Don't tamper with the global sum

How many people bolt and bar their front door, then leave their back door protected by a single small lock? This is what has happened with the new contract. While everyone has been concentrating on the obvious but minor quality framework amendments, a potentially much bigger problem has sneaked in round the back.

In a letter to primary care organisations, Barbara Hakin, chairwoman of the GMS negotiators, writes: 'For future years, we have agreement, where relevant, that increases to the global sum will reduce correction factor payments and thereby support the "phasing out" of MPIG costs.'

Really? What agreements might these be? Are they acceptable to the profession?

Are they better than the Carr-Hill negotiations, for example? Because tampering with correction factor payments is a potential minefield.

The minimum practice income guarantee (MPIG) arose because the Carr-Hill formula - meant to reward practices according to workload - was chaotic and inadequately funded. MPIG was to be achieved for all Carr-Hill losers by a correction factor that would thereafter be added permanently to the global sum if required. This was the financial basis upon which we voted for the new contract.

However, the government now has the worst of all possible worlds - no workload-sensitive remuneration for the vast majority of practices, plus a stiff bill to prop up all the Carr-Hill losers (or, alternatively, the same bill as before for the Carr-Hill losers plus extra money for the Carr-Hill winners). No wonder they want to phase out the correction factor.

But how can they develop the present muddle into a workload-sensitive system without penalising the 90 per cent of GMS practices that are Carr-Hill losers? It might look a simple problem, but it isn't.

A solution is for any increase in the global sum to decrease the correction factor by the same amount. If this happened, MPIG practices would need to take on hundreds of additional patients before increasing their overall remuneration. It would create a huge incentive: increase your list size, work harder and lose large quantities of time and money; or sit on your laurels and keep your current income.

So can the DoH change things without causing a war? More next week.

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