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Funding changes could lead to practices closing, NHS England chief admits

Exclusive A senior NHS England official has told Pulse practices could close as a result of ongoing GP funding redistribution such as the withdrawal of the minimum price income guarantee.

In an exclusive interview with Pulse, Dr David Geddes, who is head of primary care commissioning and a GP in York, said that support provided by NHS England to MPIG-affected practices did not necessarily relate to financial support and said he wasn’t expecting ‘cheque books to come out and just create another small MPIG’.

Dr Geddes also said that he expected practices to ‘merge’ or ‘move’ as a result of the changes to MPIG.

His comments come after Pulse revealed that no area team in England has committed to offer financial support to practices despite NHS England’s previous promises to protect ‘outliers’ through measures such as commissioning extra services from them.

NHS England has continued to claim that area teams will support practices but, when asked whether he could guarantee no practices will close, Dr Geddes said: ‘Well, I can’t say that. Because obviously what you are implying there is that we will be focusing on all practices and saying that “none of them will ever close”. Some of them may decide to, some of them may merge, some of them move.’

‘We do know that there are some practices that will actually see themselves and say that actually this doesn’t really fit, this doesn’t really work.’

Dr Geddes said that actually area teams are providing support although it was not financial.

He said: ‘I can understand the anxiety and there is a lot of focus on what are the financial solutions that might be presented by NHS England area teams [but] what we need to do is to actually ensure area teams are supporting discussions at practice level. Now, I don’t think that means that we will immediately be coming along with a cheque book and say here, let’s buy another new service from you.’

Asked if the cheque book might come out eventually, he said: ‘Well I think what we aren’t expecting is for the cheque books to come out and just create another small MPIG. In other words, provide some backfill with no purpose, no attached sort of quality issue, or no attached service development.

‘So it is not like we want to replace like for like, we want to move away from that. But it is about recognising that if we have got practices who will need some transitional support, who have identified an additional service they provide, or quality they can deliver, then actually we want to work with the CCGs in establishing better ways of managing that.’

Some practices, such as the Jubilee Street Practice in Tower Hamlets, have already set a ‘red button closure date’ just months away if no funding materialises.