The predicted swings in funding with the removal of the MPIG are disturbing, but they only represent one piece of the jigsaw in the Department of Health’s planned revamp of practice funding.
The DH claims that half of practices will gain, and half will lose, but this assumes that the envelope of funding remains the same.
The wildcard is the DH’s plans to revamp the Carr-Hill formula to increase the weighting for deprivation and the age of a practice population. How this works in practice will be crucial for smaller practices in more affluent areas who stand to lose the most.
The larger move towards a ‘single weighted capitation price’ contains so many variables – PMS funding being the biggest – that it is almost impossible to predict how practice funding may look from 2014 onwards.
These, in a sense, are the ‘known unknowns’ – to coin a Rumsfeld – but the bigger elephant in the room is the Government’s larger agenda by introducing the changes.
In shifting funding to more deprived areas, ministers are risking the political fallout of practices in leafy traditionally Tory-supporting areas going to the wall. Can they afford the wrath of the worried well once they find out their local GP practice is closing?
The answer may lie in a little-known ‘manifesto for whoever wins the election’ published in 2010 by the right-wing think tank Policy Exchange. This suggested that MPIG should be abolished and practice funding be redrawn to allow cash to follow a patient. Its rationale? This would allow greater competition in GP services.
Suddenly the complete picture looks a little clearer.
Nigel Praities is deputy editor of Pulse