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GP surgeries threatened by funding changes

BMA warns that end of practice income guarantees could see 98 surgeries close

Mark Gould

Friday, 21 February 2014

The BMA has today warned that changes to the way general practice is funded in England could threaten the future of at least 98 GP practices, including some that provide vital services to thousands of rural patients.

Last year the government decided to begin phasing out the minimum practice income guarantee (MPIG) from April 2014. The BMA says that MPIG provides an important financial lifeline to many smaller GP practices by guaranteeing a minimum level of funding that is not dependent on the number of patients a GP practice has on its practice list.

The government intends to withdraw MPIG over a seven year period, with the amount of funding declining by one seventh of the current total under 2012. GP funding is allocated to GP practices partly on the basis of the number of patients who have registered with that practice. This is to ensure that each GP practice has enough resources to deliver services to its local populations.

NHS England has identified but not named 98 GP practices that will lose substantial levels of funding that could place their long-term survival in question. In addition to the 98, there are a significant number of other practices that will be severely affected. The BMA says that this is compounded by the government's failure to put in place a national plan to help support the practices affected.

GP Dr Katharina Frey runs a practice in Cumbria which she says could be threatened by the changes. “My practice is a very small one that cares for just under 1,000 patients in a rural South Cumbrian area. We have for many years provided a real family orientated service for patients and I believe we are a really vital service for our local community," she said.

“We are under real financial pressure already and can’t, because of the current funding climate, afford to employ a practice nurse. We are also having to think very carefully about how we replace senior staff. This situation will become even more pressurised when we lose the MPIG support that currently accounts for our around a third of our current core funding. We are already working at full capacity with declining resources: I just don’t know how we will cope with this additional financial blow.”

Dr Chaand Nagpaul, chair of the BMA’s GP committee, warned that the government has "seriously misjudged" the potential impact of its funding changes, especially on rural GP services.

"It is likely that a few hundred practices will lose noticeable levels of funding, with 98 practices identified by NHS England as being at serious risk from severe cuts in their financial support that could threaten their ability to remain open. This comes at a time when GP practices are already under pressure from rising workload and declines in overall levels of funding.

“The government has not confirmed where these practices are or the extent of their financial difficulty, however some will be smaller GP practices in rural communities with comparatively small number of patients registered with them. These GPs provide vital services to patients in areas where accessing healthcare is already not easy because of the large distances patients have to travel to get to their local NHS services. If these practices were to close it could leave large geographical areas without a nearby GP practice.

“The situation has not been helped by NHS England’s decision to devolve responsibility for this issue to local NHS managers without a framework on how these GP practices should be supported. We are without a national plan of how to tackle this problem and safeguard GP services.

“Ministers have to get a grip on this problem urgently given these funding reductions are just weeks away from being implemented. We need to ensure no practice closes and that there is a coordinated approach to deal with this issue.”

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