Darzi review must not destabilise practices

Lord Darzi's 'Next Stage Review' was broadly welcomed when it was published at the start of last week.

With its focus on quality, driving up standards and improving patients' experiences it was hard to find fault.

But, as with all such things, the devil is in the detail, and it wasn't until Thursday, when the DoH published its 'Vision for Primary and Community Care', that we had an indication of what it all might mean for general practice. And it seems big changes to how practices are funded are on the cards.

As expected, the DoH signalled its intention to phase out the MPIG. It also revealed plans to overhaul how prevalence is calculated and to shift the focus of the quality framework so that it incorporates more preventive work. The latter could make it harder for practices to score as highly as they have in recent years.

Individually, each of these elements is cause for concern, but taken collectively most practices would face a significant hit to their income, and some would find it difficult to survive.

Of course, this is all still just a DoH wish list, and whether some or all of these changes are implemented depends on negotiations between NHS Employers and the GPC over the coming year.

The GPC is not averse to the idea of getting rid of the MPIG, but only if the global sum increases to the point where no practice loses out.

Let's not forget, the reason the MPIG came into being was because the government did not invest enough in core funding in the first place.

The intention was always that the MPIG correction factors would decrease as core funding rose year on year.

But, with little increase in income since 2003, 90 per cent of practices still rely on the income guarantee.

The government says that the MPIG preserves 'unfair' historic incomes and, as such, is a barrier to reforms in primary care - in particular, to allowing patients to choose their GP surgery.

Yet it has done nothing to create a situation where the payment is not necessary.

If the DoH is serious about ending historical trends in funding, then it needs to invest in the global sum to ensure that existing practices do not lose out, or worse, struggle even to survive if the MPIG is scrapped.

If not, it risks destabilising general practice as a whole and, consequently, endangering many of the improvements in patient health that have been achieved in recent years.

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