GMS contract changes that will take effect in England from April appear largely unchanged from proposals set out in a consultation earlier this year.
MPIG top ups to core pay will be phased out over seven years from 2014, and this funding will be redistributed through practices' global sum payments. Accountants and senior GPs have warned that the move could trigger six-figure swings in GP practice income.
The DH announced that it would increase GMS funding by 1.32% in 2013/14, despite advice from the independent Doctors and Dentists Review Body that general practice should be awarded a 2.29% rise.
Practices will receive an additional element of funding as part of plans to make them responsible for paying employers' superannuation contributions for locums. This will be equally distributed across all practices and will take the total increase practices receive to 1.47%, the DH has said.
The DH has confirmed that all GMS practices in England will receive the 1.32% contract uplift for 2013/14 whether or not they rely on MPIG top ups to core pay.
Around 65% of GMS practices rely on MPIG 'correction factor' payments to top up core funding. In previous years, contract uplifts have been applied via a mechanism intended to cut relaince on MPIG, leading to huge variation in the actual increases different practices received.
No practices will be lifted off MPIG in 2013/14 as a result of the 1.32% uplift.
The DH will also press ahead with plans for the largest overhaul of QOF since its inception, scrapping organisational indicators worth around £20,000 per practice and implementing the vast majority of QOF changes proposed by NICE.
Practices will still be expected to carry out the work covered by the 'retired' indicators, but will now have to fulfil four new enhanced services to earn back the £164m England-wide that they brought to general practice.
The enhanced services will cover:
- a more proactive approach to patients who may have dementia.
- better care management to support at-risk patients and cut hospital admissions.
- ensuring patients can book appointments and order repeat prescriptions online.
- arranging remote monitoring for patients with long-term conditions.
Full detail of the schemes will be published by the NHS Commissioning Board shortly.
The DH has suggested GPs will be able to earn more funding through planned rotavirus and shingles vaccination campaigns worth £10m across England.
DH officials estimage that around 100 practices in England serving unusual populations, such as care homes, the homeless or private schools, could need additional support to survive after MPIG is phased out.
These practices could be handed extra financial support through enhanced services at the discretion of the NHS Commissioning Board, the DH has said. DH officials confirmed that no other support is currently planned for practices hard hit by the removal of MPIG.
Health secretary Jeremy Hunt said: 'Improving care for patients has always been my priority. The GP contract needs to change to make sure the excellent care enjoyed by some patients is more consistent across the country.
'Providing better treatment for people with long-term conditions helps save lives and I know GPs will rise to the challenge to make sure standards of care in this country are world class and continuously striving to improve.
'We have listened to GPs and stakeholders and made some changes to our proposals to reflect these views and now feel we are in the right place to go forward.'
However, the BMA hit out at the changes. GPC chairman Dr Laurence Buckman said: 'Ministers have completely failed to take on board the concerns of thousands of GPs about the cumulative impact of these proposals on general practice. Practices will face numerous new targets that will divert valuable clinical time and resources towards box ticking and administrative work.'
He said QOF changes would make it more difficult for practices to maintain services, at a time when many are already struggling to cope under the pressure of rising workload and shrinking resources.
The GPC also called for support for rural practices that receive large correction factors.