On the eve of the delayed launch of the Darzi Review primary care strategy, Health Minister Ben Bradshaw has hit out at GPs for preventing patient choice by preventing practice lists being open to new patients.

The Minister also attacked the current funding of practices with a ‘lump sum’ including the Minimum Practice Income Guarantee (MPIG), which was introduced in the new 2004 GP contract. He said the system “dampens the incentive” for practices to attract new patients and expand. The Darzi review promised to remove MPIG, but the timescale is not yet clear.

Bradshaw also told BBC News Online that “there’s also no doubt that there are some areas where gentlemen’s agreements operate that mitigate against lists being open to new patients, and therefore work against real patient choice”.

He also said that "it's the patient who pays the salary ... all too often in the heath service, the approach has been a kind of patronising 'we know best' one, when actually you're being paid by your patient, so your patient should be in charge. that's still a cultural challenge that we still need to crack".

BMA reaction
Reacting to the Minister’s claims, Dr Laurence Buckman, chair of the BMA's GP committee, described Bradshaw's claims as "absolute nonsense ... it just doesn't happen". Buckman described the BMA’s position as not opposed to moving the funding basis on to one based on practice list size, but added that GPs were not going "to compete for patients, that is not the way general practice works".

Technically, it is already possible for patients to change GP practice if they can find one with a list that is ‘open’ – i.e. willing to accept new patients. The issue described by the Minister is understood by sources in primary care to be a real problem in certain inner-city (and often poorer) areas, albeit not necessarily widespread nationally.

However, take-up of switching practice is low, other than among people moving house (which is not currently widespread). there is a financial disincentive for practices, in that the initial per capita payment for new patients is lower.