Guidance issued by NHS England also suggested commissioning enhanced services to help practices worst affected by the MPIG withdrawal which begins in April.
In a letter sent to area teams on Monday NHS England’s head of primary care commissioning Dr David Geddes outlined recommended options for area teams to consider to help so-called outlier practices.
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.
In his letter Dr Geddes said he had identified 98 outsiders ‘which will lose the largest amount of funding per patient’ which will be unable to provide services with their adjusted funding.
Options reccomended for very small practices are:
- collaborating (for example through federation or networking) or merging with other nearby practices to provide a more cost-efficient service; identifying other ways in which the practice might potentially improve cost-efficiency, such as reviewing staffing structures; and, where appropriate, reviewing other commissioning and/or contracting options
For practices which provide a range of services outside their core contracts, or services for atypical populations, area teams are asked to consider:
- whether these are services that should be funded at least on a transitional basis as enhanced services, either directly by the area team or via the local CCG; and
- agreeing a new contract type (PMS or APMS) with the practice involved to fund some of these services through core contract, if there are special factors that warrant this approach.
In his letter Dr Geddes said: ‘Ultimately, decisions on how to address the issues will need to be taken by area teams, after a full assessment of all the local circumstances’.
Last week GPC chairman Dr Chaand Nagpaul expressed concern that handing responsibility to ‘overstretched’ area teams could result in ‘protracted local discussions’.
The solution must be ‘directed and managed’ centrally, he said, even if funding is locally deployed.
‘We need to make sure there is a national approach to make sure this matter is dealt with swiftly and not left to local dialogue that may get drawn out right up to April,' he said. ‘We need something swiftly, and a national framework to make sure that happens.’
‘Area teams are overstretched and are not dealing with normal business in a timely manner, and this will now become an additional task for them,' he said. ‘This is not something we can afford to delay on. We are dealing with practices that are going to be suffering significant loses in resources that will impact on patient services and it is not right that a few months before April they have no detail.’
Area tems have been told to make decisions on support within their existing budgets by the end of January.