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Revealed: The true effect of the withdrawal of MPIG funding on GP practices


MPIG


Exclusive GP practices who had been reliant on MPIG funding in England are receiving significantly less funding than those who were not, an exclusive analysis by Pulse Intelligence can reveal.

The Government has been phasing out ‘minimum practice income guarantee’ (MPIG) funding since 2014, but its rationale was that this would lead to fair funding.

The Pulse Intelligence analysis reveals, however, that practices that received MPIG funding in 2015 earned on average around £8 less per patient in 2020/21 than those who didn’t.

They earned £4 less per patient through the global sum, and less in CCG discretionary funding such as GP Forward View payments and local enhanced services.

The MPIG was introduced as part of the 2004 contract to ensure that practices who were disadvantaged through the introduction of a new funding formula would not miss out on funding.

The Carr-Hill formula, which is still in use, adjusts the global sum based on certain characteristics of the practice’s patient demographics, most notably age. But many practices in deprived areas receive lower amounts of funding under the Carr-Hill formula because patients tend to be younger, but also tend to need high levels of health care. The MPIG was designed to address this anomaly.

The Government announced that it was phasing out the MPIG over seven years from 2014. But at the time of the announcement, it indicated that it would look at reforming the funding formula.

Dr Naureen Bhatti, a GP in east London who has campaigned against the removal of MPIG, said: ‘What makes me furious is that nothing has been done to look at deprivation. MPIG was removed with the understanding that a fairer funding formula would be brought in and we would have the chance through LESs to earn more. But the figures show this is not happening.

‘We are even worse off than we were seven years ago. This is shocking. Particularly in the light of the events of the last 18 months which have highlighted health and wider inequalities by the disproportionate impact of Covid on those already disadvantaged or discriminated against.’

Dr Kaye Ward, a GP partner in the Hawkshead practice in Cumbria, which has been campaigning on MPIG since 2015, said: ‘Eventually locally we did get some support through some additional local Aytpical funding. Unfortunately, we have been informed by our CCG that they have decided to stop that as of 31 March 2022. This is despite assurances previously that support would continue to make us sustainable. 

‘We are now faced with rising demand as all practices have seen but with a sizeable drop in funding from next April. It feels like Groundhog Day again but even worse than 2015.

‘Practices who had sizeable MPIG had them for a reason – but that seems long forgotten in the commissioning world.’

Andrew Pow, board member of the Association of Independent Specialist Medical Accountants and healthcare partner at Mazars, said: ‘The withdrawal of MPIG has not been good for many practices. It counterbalanced low funding delivered via the Carr Hill formula and removing it has widened the gap in funding which is why many with a low Carr Hill factor now struggle.’

Methodology

The raw data were from NHS Digital’s publication Payments to General Practice 2019/20. We  included network DES participation fees, but no other PCN funding (including Covid vaccination payments). To give meaningful comparisons, we removed practices with ‘atypical characteristics’, as defined by NHS Digital, and practices with fewer than 1,000 patients. We removed funding for premises, dispensing costs, and reimbursement of drugs, locum fees and Covid support fees. All calculations were on a per-registered patient basis. We identified all those that received MPIG payments in the Payments to General Practice 2014/15 publication, then applied those practice codes to the most recent publication to identify ‘MPIG practices’.

For full analysis of all the data, visit the Pulse Intelligence website. PI is set to relaunch this month, with a new look and layout to make it easier for practices to identify areas where they can increase funding and expert guides to help them do so. Visit www.pulse-intelligence.co.uk for a free trial

READERS' COMMENTS [9]

David Jarvis 10 December, 2021 10:28 am

I suspect for holiday areas the issue is TR’s where payment stopped and was aggregated into global sum. Now stopped and no TR payments. For them the answer would be to stop seeing TR’s en masse. It would seem that it is effectively removed from the contract.
I will say however some of the huge variation in funding could not be justified in lots of cases. As a practice that was below the average per patient funding we have see a rise oddly with fair shares. We where slowly corrected over 5 years as other were defunded. So made to wait for equity so how mad is that.
The level of funding and how deprivation payments are worked out clearly does not help inequalities at all.

Reply moderated
Subhash Chandra Bhatt 10 December, 2021 10:39 am

My old practice was single handed with bigMpig (73 k I think) as I had big number of staff. Practice had big list size but so called waited list was much lower . Mpig loss probably resulted in reducing number of staff as only little profit can be made with waited list . Work load did not decrease.

The Prime Minister 10 December, 2021 1:05 pm

DEAR PULSE…….

I WORK IN A DEPRIVED AREA AND AM PROPPING UP A PRACTICE BY “PERSONALLY FUNDING THE SERVICE” PROVIDING A “GOLD SERVICE WITH TIN MONEY” AND REDUCING DRAWINGS AGAIN AND AGAIN AS WE ARE GROSSLY UNDERFUNDED…..I AM SICK TO THE BACK TEETH OF WORKING UP TO 15 HOURS PER DAY, BEING PAID HALF WHAT A LOCUM GETS AND HAVING ALL THE HASSLE.

IF I HAND BACK THE CONTRACT, NHSE ARE SCREWED….BUT…THEY ARE TOO ARROGANT TO REALISE THE DEAL THEY GET……IF I WERE IN THEIR SHOES I WOULD BE “PANDERING TO ME” ON A DAILY BASIS TO KEEP ME “SWEET”…..

THOUSANDS OF PATIENTS WILL BE THE LOSERS WHEN THEY START GETTING THE SERVICE THAT THEY ARE ACTUALLY PAYING FOR FROM ANOTHER PROVIDER……IT IS INCREASINGLY CLEAR THAT NOBODY ACTUALLY GIVES A SHIT ANYMORE…….BUT I COULD THEN JOIN THE LOCUM WORLD…AND HAVE A MUCH BETTER LIFE……ANY ADVICE PLEASE??????

Reply moderated
Matt Hancock 10 December, 2021 2:03 pm

The Prime Minister: You only have yourself to blame. Just give the contract back and let it burn

Reply moderated
The Prime Minister 10 December, 2021 7:56 pm

THANKS MATT…..WHAT THE REAL SHAME IS THAT MY POST WAS DELETED……A BLOODY CHEEK AND TOTALLY UNACCEPTABLE AS FAR AS I AM CONCERNED……ANYBODY WOULD THINK BORIS JOHNSON AND NHSE ARE POLICING THIS SITE…….

Grant Jonathan Ingrams 12 December, 2021 12:19 pm

“many practices in deprived areas receive lower amounts of funding under the Carr-Hill formula because patients tend to be younger, but also tend to need high levels of health care. The MPIG was designed to address this anomaly.” This statement is not true. When the first version of the global sum was published, most deprived practices would have received a huge boost. MPIG mainly protected practices in more affluent areas who due to various factors, on the whole under the previous SFA (Red Book) received much higher levels of funding. So MPIG itself watered down the funding for deprived practices due to funding the MPIG. This underfunding had been recognised as one of the causes of health inequalities. MPIG set in stone (at the time) these historic payment anomalies. Separate to this, practices with peculiar demographics for their patients, which are not recognised in the Carr-Hill formula, appropriately used PMS contracts. It is this group of practices which have been adversely affected by the removal of the so-called PMS premium. Carr-Hill did not give weighting for deprivation as the main determinant of workload is age of patients. However this means that the ‘bother’ factor of working in the less appealing deprived areas has never been recognised – so no wonder these practices have always found it the hardest to recruit GPs. Of course, the main problem is that the whole ‘cake’ for general practice is too small so however you slice it , there will never be enough.

John Glasspool 12 December, 2021 8:36 pm

Gosh! Still ongoing? When I pointed out to our LMC chair that unless Carr-Hill gave us ( in a deprived area) a positive value, we’d be looking at a massive cut in income he told me, “John- take some Prozac”. Of course, come the day when figures were released we were looking at about a 30% hole in our finances. Almost ever practice in the country had a Carr-Hill number of lessthan 100. It was clearly a farce and clearly WRONG. But instead of the BMA saying, “This isn’t right” we had this ridiculous MPIG foisted on us, which was, you may recall, “in perpetuity”, except it isn’t. You wee all sold down the river by the BMA and their lackeys in the LMCs.

Finola ONeill 15 December, 2021 3:12 pm

Renegotiate the contract and find some gonads GPs.
WE are independent contractors, provide 90% of consultations for 8% of funding.
We can literally demand what we need to make those 90% of consultations sustainably providable and then work to rule until we get it.
It is the strongest possible negotiating position.
We are not even employees. We have a contract. We have a service no one else can provide.
The only thing in our way is our own lack of gonads and the willingness and wherewithal to coordinate and take a stand.
In the end we will get what we deserve.
What we deserve depends on how wet we are planning on being.

John Evans 5 January, 2022 7:07 am

Why complain. Just act.

It is inconceivable that the govt would be able to sustain even a few days of loss of GP services. However, I am certain that the BMA will fail to act once more.

At the last crisis for GP service, when GPs held the upper hand, the BMA negotiating committee tried to tell us that it was a big win despite many of us recognising the one sided nature of the contract. The inclusion of MPIG fudge and the effective imposition of a the new GMS model by the BMA “there is no plan B” was shameful. A significant.though temporary pay increase was attached to massive admin burden. The calculation left many GPs with locked in stagnant income alongside rapidly increasing workload as QOF was repeatedly changed and secondary care workload was dumped on practices. Additional costs unfounded, such as soaring practice / staff costs including prep for CQC.

The only option for many has been to leave – reflected on the rapidly reducing percentage of partners and the long list of practices handed back.

Several years of COVID with GPs sacrificing themselves including many giving their lives, and others burning. When if the pandemic settles it will take several years for the secondary care backlog to ease – GPs left managing the patients in the meantime. By the time COVID has worked through, the increased med school numbers of recent years will have provided fresh meat to replace you. Hence, timely action to redress the damage should be pressed for now whilst you have the power.

I have logged on periodically to Pulse since giving up my partnership over a decade ago. Nothing that I have read since or indeed have heard from ex colleagues makes me regret that decision in the slightest. I have been well rid of the burden and been several hundred thousand better off.

I will collect my NHS pension imminently before the govt have any further opportunity to claw any of that back through lifetime allowance.

Apart from Cuba who over train doctors to exploit a medical workforce that is deployed overseas to source foreign currency, most societies would suffer due to policies that force a significant proportion of highly qualified essential workers to retire early. In the UK the impact has fallen on those remaining and propping up the system.

Hence, as above, if you continue to prop up the system then you only have yourselves to blame. (well not only yourselves but also any medical organisations funded by your contributions to represent your professional interests).