Private providers on alternative provider medical services (APMS) contracts are undercutting existing practices because their contracts do not include global sum top-ups that the vast majority of GMS practices have come to rely on.
More than 90 per cent of GMS practices receive correction factor top-ups under the MPIG, to protect them from earning less core pay than they did under the Red Book. Correction factors account for about a quarter of core pay on average, equivalent to about £100,000.
APMS contracts do not have to take account of the MPIG.
Around 15 per cent of practices will operate on APMS deals in three to five years, accountants predict. They believe PCTs see this as the tipping point to say MPIG is no longer justified.
Laurence Slavin, a partner at accountants Ramsay Brown and Partners, told GP: ‘APMS can be a lever to cut correction factors. Once, for example, 15 per cent of practices are APMS, PCTs can say to GMS practices: “Hang on, why are they all working for global sum alone, when we have to pay you extra?” ’
He said private companies could afford to ‘make losses to make inroads into primary care’.
PCTs may see APMS as an op-portunity to get tough with prac-tices seen to be underperforming, because they could save money by shutting them down and putting them out to tender, Mr Slavin said.
Paul Kendall, a partner at ac-countants Dodd & Co, said the MPIG could disappear in three to five years.
‘The dentists’ contract shows the DoH is not afraid of this — the vast majority of dentists took a drop in income. They were told to accept it or go private,’ he said.
Valerie Martin, medical director at accountants PKF said that ‘cutting MPIG overnight’ was unlikely.
But she added: ‘I would question whether different funding methodologies will be kept in the long term.’
She predicted a convergence of APMS, GMS and PMS with more emphasis on ‘money following the patient’.
GPC deputy chairman Dr Laurence Buckman said many practices would close if the MPIG were cut: ‘We have an agreement that the MPIG is there in perpetuity until it can be phased out. The MPIG is justified until you get rid of primary care, but that’s not going to happen.’