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.’
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