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MPIG set to be phased out within seven years in sweeping overhaul of GP funding



GP practices are facing a radical reshaping of practice funding after the Government laid out plans to phase out the minimum practice income guarantee (MPIG) over the next seven years in order to achieve ‘equitable core funding’.

The plans, disclosed today by the Department of Health, would move all practices to a common capitation price, based on current average expenditure on the global sum, correction factor payments under MPIG, and basic elements of PMS funding, from April 2014.

The plan was initially drawn up by the BMA and NHS Employers, but the GPC said the DH’s controversial announcement that it could impose a series of radical changes to the GP contract for 2013/14 had ‘overturned’ any prior agreement to pursue the phase out.

Today’s announcement on the MPIG applies to GMS practices, but the DH said the NHS Commissioning Board, which it has tasked with taking forward the plans, was likely to follow the same approach for PMS agreements, subject to consultation with practices.

The MPIG was originally agreed by the GPC and the Labour Government in 2004 to ensure financial stability and continuity of care when the new GMS contract came in, but successive governments have for a long time tried to phase out the payment on the grounds that it is inequitable to some practices. The Doctors’ and Dentists’ Remuneration Body (DDRB) estimates that around 61% of GP practices currently receive an MPIG payment alongside their core funding.

The details of the plans are set out in a letter to PCT and SHA chief executives from the DH’s national managing director of commissioning development Dame Barbara Hakin, which outlines in detail proposed changes to the GP contract for 2013/14, including plans to retire organisational QOF indicators and offer GPs a 1.5% practice funding uplift.

But Dame Barbara said the phasing out of the MPIG would not kick in until 2014/15 because of the scale of the work needed to implement the changes.

She wrote: ‘[The plans] would mean moving in a controlled and phased way towards equitable funding for all GP practices, based on the numbers of patients they serve with an appropriate weighting for demographic factors that affect relative patient needs and practice workload. Given the work needed to prepare for these changes, these changes would begin from April 2014 and would not affect the 2013/14 contract.

‘The department intends that these changes should include appropriate adjustments to the capitation formula to ensure that sufficient weight is given to deprivation factors.’

But GPC deputy chair Dr Richard Vautrey told Pulse: ‘We haven’t agreed anything, as the imposition [of the 2013/14 changes] has overturned everything we were working on. The DH wanted to reduce funding differences between PMS and GMS over a very short timescale. We said it would cause significant destabilisation and pushed them to a seven year timescale but in addition this had to be agreed by the profession once they had seen modelling at practice level. We would therefore only proceed if the majority of GPs agreed.’