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MPIG might fly

GMC Arora

It has always struck me as odd that GP practices in deprived areas weren’t necessarily funded more than practices in more affluent areas. Under the current Carr-Hill funding formula for GP practices in England, the age of your patient population is the most significant factor in determining a practice’s funding.

Ever since the funding formula was introduced in 2004, the debate has raged whether this should be the case, and there have been a number of attempts to change this. Finally, it looks like we might actually see some change.

Dr Nikki Kanani, the NHS England director of primary care, last week called for the formula to change so practices in deprived areas more funding. They are struggling to recruit far more than those in affluent areas with a higher percentage of older patients, she said, and it is increasing health inequalities.

Last year, LMCs voted for a change in Carr-Hill to prioritise deprivation. With both NHS England and the profession seemingly in agreement, this should see a change in the 2024/25 contract (the next major negotiation).

Except, of course, it’s not that simple. The reason it has never changed is that it will create losers, as well as winners. For members of the BMA GP Committee, it’s been impossible to get a consensus because either they individually or their constituents would lose funding. And all practices – even those in less deprived areas – are struggling in some way.

There is, of course, a ready-made solution. When the 2004 contract was introduced, there were funding winners and losers then as well. But those who lost out were given a funding boost in the form of the minimum practice income guarantee (MPIG). It was imperfect, but it ensured deprived practices – among others – could actually survive. But this was phased out and, since then, a number of practices have closed, citing the withdrawal of MPIG.

We should be adapting the funding formula to benefit deprived practices. But, alongside this, we need a new MPIG to support practices who will lose out. It will mean more funding, but that’s better than practices closing, or vulnerable populations missing out on care. This idea might just fly.

Jaimie Kaffash is editor of Pulse. Follow him on Twitter @jkaffash or email him at


Seun Akande 22 June, 2022 6:21 pm

Thanks Jamie.
I worry about this approach of ‘winners and losers’.
At the end of the day it may just mean the problem is shifted elsewhere.
Practices who benefit from the Carr-Hill formula at present do so for a reason, some for the very high burden of frailty within their catchment. Depriving them of needed funding will create another set of problems.
Why not use an index of deprivation to sift out the practices serving the most deprived areas and then offer them additional funding?
There’s another pitfall to avoid.The impression that the inability of practices in deprived areas to recruit is solely down to a funding problem.I have worked in deprived areas and there are often a multitude of other factors such as availability of decent housing, accessibility /transport, good schools and availability of employment opportunities etc. Inequality isn’t always a health issue.And providing money isnt always equal to providing resources.
This is a typical wicked problem that’s not amenable to a solution. But clever interventions might help.

Vinci Ho 23 June, 2022 10:56 am

Multi factorial indeed
At the end of the day ,GP( and other medical professionals working in these deprived area practices) need to have enough incentives to work there . That is simply common sense as far as human nature is concerned. The system needs to offer more , apart from money , to these practices to retain and recruit key professional staff .
It is difficult to know whether a ‘new’ MPIG is sufficient to provide the answer(s) .🤔🤨

David Jarvis 23 June, 2022 6:11 pm

I do wonder if MPIG should not be conflated with deprived areas underfunding. You might argue that MPIG actually fixed variations that were historical inequities in funding not necessarily in favour of the deprived areas. The Carr Hill meant some more affluent areas were where practices would lose out. Now MPIG is a whole lot more complicated than that because some practices were funding outliers. A good example being holiday areas who gained more funding from TR’s but with that had more work from TR’s. When payment was rolled up and evened out suddenly the funding didn’t match the workload. I don’t know many deprived areas where the practices had disproportionately high funding needing protection of MPIG. The last few years of working towards fair share has seen some partners income drop but some have risen also. Curious how as a practice that has been levelled up they made us take 5 years too get level as they reduced the overfunded slowly. So excuse my chip. The variation in partner income is huge and not always clearly linked to quality of patient service.