Wales is, as you’ve probably realised, pretty rural, and Welsh GP practices are more concerned about the removal of MPIG than anything else. A large number of them will essentially be totally shafted by this change. In Wales you have small rural practices covering a hundred square miles with one doctor. They are affected disproportionally by a removal of correction factor payments because the global sum does not take account of unavoidable smallness, and most of these practices are small by definition.
It doesn’t take into account of a practice with multiple sites. These practices are also affected by locum superannuation (which is being transferred into the total global sum) because they need to pay locums whenever they have a holiday.
If correction factor counts for almost 20% of your total funding, the problem is that if you take that out, all of that will come out of the GP’s pay. Because it is very difficult to cut anything like that from your practices, since most of your expenses is staff pay. So GPs will, instead of making staff redundant, be taking a massive cut out of their personal income. That is what people are worried about, and quite rightly so, and what the Government does not seem to really understand.
They have partly made this argument in Scotland, and I think that is why they came to an agreement in the end. They are effectively not going to start reducing correction factor payments in Scotland, and I think that would be the difference – the thing that sold it to them. The problem of rurality in Scotland is even more pronounced – you’ve got 300-odd little islands in the middle of the North Sea, and there is no formula that takes account of that.
This means that you are left with a situation where the most vulnerable of practices, the small practices, are the ones that are worst affected, especially around the correction factor.
The bottom line is that there will be cases where it is going to be almost impossible to recruit. Many of these doctors are in the latter end of their career, and they are just wondering where the hell they are going to find someone who will actually want to take over their practice when they retire and practice income has been hugely eroded.
Now there is a huge difference between eroding a senior GP’s income eroding, when the GP feels caught up in a community they have lived in for a long time, and asking a 28- or 30-year-old GP to come in and take that practice on when they could earn significantly more elsewhere.
Not a question of fairness
Politicians seem to think this is a question of fairness, but it is not.
We now have a situation, 10 years down the road from the new GMS contract, where practices have totally changed. This introduces a whole new load of unfairness. Practices can’t increase their resources, and have relied on static incomes for the last five or six years, and this is going to take a huge chunk out of a small number of practices across the UK.
Of course, some practices will get more income from the removal of the MPIG. My practice, for example, will get more by the virtue of global sum, but I don’t want to see a couple per cent extra coming into my practice, and at the same time hear that neighbouring practices in Wales will have to close. I don’t think that advantages anybody, and it doesn’t advantage the Government either because there will be tracts of Wales where you can’t get a GP.
It is not really about ‘fairness’, and nor will it save any government any money, because it is just recycling money which is already there. It isn’t Treasury-driven; it is driven by a load of civil servants and people in audit offices, who say that correction factor is for some reason unfair.
Despite the MPIG, practices all over the country are struggling. To suddenly introduce a massive change to a small number of them, and disproportionately – where the practices most reliant on correction factor are going to have a big hit – that is unfair. Global sum practices may get a small benefit but it is something practices could live without.
I have told the Government that only if we can come to some sort of arrangement about protecting correction factor for practices, then everything else becomes up for grabs. The rest of the imposition I don’t like, but we have ameliorated it considerably compared with what is happening in England. I doubt they liked the agreement they reached in Scotland either, but probably felt that is the best they could get and that they had got to be pragmatic.
But I am not going to be “pragmatic” in the biggest recession in living memory, if it means that 20 or 30 Welsh practices are going to go bust.
Dr David Bailey is chair of the Welsh GPC and a GP in Cardiff.