Opinion  

MPIG came about because the government's attempt to reward GPs according to workload fell flat on its face. First they produced a thoroughly inaccurate measure of the work we do: then they compounded the error by underfunding it. Instead of doing the sensible thing and revising the whole concept, they put on a sticking plaster in the shape of MPIG and agreed to continue with it for as long as needed. And that's what we voted on.

Now the government wants to withdraw MPIG, implying that practices that receive it are both overpaid and lazy. Totally absent (of course) is any government admission that they were the ones who fouled it all up in the first place.

There are three problems here. The first is the workload formula itself which currently is both inconsistent and incomplete: two practices, superficially identical, might have completely different Carr-Hill factors. The original formula took no account of ethnicity, nor rurality. Yet rather than rebuilding the formula from scratch the government wants to reintroduce rural practice payments and give additional funds to high-turnover practices.

It is self-evident that a properly worked-out formula would need no further tweaking because all sources of extra work will have been recognised within the formula itself. A truly comprehensive formula will also acknowledge disease prevalence, giving practices more money for taking on a patient with, say, migraine, RA and osteoporosis by comparison with a fit person of the same age.

The second failing was that the Carr-Hill formula was never funded properly. Just what did the government think it was doing by introducing a system of payments that made 90 per cent of practices worse off?

Finally, how do we get rid of the MPIG lash-up now that it forms part of the contract we voted on? The solution is simple: the Carr-Hill formula should be published, then refined until all parties agree that it reflects practice workload. Then the government must fund it properly. With a balanced formula, the need for the MPIG will disappear. But this requires an admission of error on the government's part, so don't hold your breath.

Dr Lancelot is a GP from Lancashire. Email him at GPcolumnists@haymarket.com.