NHS England revealed to GP that 1,925 out of 4,517 GMS practices in England face an average annual loss over the next seven years from the cuts to correction factor payments.
The hardest-hit practices face average losses of over £162,000 over seven years, according to official data released last week, but are still not guaranteed any support to cope with the cuts.
NHS England figures showed the average loss per weighted patient per year for 98 practices identified as 'outliers' - because of their heavy reliance on MPIG - over the next seven years as the top-up payments are redistributed. The average outlier loss is £7.41 per patient per year. Over seven years outliers, with an average list size of 3,141 patients, faces an average loss of £162,923 per practice.
Two practices will be so badly affected that their losses calculated over seven years, based on the outliers' average 3,141-patient list, could be over £2.5m.
Outliers are those practices calculated by NHS England to face an average annual loss of over £3 per weighted patient. The worst-hit practice faces losses of £119.27 per weighted patient per year, while the second worst-hit faces losses of £113.85.
Under imposed changes in the 2013/14 GP contract, MPIG top-ups to core pay will be redistributed over seven years from 2014. About 65% of practices in England benefit from MPIG. The majority of practices are set to gain from the redistribution, but a small number of practices will be hit hard.
Advice issued by NHS England to area teams on how to deal with outliers suggested smaller practices could be merged, federated, made more efficient through cost cutting, or that other contracting and commissioning solutions could be found.
Alongside the new data released on Tuesday, NHS England said the list of outliers was ‘only a guide for area teams’, and there was ‘no guarantee that all practices on the list will receive support of other kinds’.
‘Conversely,' the documents added, ‘there may be practices outside the list of 98 "outliers" for whom other commissioning arrangements may be appropriate.’
The documents also noted that while there had been concerns that rural practices would be worst-hit by the MPIG cuts, just 15% of outliers were in rural areas, while 18% of practices overall all are rural.
Some rural practices have been hit hard by the reforms, among them Dr Karen Massey's rural Lancashire practice that stands to have its income halved by the removal of MPIG.
But Laurence Slavin, from specialist medical accountants Ramsay Brown and Partners, said the new information confirmed that the idea rural practices would lose most was ‘based on a false premise’. ‘I am confident that the [biggest] losers will be inner city practices,' he added.