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MPIG to be cut by 14% each year

The Government’s plan to phase out MPIG payments will see the income of practices dependent on a correction factor reduced by an average of £1,700 a year from April 2014 until it is completely phased out in 2021, the Department of Health has revealed.

GP leaders have warned the move could spell ‘absolute disaster’ for practices that receive large sums under the MPIG, and the announcement came as the DH said it may also force through changes to the Carr-Hill formula based on an agreement reached with the GPC in 2006.

The radical changes to practice funding were first announced in October, but full details emerged in a letter written to the GPC as the DH launched its formal consultation on the changes.

MPIG payments would be reduced by one-seventh  each year over seven years. The DH said the money would be reinvested in global sum payments and other payments providing ‘some uplift across the board’ and closing the funding gap between practices.

Richard Armstrong, DH head of primary care, wrote: ‘Correction factor resources released in this way will be reinvested in global sum payments so as to benefit all practices, not just those in receipt of correction factor payments.’

Pulse revealed last month that a correction factor is paid to 61% of practices, with the average sum received £12,000 and one unnamed practice receiving as much as £370,000 a year.

The Government has previously said it expects 50% of practices to gain from changes to the MPIG, and the other 50% of practices to lose.

But Dr Nigel Watson, chair of the GPC’s commissioning subcommittee, said the changes would be an ‘absolute disaster’ for some.

He said: ‘A small number still get 30% of their income through correction factor payments. They might be a rural practice, or have a very young population or split sites. Removing correction factor payments would leave these practices unviable.’

The DH also confirmed it was preparing proposals – based on work from 2006 – to revise the Carr-Hill formula to increase the weighting for practices working in more deprived areas from April 2014.

The work by the Formula Review Group, which included representation from the GPC and NHS Employers, is to be updated by the NHS Commissioning Board and negotiated on next year – but the DH warned if no negotiated solution can be reached, it will ‘consider whether to pursue the improvements’.

A Department of Health spokesperson said: ‘We hope the NHS Commissioning Board will have an agreed and updated version in place for 2014.’

The Formula Review Group analysis recommended scrapping adjustments for rural location and the number of nursing homes, and introducing more accurate data on practice workload and an index of multiple deprivation into the Carr-Hill

GPC negotiator Dr Chaand Nagpaul warned: ‘It still needs to be translated into proper modelling of how funding is redistributed. It needs to be handled very carefully.’

Dr Mohammed Jiva, secretary of Rochdale and Bury LMC, said: ‘Removing the MPIG is going to be the last nail in the coffin for some practices. The ultimate losers will be patients – if you don’t have stability, you can’t provide patient care.’

What is in store for 2013/14?

QOF thresholds
Raised to match current performance of top 25%

New QOF work
20 clinical indicators replaced or retired, 13 new clinical indicators added

QOF shrunk by 10%
QOF organisational domain to be scrapped, with funding for 100 points shifted to fund new DES agreements

Four new DESs
DESs to expand online services, increase dementia diagnosis, encourage telehealth and incentivise case management of high-risk patients worth average of £3,600 per practice

Locum superannuation
GP practices will be responsible for paying locum superannuation costs, with funds transferred to practices’ global sum

Vaccination programmes
Programmes for shingles in the elderly and rotavirus in infants

Devolved nations
GPs in Scotland have agreed a deal with a raft of concessions on the QOF changes proposed for 2013/14. Pulse understands GPs in Wales are also in line for a less stringent deal than practices in England