Viewpoint: Withdrawing MPIG puts practices at risk, warns Dr Kailash Chand

As the BMA seeks talks with NHS England over errors in the way practices' MPIG losses have been calculated, its deputy chairman Dr Kailash Chand - writing in a personal capacity - warns removing this funding could endanger valued GP services.

Dr Kailash Chand: MPIG warning
Dr Kailash Chand: MPIG warning

The withdrawal of MPIG, which began in April last year and is set to continue for another six years, would seriously affect the viability of scores of GP practices, particularly in rural and deprived areas.

About 65% of GMS practices in England benefit from MPIG top-ups to core funding. A total of 40% of England’s GMS practices – nearly 2,000 in total – face losses over the next seven years from the redistribution of correction factor payments.

MPIG is considered ‘anti-competitive’ by privatisation advocates, in that a competitive market demands some providers go out of business so others can easily enter the market.

GP practices vulnerable

The government seems to have decreed that GP practices are to be made vulnerable to insolvency and closure, so corporate providers can replace them. Therefore, the MPIG must go.

Let us remind ourselves of the example of the Camden Road GP practice, which was put out to tender in 2008.

The incumbent GPs’ bid lost, so the contract went to an American company, which transferred it to another provider after two years.

The practice then shut down when its premises lease ran out, leaving 4,700 people to find a new GP practice.

Observers saw this as a cautionary tale, but health secretary Jeremy Hunt is removing the protection – MPIG – that stops similar things happening throughout the country.

MPIG impact misjudged

The government has seriously misjudged the potential impact of its funding changes to general practice in general, and on rural GP services in particular. This comes at a time when GP practices are already under pressure from rising workload and declines in overall levels of funding.

Given that NHS ‘general practice’ is envied around the world as the best model for primary care, why is it that overall funding has fallen for general practice from over 10% of the total NHS budget in 2004 to a projected 7.3% by 2017. With 69m extra consultations per year, the service is on its knees.

It is high time for Mr Hunt to tell the profession and general public that his government will restore GP funding to the 10% level needed to meet demand and halt the recruitment and retention crisis in general practice.

A sustained loss in primary care funding is having a detrimental impact on the care GPs give to their patients, many of whom are vulnerable, elderly and alone. The MPIG was introduced to ensure that individual GP practice funding did not drop below historical levels after the introduction of the 2004 GMS contract.

When the DH decided to phase out MPIG as part of the imposed 2013 contract, the GPC negotiated a deal to keep the funding in general practice. NHS England must honour that commitment. 

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