MPIG support package labelled 'unfair' by GP accountants

Support packages for practices facing MPIG losses will be extended across the country, but specialist accountants warn that 'unfair' criteria mean very few will benefit.

NHS England area teams have begun contacting practices hit hard by MPIG cuts, with details of a financial support package first announced for London last month. This will, in effect, restore MPIG for two years for a small number of the 98 practices facing the heaviest losses.

Only those identified by NHS England as outliers – losing more than £3 per patient per year – can apply for support, which was offered following a high-profile protest campaign led by east London GPs.

Other restrictions have drawn criticism from accountants. Laurence Slavin, a partner at specialist medical accountants Ramsay Brown & Partners, told GP that the criterion for no GP at the practice to have declared pensionable earnings of more than £106,100 per year was ‘foolish’, as it took no account of the source of the income.

He said: ‘If you have a GP doing work on out-of-hours or locums elsewhere, that would potentially prejudice [the practice’s] opportunity to benefit from this safety net, and it has nothing to do with the practice,’ he said. 

NHS England confirmed that the earnings cap included all of a GP’s pensionable income, whatever the source.

Practices have until 30 September to apply for and sign up to the funding agreement. Funding available to practices will be the ‘total annual loss as determined by NHS England arising from GMS global sum changes for 2014/15 and 2015/16 (and no greater than this)’.

Financial help

Funding will be provided using the provisions of section 96 of the 2006 NHS Act, which allows commissioners to provide discretionary financial assistance to primary medical service providers.

NHS England London region has refused to disclose how many practices will benefit from the two-year MPIG reprieve, or what they expect the support to cost.

Criteria for MPIG support
  • GMS global sum reduction greater than £3 per patient in 2014/15
  • No GP should have declared pensionable earnings of more than £106,100 per year
  • Practice expenses must be no greater than 63% of revenue
  • No contract breaches since 1 April 2013
  • Half of contract holders do not have live cases with NHS England performer machinery or GMC, including interim orders panel
  • Fewer than five outliers on the GP High Level Indicators system
  • Practice population must meet score of 35 or higher on Index of Multiple Deprivation, the upper quintile, to demonstrate local demographic factors not fully reflected in Carr-Hill formula

Source: NHS England

A spokeswoman for NHS England North, Midlands and East said financial support would be available using the nationally agreed criteria and it was contacting local practices. An NHS England South spokeswoman said its area teams were finalisingdetails of qualifying practices.

Mr Slavin said it was ‘unfair’ that only outliers with losses of more than £3 per patient were eligible. ‘If they are losing £2.90 per patient, they are going to get no help. It’s not graduated. It’s all or nothing,’ he said.

‘Very few’ would qualify for support, he added. ‘There is an implicit acceptance the [Carr Hill funding] formula they’ve got doesn’t work. We know it doesn’t work. So they are going to carry on with a flawed formula for everyone else. It’s stupid. If they know there is a problem, they should suspend this for 
everyone until they get it right.’

GPC chairman Dr Chaand Nagpaul said NHS England’s decision to put MPIG cuts on hold for a small number of practices had come after ‘sustained pressure’ from the BMA and local campaigns, but was ‘not in any way enough’.

‘We need a sustained, long-term and national approach that maintains these vital GP services,’ he said.

Virginia Patania, practice manager at Jubilee Street Practice in Tower Hamlets, east London, which spearheaded the campaign against MPIG cuts, said the surgery needed the reassurance of a buffer against future losses after the two-year package ended.

Worse losses

‘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 funding is phased over seven years – or a loss of £10.43 per patient. There must be provisions in place to avoid this happening. If this were to happen, we would be unlikely to be able to offer even so much as a six-month notice period,’ she said.

This comes as two main political parties answered GP’s call to make a statement in support of general practice. In his statement, Labour’s shadow health secretary, Andy Burnham, said: ‘Ministers must stop GP-bashing and accept responsibility for the growing crisis of their making.’

Liberal Democrat health minister Norman Lamb said GPs played a ‘vital role’ in communities and would be ‘at the heart’ of future changes to the NHS.GP’s call was also backed by union Unite. 

As GP went to press, the Conservative party had yet to respond with a statement.

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