Historically the minimum practice income guarantee (MPIG) was used as a sticking plaster to deal with perceived inequalities that emerged as part of the Carr-Hill formula. It was meant as a temporary measure but was never phased out, so practices that receive it have not downsized their spending to prepare for its withdrawal. It doesn’t seem right that two similar practices in the same area might have different resources – and different services – based on this outmoded payment.
Some practices argue that the loss of the MPIG would force them to sack staff or even close, but I would like to see greater transparency in cases like these. There is nothing to protect this income stream from going into unscrupulous GPs’ pockets, rather than to clinics or staff. GPs need to make the case for funding by stating their own position if they want the MPIG to continue. Partners should be required to disclose their drawings when they claim the loss of the MPIG would shut them down. There is great variation in GPs’ take-home pay across the country and this income stream cannot be seen as a way to make more money than a neighbouring colleague.
The MPIG is sometimes used to improve recruitment in rural areas, but it’s difficult to argue that that reason alone should keep it in place. It would be easy to set up a new incentive to deal with the problems of attracting GPs to country practice, such as a rurality payment. Keeping the MPIG for rural recruitment alone is a poor defence.
The MPIG should be withdrawn, and the funds reinvested in the global sum. Income must follow the patient and GPs need to be able to practise on a level playing field again. Funding for primary care is tight for everyone at the moment and we should be campaigning for increased funds to all. But, going forward, funding must be fair and transparent. Investing the MPIG in the global sum is surely the way to ensure this.
Dr Glen Hall is a GP in Dunoon, Argyll