The minimum practice income guarantee is set to make headlines again this year, as GPs and patients in Wales begin to see the effect of its withdrawal.

The minimum practice income guarantee (MPIG), which is variously described as a ‘correction factor’ or ‘compensation payment’ for small practices, is being phased out over seven years in Wales from 2015 despite doctors’ lobby for maintaining the MPIG’s protective and stabilising effect on the finances of small practices, including those located in rural areas.

According to BMA Cymru (Wales), which represents doctors in Wales, around 40% of practices will see reduced income as a result of the MPIG withdrawal – on average by around £5,000 a year per year. As the BMA has accepted in its communications to GPs, “affected practices will have to make some difficult business decisions in order to absorb these losses”. English practices know all too well about these difficult business decisions. The process of removing MPIG from GP funding in England started in 2014, and already it has attracted significant political opposition. In February, 2014, South Lakes MP Tim Farron called for Parliamentary debate about rural GP funding following concern about the risk to smaller local surgeries caused by the MPIG withdrawal, and the effect closures could have on patients.

Delivering on rural promises

In its 2012 Rural Statement , the Government restated its commitment to rural England, focusing on three objectives:

  • economic growth – rural businesses can make a contribution to national growth
  • quality of life – people living in rural areas have fair access to public services
  • talking directly to rural communities – political empathy with rural areas.

NHS Pharmaceutical Services policy in England, Wales and Scotland dictates the framework and, in part, the funding for dispensing GPs, which as a group provide primary medical and pharmaceutical services in Britain’s most rural areas. It is the position of their representative organisation, the Dispensing Doctors’ Association, that the current regulatory and financial  arrangements for rural GPs fail to deliver on the promises made by Government in its 2012 rural statement, for the following reasons:

1) economic growth: in 2012 the Welsh Assembly concluded that “the cost factors incorporated into funding formulae can be too low, and so fail to accurately account for the costs of rural service provision”. For the rural GP practice these costs may include the increased costs of transportation (home visits) and supplies (low volume surcharges), staffing costs (incentivised recruitment) and provision of a wider range of healthcare services that acknowledges the lack of other local healthcare service providers. In dispensing practices routinely reinvest the profits from the dispensing activity to cross-subsidise the increased costs of providing rural general medical services. In hard to staff areas, dispensing income is also used to incentivise GP recruitment and retention. This phenomenon was only publicly acknowledged for the first time in 2014 and at the time of writing, the principle is yet to be embedded in either rural GMS funding or in the remuneration/reimbursement processes for the GP dispensing activity

2) rural patient engagement: When patients are eligible to choose to receive dispensing services from their GP the overwhelming majority choose to do so. A 2008 Patient Survey by the Dispensing Doctors’ Association demonstrates patients’ preference for GP dispensing services. However, in England patient eligibility for the GP dispensing service takes no account of patient choice. Only last year (2014), Scotland passed new regulations affecting dispensing practice, which acknowledged prior shortcomings in the dispensing patient engagement process. It is yet to be seen how the new regulations will improve the patient engagement process.

3) Equitable service provision: Throughout Britain rural patients are denied services that are available to urban patients who access pharmacies. Pharmacy services currently unavailable to rural patients using dispensing practices include: the electronic prescription service, the new medicines service, the medicines use review service, and the chronic medication service. The untapped economic potential of rural areas is said to be worth an extra £347 billion per annum to the national economy, if only more policies supported rural economic development. Defra has made this issue its top priority and has launched a number of schemes aimed at growing the rural economy.

Rural GPs would urge the NHS to follow Defra’s example, and allow rural medical services to play their full part in the development of Britain’s countryside areas.

Dr Richard West is chairman of the  Dispensing Doctors’ Association

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One Comment

  1. The Rural areas have always supported right wing politicians and this is how they are repaid. When will they or will they ever wake up.

    This video by Michael Sheen should be seen and heard by everyone in this country, and politicians should hang their heads in shame, but they are too well paid though to care.

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