DH to scrap MPIG by 2021 in huge funding overhaul

GP practices face huge swings in income under DH plans to scrap the MPIG top-up to core funding over seven years and introduce a 'single weighted capitation price' across GMS and PMS contracts.

GPC chairman Dr Laurence Buckman: changes will destabilise practices
GPC chairman Dr Laurence Buckman: changes will destabilise practices

In a letter to PCTs and SHAs today, NHS Commissioning Board (NHSCB) commissioning lead Dame Barbara Hakin set out the detail of sweeping contract reforms the DH plans to impose on the profession after contract talks with the BMA collapsed.

The letter marked the start of a 13-week public consultation period after which the DH will be legally able to alter the GP contract unilaterally.

In addition to imposing the largest overhaul to QOF since its introduction, the DH plans to begin phasing out the MPIG from 2014, even practices were offered MPIG 'in perpetuity'.

Over a seven-year period from April 2014, the DH plans to begin moving all GP practices towards 'equitable core funding'.

A note included in Dame Barbara's letter explains: 'This would involve calculating a single weighted capitation price, based on current average expenditure on "global sum" payments, correction factor payments (under MPIG) and basic elements of PMS funding.

'GMS practices would then move over a seven-year period to that common capitation price. We understand that the NHSCB, which will take over responsibility for PMS agreements on the abolition of PCTs, would wish to follow the same approach for PMS agreements, subject to consultation with the individual contractors involved.'

The BMA has always argued that MPIG must only be phased out on a 'rising tide' basis, with practice funding being levelled out through increases to all practices' funding, rather than redistribution of existing funding.

But GPC chairman Dr Laurence Buckman confirmed that the DH proposals would create 'winners and losers'. He said that it may be possible to come up with a fair redistribution by pooling all additional funding received by PMS practices and all MPIG funding and moving it between practices over time.

But he warned: 'You have to model how this will affect every practice and work out what to do with people who don’t work out as you expect. We said we wanted to do that testing, and no way would we do it without global support from the profession.

'You can’t just do this to people. It means every practice that is "overfunded" will get money chopped. This is just shunting money around and will be very destabilising for some practices. We wanted practices to be told what would happen, discuss it and vote on it.'

Around 65% of UK practices on GMS contracts rely on MPIG top-ups to core pay to maintain levels of funding they received before the 2004 contract took effect.

Dame Barbara's letter said the seven-year plan would move in a 'controlled and phased way towards equitable funding for all GP practices, based on the numbers of patients they serve with an appropriate weighting for demographic factors that affect relative patient needs and practice workload'.

It added: 'Given the work needed to prepare for these changes, these changes would begin from April 2014 and would not affect the 2013/14 contract. The department intends that these changes should include appropriate adjustments to the capitation formula to ensure that sufficient weight is given to deprivation factors.'

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