The dominoes, of course, are GP practices. Data from specialist medical accountants published exclusively in this issue of GP magazine reveal the huge swings in income that practices are facing as MPIG is phased out - from rises of up to £11 per patient, to falls of £32 per patient.
The losses faced by the worst-hit practices will have a catastrophic effect on their ability to function - and it is far from just a tiny minority who will struggle.
Accountants suggest that as many as one in five GMS practices could become unsustainable under the MPIG reforms.
Practices have for years been experts at coping with swings in income as once-a-decade contract gains are gradually eroded.
But years of pay freezes and efforts to maintain profits have left practices in a weakened state - GPs are in no position to handle the 'big bang' financial reform that has been thrust upon them.
With the removal of MPIG, there are some practices - including but not limited to the 98 'outliers' identified by NHS England - whose losses will be so great that closure seems the only option, unless a rescue package is agreed.
For many more practices that have already been forced to make staff redundant in recent years to keep their heads above water, even losses far below those seen at outlying practices could prove to be the final straw.
It is at practices like these that partners are losing the will to go on and taking early retirement.
And once one partner withdraws, others begin to panic. They become fearful that they won't be able to cope and will be left with huge legal liabilities they cannot sustain - this, one GP said, 'is when practices fall over'.
UK general practice is the envy of the world, but it is struggling like never before. NHS England must act swiftly to resolve this before all of its dominoes fall.