Are last-minute concessions ever a good idea? If you’re on the receiving end, of course they are. Which is why GPs can be particularly pleased with the minimum practice income guarantee, which was introduced as a last-minute concession to GP negotiators when the new GP contract was implemented in 2004.

It was devised to ensure that no practice experienced a drop in income when the new needs-based allocation formula was introduced. But Health Service Journal (March 27) reports that the guarantee has driven inequity across the country, with huge variations in payments to practices, regardless of the number and need of their patients.

Figures released to HSJ under the Freedom of Information Act indicate that the guarantee has inflated the basic income received by hundreds of practices under the funding formula by more than 40 per cent.

HSJ obtained details of payments made by 16 primary care trusts (PCTs) to 675 GP practices operating under the general medical services contract. The 675 practices were paid an extra £42 million under the guarantee – 19 per cent above the amount they were due under the allocation formula.

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Of these, 73 had their income boosted by 40 per cent or more. Ten practices had their core income boosted by more than 70 per cent. Two Westminster practices, including the practice for Buckingham Palace staff, more than doubled their income.

David Stout, director of the PCT Network, says that the income guarantee “institutionalises unfair variation as a matter of course” and “undermined” the attempt to make services responsive to patient choice. “If you lose people from your list, it doesn’t make any difference to the income guarantee.” About £330 million extra will be paid in the guarantee this year.

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