Higher payments for rural practices and those with high patient turnover could offset the end of the MPIG, the government has revealed.
The Darzi review says that the MPIG is blocking patient choice, and commits the government to abolishing it as it moves to a fairer funding system.
Further changes set out in the review threaten financial upheaval for practices. The DoH plans to scrap the square-root mechanisms that 'damp down' redistribution of quality pay according to prevalence.
This will benefit practices with high disease prevalence, but could mean dramatic cuts for practices with healthy lists.
The DoH also wants to treble the proportion of quality framework funding spent on preventive care, from 5 to 15 per cent. This will likely mean the end of funding for some administrative tasks.
A DoH spokesman told GP that it would propose changes taking into account factors such as the higher costs of rural services and geographical variation in staff costs.
Also on the table will be payments for high turnover, to reflect the fact that patients need more consultations during their first year of registration.
A revised funding system would also take account of patients' age and sex, deprivation and nursing home residency.
Plans to remove the MPIG remain controversial, however. GPC policy is that it should be abolished only if increased global funding means no practice suffers drastic funding cuts.
At present the average practice relies on the MPIG for 25 per cent of its income, while for some remote practices that figure rises to 80 per cent.
NAPC chairman Dr James Kingsland warned: 'I don't see how you can do it so that no one is disadvantaged.'
Dr David Jenner, GMS contract lead at the NHS Alliance, said that any change was likely to be phased in to give practices time to adjust.
He said it was vital to remove the disincentive for practices to grow their lists.
A DoH spokesman said the government wanted to 'phase it out in a way that does not destabilise practices'.
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