An LMC has become the first in England to reject the offer made by NHS England to mitigate the effects of the withdrawal of MPIG.
Cambridgeshire LMC said that the process for supporting practices that were most under threat from the withdrawal of the minimum income price guarantee was ‘unreasonable on a number of grounds’ and ‘unfit for purpose’ in Cambridgeshire and elsewhere.
It has written to the NHS England local area team and NHS England’s head of primary care commissioning, Dr David Geddes, calling on them to review the package.
The support package, which will postpone the withdrawal of the MPIG for two years for the worst affected practices, was given a lukewarm welcome by GP leaders, who said it was ‘encouraging’, but warned that it was a ‘short-term sticking plaster’ solution.
But the statement from Cambridgeshire LMC is the first outright opposition to the deal, and the LMC says that other areas are likely to follow.
The LMC argues that the postponement was originally designed in London to resolve some high-profile threats of imminent practice closure, but that this review process ‘is completely unfit for purpose in Cambridgeshire, though many of our concerns would indicate it is also unfit for purpose everywhere else as well’.
The move by Cambridgeshire LMC follows the offer of a deal to practices in London to delay the withdrawal of MPIG for two years for the worst hit practices, which NHS England has said will be rolled out across all local area teams.
This was after a campaign by practices in east London, led by the Jubilee Street Practice, highlighting the possibility of closures.
NHS England said that the offer will be made by all local area teams to the practices identified as standing to lose the most if the plans to remove the whole of the funding over seven years, introduced as part of the contract imposition in 2013/14, were to go ahead.
In order to be eligible for support, practices need to meet seven criteria, including: a reduction in GMS global sum funding greater than £3 per weighted patient in 2014/15; no doctor in the practice declaring pensionable earnings in excess of £106,100; and have practice expenses greater than 63%.
But Cambridgeshire LMC argued that several of the criteria ‘can only have been written by people who don’t understand or value general practice’.
It said the £3 per weighted patient figure was ‘an entirely arbitrary level, offered without any rationale, and is a hard cut-off figure’.
Health minister Dan Poulter said that halting the withdrawal of the MIPG for this year would cost up to £11m.
The BMA repeated its calls for urgent protection for practices adversely affected by the changes in light of the scale of the issue.
GPC negotiator Dean Marshall told Pulse that he understood Cambridgeshire’s position: ‘I think that NHS England has started from the wrong perspective – instead of coming up with a template to help all of the 98 outlier practices they have started from “how can we solve the problems in London?”.
‘Clearly the financial package seems to be designed to solve the problems with practices specifically in London and not in places like Cambridge that has university practices, for example, or other rural locations.’