Funding and the rural practice

The BMA have called for urgent action to protect at least 98 practices, which will be adversely affected by severe funding cuts, as the MPIG (Minimum Practice Income Guarantee) is phased out over the next few years.  When is a guarantee no longer guaranteed? Well, the answer is from 2014.

The changes are implemented from next month, are will impact most on the practices who heavily depend on this funding simply to survive.

The MPIG was introduced in 2004 to support some practices moving to the new GMS (general medical services) contract who would otherwise have lost considerable amounts of funding. It seems now that at best the cuts have been delayed 10 years to bite now at a time of maximum austerity. The cuts can remove a third of income for some. The 98 practices have been identified by NHS England as being at serious risk of closure due to financial pressures, but there will be others feeling the effects to perhaps a lessor extent.

Rural practices are especially impacted as they cover large distances, often as single-handed (FTE) practitioners, with little resource support. These practices are often at great distances from other healthcare facilities such as clinics and hospitals, where supporting patient services can be offered, and therefore patients rely on the local GP to provide services which may otherwise not be available, or available at great personal effort.

Impact of patient care is a significant factor. Public transport is often irregular, or non-existent, especially significant where (say) multiple changes of bus are required to travel to a major centre. In winter, these areas may simply be inaccessible. Staff can be difficult to find, travelling to work over significant distances, by private transport, driving up payroll costs to attract applicants, and GPs, locums and other support staff may just not be there. This brings to mind a small village in rural Northumberland, 50 miles from the nearest general hospital, where the bus arrives twice a week, both times on a Wednesday.

Rural practices are all different. They tend to be miles apart and demographics vary as you cross over the hill. Rural communities can be affluent or deprived, agricultural or industrial, static or have high itinerant or seasonally migrant populations. Or be sleepy enclaves. They can be of any size or shape, and using NHS criteria, they can also be in towns or on the edge of cities.

The existing provision in the Statement of Fees and Allowances for rural practice payments covers additional travel for home visits where the patient lives more than 3 miles distant. This allowance is a minor part of income and was absorbed into the global sum when the new (existing) contract was implemented, based on a formula of practice list x average distance (over 3 miles to patient home) X population density. A largely indecipherable calculation for a practice to verify, especially as over 20% of your patients have to be resident 3 or more miles away.

The issue, however, is not principally one of rural practice payment or even MPIG. It boils down to constant squeezing of GP practice funding to the level of the “last straw”, which unfortunately comes sooner rather than later for some practices who have non-standard circumstances.

Moving to equitable funding for all will not work unless the individual needs of the diverse range of communities can be adequately addressed in an open and honest manner.


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