MPIG could be 'gone in five years'

New GMS deal - Phasing out MPIG, prevalence overhaul and 72 QOF points reallocated.

Richard Vautrey

MPIG could be gone in five years under changes to the GMS contract that take effect from next year, the DoH has said.

NHS Employers and the GPC have reached an agreement for 2009/10, which would increase core funding for all practices, provided the Doctors' and Dentists' Review Body (DDRB) recommends an overall uplift.

NHS Employers submitted evidence this week recommending a 2 per cent pay rise for doctors and dentists outside GMS, but will not recommend a GMS rise until later this year.

Under the GMS package agreed, global sums will grow more than three times faster than correction factors. This means that practices with no MPIG will receive a much more generous settlement.

Health minister Ben Bradshaw said: 'If there was an uplift of 2 per cent a year, MPIG would be gone in five years.'

But GPC Wales chairman Dr David Bailey dismissed the claim as 'complete and utter nonsense'. 'That will not get anywhere near getting rid of the MPIG.'

The new contract will see any increase in funding divided between practices based on their dependence on MPIG.

If the DDRB were to agree to a 2 per cent increase, practices would receive whichever is higher: a 2.13 per cent increase in their global sum, or a 0.61 per cent rise in their combined global sum and correction factors.

Every practice would thus receive an increase of between 0.61 per cent and 2.13 per cent in core funding.

Funding for the quality framework and enhanced services will also be increased. However, 72 quality framework points are to be reallocated, and the prevalence formula is to be overhauled, meaning that certain practices could see cuts to these elements of pay.

The number of practices lifted out of MPIG will depend on the generosity of the package agreed by the DDRB.

GPC sources stressed that this is a one-year deal, which could be radically overhauled again for 2010/11. They admitted that questions remained over how to phase out MPIG for practices that rely heavily on correction factors, without forcing them to cut staff and services.

Dr Richard Vautrey, deputy GPC chairman, said that the GPC would 'need to look at the character of those practices'. He said both the GPC and PCOs should consider the case for replacing correction factors with other funding for specific services.

Winners and losers in GMS contract change

Core pay: all practices guaranteed a share of any uplift recommended by the DDRB, but non-MPIG practices to benefit significantly more.

Prevalence: damping mechanisms will be removed over two years to redirect funding to areas of high health inequality. This is likely to benefit practices with high morbidity, but cut funding for those with healthy populations, such as university practices.

QOF points: 72 points will be reallocated to cardiovascular disease, sexual health, depression, CKD, lung disease, diabetes and heart failure. Two patient experience targets have been dropped.

Performance-related pay: enhanced services and QOF pay will rise, but less than the global sum. For every 1 per cent funding increase, these will be increased by around 0.75 per cent.

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