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Over 200 GP practices to lose more than £2 per patient from MPIG withdrawal

A further 131 practices are set to lose out on more than £2 a patient from the withdrawal of the minimum practice income guarantee, in addition to the 98 practices already identified as losing more than £3 per patient, the Government has admitted.

Responding to a written parliamentary question earlier this week, Dr Dan Poulter revealed that the total number of practices losing more than £2 a patient was 229 practices, of which 36 are rural.

The new figures give weight to the GPC’s claims that the number of practices being destabilised by the withdrawal of MPIG will grow after NHS England withdrew guarantees that the affected practices would be financially supported in order to secure patient services.

Dr Poulter said: ‘NHS England undertook provisional analysis at the end of 2013 to identify “outlier” practices, those that will lose £3 or more per weighted patient per year from 2014-15, as a result of the phasing out of the Minimum Practice Income Guarantee (MPIG). This initial modelling identified 98 outliers and, of these, 15 were rural practices. Details of these practices were sent to NHS England area teams. In the small number of cases where there are exceptional underlying factors that necessitate additional funding, teams were asked to meet with the practices to discuss and agree arrangements to ensure that appropriate services for patients continue to be available.’

He added: ‘The provisional analysis suggested that a further 131 practices might lose between £2 and £3 per weighted patient per year from 2014-15 as a result of phasing out MPIG. Of these 21 were rural practices. Further analytical work will be undertaken shortly to confirm the final figures.’

The written question to the health secretary, posed by Liberal Democrat MP for Westmorland and Lonsdale Tim Farron, sought additional statistics on MPIG outliers alongside a request for the Government’s analysis of the effect on rural practices.

However, the new figures released appeared to support NHS England’s premise that rural practices were not disproportionately affected, with rural practices making up only 16% of the 229 most affected practices, compared with 18% of all English practices.

GP leaders remain concerned about the viability of MPIG practices, and last week Pulse could reveal that the third-highest practice on NHS England’s anonymised list of 98 outlier practices has been told there is ‘no money’ to invest in extra services to keep it viable. NHS England initially said area teams would be commissioning extra services from MPIG-outlier practices to ensure they could retain patient services. However, it later emerged that this was far from guaranteed, as decisions are left entirely to the discretion of area teams, regardless of their financial position.

Asked whether NHS England might reassess that decision, a spokesperson said: ‘Area teams are best placed to make these decisions based on the circumstances of individual practices within their localities and this remains the case. There are no plans to reassess guidance to area teams on this issue.’

In its latest guidance to area teams on the matter, NHS England said: ‘There have been some suggestions that the phasing out of MPIG payments has a disproportionate impact on practices in rural areas. This is not the case. Rural practices make up less than 15% of the 98 ‘outliers’, whilst they make up 18% of all GMS practices in England. The majority of practices in both urban and rural areas will gain from the redistribution of MPIG resources.’

A DH spokesperson added: ‘We want to ensure that patients have access to high quality GP services, no matter where they live. The system needs to be equitable so GP practices are paid fairly according to the number of patients and the services they need.’

‘The MPIG was introduced in 2004 to support practices moving to a new GP contract, and was never intended to be in place for the long term. The NHS will be supporting the most affected practices to adjust as these payments are gradually phased out over seven years, but it’s important to note that most practices will be better-off as a result of a package of changes.’