Exclusive: Smaller and multi-site practices will be hit hardest by the Government’s plans to phase out MPIG, leading to closures and increased privatisation of GP services, predict accountants.
Accountants predict the withdrawal of MPIG from the 63% of GP practices who remain on the payment scheme will lead to a ‘bloodbath’, with practices with a list size of less than 4,000 patients closing for good.
The stark warning comes after the Government revealed it intends to remove MPIG completely over seven years from 2014 in order to make practice funding more ‘equitable’.
The move comes after years of rises in global sum payments designed to shift more practices from their reliance on MPIG, but accountants warn it will disproportionately affect certain practices who are already struggling to make ends meet.
The Government says that 50% of practices will gain income and 50% will lose income from the withdrawal of MPIG, although the extent of the losses ranges from ‘a few pounds to hundreds of thousands’ per practice.
But leading medical accountant Bob Senior, of RSM Tenon accountants, said the proposals will change the landscape of general practice in England, with a gradual disappearance of small and single-hander practices and a shift towards larger practices as practices could stand to lose over £100,000 in correction payments.
He said the practices that stand to lose the most are those who don’t have ‘economies of scale’ and those with split sites who may opt to run just one site going forward to reduce their overheads.
He told Pulse: ‘A lot of small practices who are going to wake up and think “Crikey, if I am going to survive here, I am not going to do it in my current, small surgery.’ So we’re going to see federations, practices running joint services, and those who will go a step further and merge into larger units.
He added: ‘I wouldn’t be astonished if you had a number of single-handers who give up, make their staff redundant and hand their list back and say “I’m done”. Because if you look at the practicalities of running existing practices, if the funding gets cut, it is going to be a bloodbath.’
Dr Mark McCartney, a GPC member and a GP in Pensilva, Cornwall, said his practice had a below average list size and would be hit hard by the changes.
He said: ‘We see that as core income. This will slice another significant percentage off funding on top of all the other cuts being imposed on us.’
He added: ‘The danger in this policy is that we will see corporates moving in who are happy to run larger practices, practices moving from GP ownership to corporate ownership. This Government has an ideological belief that corporates will run services better, but they are wrong. Corporates do not have local interests or long term commitment. They are more interested in profits than patients care and the way they are organised they move profits overseas without paying too much tax.’
But Dr Peter Swinyard, chairman of the Family Doctors Association, said the move towards more ‘equitable’ funding would be welcomed by some practices.
He said: ‘There is no justice in the same town for one practice being on about £55 per head and another on £120 per head and expected to offer the same service to patients.’
A DH spokesperson said: ‘NHS Employers and GPC have been discussing these matters and looking at the analysis on a range of options for a number of months. At this time the discussions remain unresolved.
‘Where changes proposed by the Government would take place after 2013/14 they remain subject to discussions offered to GPC on how they might best be taken forward.’