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Reaction: Practices given funding boost following MPIG announcement

NHS England (London) spokesperson

General practice is the bedrock of the NHS and has served patients well since its foundation, but we understand the pressures it faces in a growing and changing capital.

We have today committed to providing extra financial support in 2014/15 and 2015/16 to a small number of GP practices in London that serve patients in more deprived areas and which are significantly affected by recent changes to the GP funding system.

At the same time, we are working with leading GPs on a major programme to transform primary care services to better meet the needs of 21st century London.”

NHS England spokesperson

My understanding is, this is a London specific announcement and London has written to surgeries. Other area teams will be making a similar offer, so it will go out widely but they have got to meet the criteria [highlighted in the London offer].

But it will be happening, it won’t happen now but it follows on that we will make those announcements in due course.

Other area teams will be making a similar offer, or the same offer, if they [practices] meet the criteria.

Virginia Patania, practice manager, Jubilee Street Practice

We appreciate NHS England’s efforts to re-align GP funding of deprived practices to their income prior to the new contractual changes

NHS England worryingly refers to the Carr Hill formula as taking into account deprivation – it does not, and this impression is concerning. We are however confident in the commitment expressed to revising the formula, and would welcome the opportunity to input into this exercise.

The package does not, unfortunately, outline the value of the package offered. This is to be ~ the total annual loss as determined by NHS England arising from GMS global sum changes for 2014/15 and 2015/16  We look forward to the details of the offer, but are truthfully concerned that what NHSE determines to be our annual loss will not be what we calculate this to be (this was the case in May of this year), and would like reassurance that our rationale and mathematics, as accepted and supported by NHSE and the DoH just a few months ago, are what will be used to calculate the baseline loss.

The loss we incur will take place over the next seven years. This package will cover only the first two of these. With the losses getting worse year on year, we must have reassurance around the ongoing commitment to buffer these losses, as the funding support seems to expire once the losses become steeper. To be clear, the cessation of funding support would be like placing us back exactly where we are now, with the MPIG losses three times worse (since the removal of the funding is phased over seven years), or a loss of £10.43 per patient! There must be provisions in place to avoid this happening.

In summary: the detail of the funding has not been made available, and this is extremely concerning, as is the fact that the support will cease once the practice stands to lose, effectively, £90k per year. If this were to happen, we would be unlikely to be able to offer even so much as a six month notice period.

We are hopeful NHSE will offer clear and proactive responses to these concerns, and would welcome an open forum to discuss the detail of the offer.

Dr Richard Vautrey, GPC deputy chair

I think while it’s welcome respite for those practices, it is only a short-term sticking plaster when what we really need is real and sustained investment to level up the funding for all practices. Not just a very small number who have been identified.’

I think the other thing to say is, this is just the first sign of NHS England actually acknowledging that their policy of imposing the damaging MPIG changes has actually harmed practices and patient services.’

It’s two years that we’ve been campaigning against this. We raised our first concerns back in October 2012, we highlighted how damaging it would be almost in every meeting we’ve had with NHS England since.

So this has been a long-term consistent and hard-fought campaign, and the fact that we were on the streets of London again last week, is just a sign of what we’ve had to do to get to the point that we are at the moment’.

Dr Chaand Nagpaul, GPC chair

The BMA has been warning for years that the government’s decision to phase out the Minimum Practice Income Guarantee (MPIG) would leave a number of GP practices in challenging circumstances unable to deliver optimal patient care.  

The BMA has been contacted by a number of worried practices including those in rural, university and commuter belt areas who are concerned about their long term future. These GP services deliver vital care to a large number of vulnerable patients and need support to be able to provide the local community with the care it requires.

NHS England’s announcement today is an encouraging sign after the pressure the BMA has been exerting on the government to wake up  to this problem.

But it is not in any way enough.  While some practices will today breathe sigh of relief for the next few years, this plan does not provide a long term solution and leaves many still with no sign of help. Thousands of patients are today still facing the same situation as yesterday: a local GP practice that will increasingly struggle to provide care.”

Dr Tony Grewal, medical director of Londonwide LMCs

It is an offer to practices which are affected by £3 or more, with justification for needing it, and there are a number of other criteria that have been put into this.’

What it does means is that they’ll be looking at practice drawings, they’ll be looking at practice expenses, they’ll be looking at expenses, and other things. So it’s not a given that it will happen for every MPIG practice, practices will have to show that they are of a quality to receive the package.’