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Small practices set for contractual changes over MPIG withdrawal

Excusive: Small practices are set for contractual changes to protect their viability following the withdrawal of MPIG, says NHS England after it promised to protect ‘outlier’ practices where MPIG payments make up a significant proportion of their income.

The committment comes after lobbying from rural GPs and their members of parliament, who are more likely to be reliant on MPIG, with one MP saying that health secretary Jeremy Hunt was ‘sympathetic’ to GPs’ problems.

The governing body of the NHS told Pulse that it was prepared to negotitate different contractual arrangements with the GPC for the ‘very small’ number of practices that heavily reliant on MPIG, although it stopped short of one proposal to grant practices in rural areas ‘specialist centre’ status.

DH officials confirmed earlier this year that around 100 practices are currently heavily reliant on the MPIG, and said that NHS England may have to consider different ways of funding their services.

The GPC has demanded that practices in England are informed in advance about how the MPIG will be withdrawn, and then surveyed to approve the process before it begins.

In contrast, the Scottish Government has put the abolition of MPIG on hold and the Welsh Government has guaranteed it will protect the practices that will be hardest hit, such as single-handed or rural practices.

The exact arrangements will now rely on negotiations with the GPC, but rural practices have been mounting a campaign to get their local MPs to highlight the drastic impact the withdrawal of MPIG would have on their viability.

Dr Karen Massey, a GP in Lancashire, has started an petition titled ‘Save our rural GP surgeries’ on the Government’s e-petitions website. It has nearly 400 signatures.

She told Pulse that after lobbying from her and her MP, Nigel Evans, the health secretary has promised to arrange an audience for with NHS England senior officials to discuss her concerns.

Dr Massey said: ‘There will be a large number of practices that will have no choice but to shut their doors. We need the Government to recognise rurality in its calculations – so that little practices like ours will be able to survive.’

Nigel Evans, MP for Ribble Valley in Lancashire, has already met with Mr Hunt to discuss the cash crisis, which will cost some small surgeries almost £100,000 a year by 2020. Mr Evans said Mr Hunt was ‘sympathetic’ to GPs’ problems.

Mr Evans told Pulse he wants the Government to give ‘specialist centre’ status for practices in remote areas with low patient numbers, leading to extra funding.

Other prominent MPs are also pressing the case for rural practices. William Hague, MP for Richmond in Yorkshire and former Conservative party leader, and Scarborough and Whitby MP Robert Goodwill are pushing for a joint meeting with Mr Hunt in October to raise GPs’ concerns.

National Parks England, which represents 15 areas of mountains, meadows and moorlands across England, is also campaigning on GPs’ behalf. Chair Jim Bailey said in a letter to Sara Eppel, head of rural policy at the Department for Environment, Food and Rural Affairs that older people will be disproportionately affected if surgeries shut. ‘Closure of any of the few remaining GP surgeries in our remote rural areas would have a significant detrimental impact.’

Dr Giles Horner, a GP at Egton Surgery in Whitby, said he would lose £70,000 a year and they would have to lose a GP.

He said: ‘We are stuffed. There are only two of us. You couldn’t cover the workload with just one GP. The funding formula doesn’t work for us – we are in the North Yorkshire Moors in a national park and we can’t just go out and get extra patients.’

An NHS England spokesperson told Pulse that it was ‘committed’ to ensuring that patients in rural areas can continue to access appropriate GP services.

She said: ‘We want to ensure that there is a fairer system of funding for all GP practices, with money for GPs shared more equitably depending on the numbers of patients they serve and the health needs of those patients (with funding per patient weighted to reflect factors such as age and rurality).

‘As part of the contract settlement in 2013, it was therefore decided to phase out the MPIG top-up payment.  Only some GMS practices benefit from an MPIG payment and this will be reduced by a seventh over a seven year period, starting in April 2014.

‘The money that this releases will then be used to increase the basic funding that all practices receive for the number of patients they serve.  In this way, the money released from MPIG will be distributed in a more equitable way that reflects needs of practices’ registered populations.

‘NHS England is also committed to working with the GPC and other stakeholders over how to handle the very small number of “outlier” practices where MPIG payments make up a significant proportion of their income.

‘Different contracting arrangements may need to be considered to ensure appropriate services for their local populations.’