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28th October 2013

RIP – The Idyllic Rural Practice?

I worked in a remote and rural area for a number of years, actually in a group of islands.  One island GP practice had a grand total of 63 patients, as well as the record for the most cost-ineffective practice in Scotland, if not the UK.  However, the GP service was seen by the population as essential for the health of all the inhabitants.  This was especially for the elderly who could not travel easily to the mainland and for everyone when the weather stopped all travel for up to days at a time.  Public pressure assured the funding to keep the practice open.

The Prime Minister was hassled in Parliament this week about the planned phase-out of Minimum Practice Income Guarantee (MPIG).  This funding was introduced in England and Wales in 2004 to help practices migrate to the (then) new General Medical Services contracts.  Earlier this year, it was announced that the money would be withdrawn over a period to end in 2016.  However, David Cameron has now said he will investigate the effect of the policy on rural areas.  This is after Conservative MP for Ribble Valley, Nigel Evans, called for Mr Cameron to investigate the impact of the policy on local patients, highlighting that a GP practice in his constituency is facing closure when the income guarantee payments are withdrawn.  Mr Evans said: ‘With the disappearance of the minimum practice income guarantee, many doctors’ surgeries serving remote rural areas such as the one in Slaidburn in my constituency face death not by a thousand cuts, but perhaps by one cut.’   This 100-patient practice would be forced to close just one year into the overhaul. The practice stands to lose £91,000 - a third of its total core pay and close to its entire annual profit.

Responding, Mr Cameron said that he himself represents a rural area where there are small GP practices. He added: ‘I will look carefully at the case the hon. Gentleman makes.`   In March, the Government confirmed there were around 100 practices in England that were ‘heavily reliant’ on MPIG, ruling out any special measures to protect them. However, in August these practices were thrown a lifeline when NHS England opened up to the possibility of negotiating special contract terms for ‘outlier’ practices.

This comes only days after Health Secretary Jeremy Hunt had hinted he would not intervene to protect practices hit by MPIG cuts.  He said: ‘The most important thing about this very difficult issue about funding formulae is that it should be fair, and that is why in the new legislation we’ve given that decision to an independent body.`

So what will happen?  My feeling is that, like in Scotland, public pressure will force the issue and ensure small remote practices will keep their doors open.

Dr John Shapter – QCS Expert GP Contributor

Topics: GPs


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