Enhanced service offer will fail to plug MPIG funding gap

A practice facing near £1m losses from the removal of MPIG could receive financial support through an enhanced service built around the needs of its deprived patient population, but would remain worse off.

Tower Hamlets MPIG protest (Photo: Wilde Fry)
Tower Hamlets MPIG protest (Photo: Wilde Fry)

Partners at the Jubilee Street Practice in east London said a top NHS England official had suggested enhanced services could be made available to provide additional support.

MPIG top-ups to core funding are being removed over seven years, starting in 2014/15. Around two thirds of GP practices in England rely on the top-ups and the 98 practices hit worst by the removal of MPIG face average losses per year of around £160,000.

At a meeting with health minister Earl Howe and NHS England head of primary care commissioning Dr David Geddes last week, partners at the Jubilee Street Practice were told a localised budget could be developed that acknowledged the gap created by the removal of MPIG. The practice was also told that work was ongoing to improve weighting for deprivation in primary care funding.

Minister was supportive

Practice manager Virginia Patania said the minister ‘could not have been more supportive’ and was committed to ensuring practices were not forced to close.

But at a later meeting, Dr Geddes told the practice NHS England did not have a budget for additional support. What was on offer, he said, were enhanced services for practices which can demonstrate additional work above the core contract, to meet the challenges of deprivation.

Guidance issued by Dr Geddes to local area teams in December 2013 suggested commissioning enhanced services to help practices worst affected by the MPIG withdrawal, but there has been little sign so far of any concrete offers of support.

Jubilee Street stands to lose £903,000 in total over seven years as MPIG correction factor payments worth £219,508 a year are withdrawn.

The practice has been at the centre of the Save Our Surgeries campaign which last week organised a march of hundreds of patients, GPs, practice staff and supporters through the East End. 

Ms Patania said the enhanced services could include one for populations with low levels of speakers of English as a first language.

Another could be based on access, with requirements around phone answering times, personal doctor lists, and possibly implementing doctor-led phone triage of calls from patients. 

The partners were told by Dr Geddes that while NHS England could fund the services for the first year, it could subsequently be co-commissioned with a pooled budget with the CCG.

Funding gap not addressed

But the practice does not think the proposed solution will address its funding gap and the partners are concerned that not all MPIG-hit practices will benefit. 

‘I can tell you now, very few practices would be able to apply and perhaps only mine,' said Ms Patania. 

‘[Dr Geddes] said this wouldn't plug the gap we are suffering. He said this would not be sufficient to plug the gap, but that we needed to make compromises.’

‘We feel that it was unclear in our meeting with David Geddes how the commitment expressed in the morning for practices to be compensated in some way for the loss caused by removal of [MPIG] payments could be honoured. It is very unclear.’

She added: ‘I have concerns that not all practices affected by deprivation workload and having been hit by this cut will be equally addressed.’

Video: MPIG protest in Tower Hamlets

GP leaders and NHS England have agreed in principle to reforming the GP funding formula to place greater weighting on deprivation factors.

Proposed changes are expected to be implemented in the 2015/16 GP contract, negotiations for which are due to begin shortly.

An NHS England spokesperson said: ‘NHS England area teams have made offers to meet with and discuss the impact of MPIG changes with those practices most significantly affected by the decision to move MPIG funding into the global sum.

'Discussions have focused on the types of services offered by the practice and how these services may have developed in response to the particular characteristics of the population served. Our commitment is to ensure that all patients have good access to high quality primary care, and discussions between area teams and practices together with CCGs will be focused on the focus on how this can be best achieved.’

A DH spokeswoman said: 'It was agreed that Dr David Geddes would meet with the practices individually to discuss a range of possible options to address the challenges they are facing. We understand that NHS England will look to make decisions on the way forward in the next few weeks in light of these further conversations.'

Free GMS financial forecast

Medeconomics has teamed up with specialist medical accountants to produce individual forecasts of practice financial performance as the MPIG is phased out.

View a sample report here

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