: 30 April - 1 May, Birmingham

You can find out more about how to protect your earnings at Pulse Live, Pulse’s new two-day annual conference for GPs, practice managers and primary care managers. Richard Apps, partner at RSM Tenon, will be presenting a session on how to maximise your practice income and keep an eye on your cash flow.

Pulse Live offers practical advice on key clinical and practice business topics, as well as an opportunity to debate the future of the profession, and a top range of speakers includes NICE chair designate Professor David Haslam, GPC deputy chair Dr Richard Vautrey and the Rt Hon Stephen Dorrell MP, chair of the House of Commons health committee.

To find out more and book your place, please click here.