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GPs buried under trusts' workload dump

Wanted: new GPs to work for the NHS

The NHS plans ‘golden handshakes’ to attract trainees and returners, but there are doubts whether they will work, finds Jaimie Kaffash

Golden handshake - online

The warning lights have been flashing bright red for years, but the NHS is only just taking action to address the crisis in the GP workforce.

NHS England has published a £10m strategy to tempt medical graduates to become GPs and experienced GPs to delay retirement.

The ideas include ‘golden handshake’ deals for GP trainees if they work for three years in areas with a shortage of GPs, and incentives for older GPs to stay in practice.

There will be a new national scheme for returners, and cash inducements if they also agree to work in an under-doctored area.

GP leaders have cautiously welcomed the new plan, but warned that it is dwarfed by the scale of the challenge.

Last year, Pulse revealed that practices in some areas were waiting a year to fill a partnership vacancy. Some areas were having to cope with one GP to every 8,000 patients and even those in more prosperous areas were struggling to recruit.

What is a ‘golden handshake’?

‘Golden handshakes’ are financial incentives used to attract staff above and beyond standard pay. They normally come with conditions attached, such as a particular length of service. GP practices, CCGs and Health Education England have started using them in areas of particularly poor GP recruitment. The Department of Health introduced a ‘Golden Hello Scheme’ for GPs in 2001, with the same intentions. It was dropped in 2005.

Retirement timebomb

There has been a rise in GPs applying to move abroad and a GPC survey showed that more than half were considering early retirement.

And there is little sign of their imminent replacement by newly trained GPs; last year, 12% of GP training places remained unfilled, despite Health Education England running an unprecedented third round of recruitment.

And the signs are that this year could be even worse.

An internal briefing paper from the GPC – revealed by Pulse last year – said the effects of the workforce crisis could ultimately be ‘catastrophic’ for general practice. And this seems to have spurred NHS England to throw money at the problem.

GPC education and training subcommittee chair Dr Krishna Kasaraneni says he is ‘tentatively’ positive about the plan, but adds that the profession needs to see the promises translated into actions on the ground.

He says: ‘A few years ago, policymakers and NHS managers had their heads buried deep in the sand, denying there was any crisis in general practice and particularly with the workforce.

‘A shift has taken place in the past 12 months. You can’t move at the moment in the media for promises of more funding for GP services, and policymakers are constantly chattering about the problems facing GP practices.’

Undeliverable promises

But Dr Kasaraneni warns the current strategy is not enough: ‘Wider GP services are continuing to struggle and politicians of all parties have still not realised that they cannot keep bombarding voters with promises that are undeliverable, whether it be 48-hour targets for GP appointments or extensive, longer opening hours for practices.’

The 10-point plan was developed with NHS England, Health Education England, the GPC and the RCGP, and published last month.

It resolves to attract medical graduates to the profession with a national marketing campaign extolling the virtues of general practice. The RCGP has already released a video claiming ‘this is the best time in a generation to become a GP’ and has begun holding a series of 16 roadshows with HEE to encourage more medical students and foundation doctors to choose general practice.

GP trainees will also be offered the opportunity to spend an extra year outside general practice after training – for example taking an MBA or working in emergency medicine – and financial incentives to work for three years in an under-doctored area.

This is a welcome move as there are no signs that this year’s recruitment drive for GP training places will be any easier than last year’s.

The GPC told Pulse before Christmas that fewer than 40 graduates had applied for 148 GP training places in the North-East of England this year – although HEE says it ‘does not recognise’ the figures.

But ‘golden handshakes’ are not a new idea. The Department of Health’s ‘Golden Hello Scheme’ was introduced in 2001, and closed in 2005 because the incentive was no longer seen as necessary for GPs under the new contract.

And there are doubts over whether they will work this time round.

Limited success

In Doncaster, the Thorne Moor Medical Practice offered a £20,000 ‘golden handshake’ to recruit a new GP partner to stay at their practice for three years or longer last summer, having spent a year failing to find a partner. 

But Dr Dean Eggitt, medical secretary of Doncaster LMC, says it took several months for people to start applying, and although the practice ended up finding a ‘very good candidate’, he doubted whether it would work nationally.

He says: ‘The difficulty is that we don’t have an abundance of doctors. If you have 10 spare doctors, and 20 practices need them, if you give everyone the opportunity of the golden hello, you have simply recreated the status quo.’

HEE also recently put up £400,000 to fund golden hellos worth £10,000 for practices across Essex, but Dr Brian Balmer, chief executive of Essex LMCs and a GPC negotiator, says it is too early to tell whether or not the local scheme is likely to be successful.

He adds: ‘It is being extended to more CCGs than it was, but it hasn’t been going long enough to know how good it is going to be.’

Elsewhere, NHS Hull CCG promised to find overseas placements for trainees and qualified GPs, and said it would fund MBA or a Masters degrees in education or leadership and will give GPs the opportunity to work in different practices to make the package as ‘attractive’ as possible.

But there were rumours that the deadline for applications had to be extended because of a lack of interest and, five months after it was set up, the CCG has admitted to Pulse that it is ‘still in the process of recruiting to the scheme’.

NHS England also has ideas to tackle the retirement ‘leaky bucket’ and encourage older GPs to stay practising. It says it would look at offering experienced GPs the opportunity of portfolio careers or heading up mentorship programmes.

There will be a review of retention schemes and a new national programme to make it easier for GPs to return to practice, potentially offering financial incentives to work in under-doctored areas.


NHS England ‘will make available additional investment to attract GPs back into practice, increasing over time’, with resources given to practices to help with the cost of employing these staff.

There are also plans to recruit new grades of staff – such as physicians’ assistants – to help take the pressure off GPs. These non-medically trained staff will take medical histories, perform examinations, diagnose illnesses, analyse test results and develop management plans.

But practising GPs to whom Pulse has spoken to are less than impressed.

Dr Peter Holden, who was a GPC negotiator for 15 years until last year, says: ‘When a boat is sinking, stick your finger in the hole first, don’t try to pump the water out.

‘We will have gone by the time they have reviewed the retention schemes. What is immediately needed is a reversal on the seniority system, so we keep [the payments] in full until we retire. That is the way to keep us in. Otherwise, there is no incentive to stay.’

Dr Gaurav Tewary, a GP in Wollongong, New South Wales, Australia, who moved from Coventry last year, says the package of measures would not be enough to tempt him to return to the UK.

Dr Tewary says:  ‘This is simply saying “we’ll give you some more money”. That’s not why I left. I probably earn less here. I would like to see changes to the things I didn’t like before I left.

‘Removing political interference would be the first thing that could tempt me to come back. We have lost our independence.’

Wider problems

So the plan may not be enough to provide a quick fix for the GP workforce, as the real problems are much wider.

As Dr Eggitt bluntly puts it: ‘What we really need is stability and long-term investment. We don’t want one-off election pledges. If you are just going to give me a one-off, keep the bloody money, I don’t want it.’

What does the 10-point plan include?

1. A marketing campaign for general practice careers, including a letter to all newly qualified doctors

2. An additional year of training to study a special interest in medicine or business for GP trainees

3. ‘Training hubs’ for GP practice staff to extend their skills

4. ’Golden hello’ incentives for GP trainees committing to work in an under-doctored area for at least three years

5. A review of retainer schemes and investment in a new national scheme

6 New premises funding for training practices

7. Incentives for experienced GPs to remain in practice, such as a funded mentorship scheme or portfolio careers

8. Pilots of new support staff to take workload off GPs, such as physician associates, medical assistants, clinical pharmacists and advanced practitioners

9. Clearer induction and returner scheme for those who have worked overseas or taken a career break

10. Financial incentives for returners opting to work in under-doctored areas and reviewing the value of the performers list

Source: NHS England, Jan 2015 Building the workforce – the new deal for general practice.


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Readers' comments (32)

  • 10 point plans which completely miss any point!!

    Don't you feel sorry for NHSE, they are really incompetent.

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  • Golden handshake,better tell prospective GPs that the hand that shakes yours holds a turd!

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  • ....Like cheese on a mouse trap

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  • £20000 for a golden handshake is chump change. Absolute peanuts, especially after deductions and the attached conditions ( 3 years service in some instances) take a look at what's on offer in remote Australia for 5 year service ( more than £200,000) and you get the idea. There always seems to be plenty of money in Britain when it needs to be wasted ( politicians first class travel and Xmas party allowances ) but when they need attract highly skilled and educated talent they offer this garbage!! No wonder medics are moving abroad where there is real reward for hard work and real remuneration.

    Case in point, I emigrated 2 years ago and as above it wasn't about the money. I detested the constant political interference in our day to day lives. I used to attend our locality ccg meetings and quickly found out this was an outlet to dump more and more unnecessary work on us!! Just before I left we were spending almost an extra hour a day auditing ALL our referrals ( in a 12 doctor practice it took ages), I had to perform an audit on antibiotic prescribing for the previous year, out of hour admissions for the previous year and A&E attendances also!! Also we had extended hours thrust upon us as well as mountains of extra paperwork. I had simply had enough of working as a 9 session partner. NHSE/ DOH/CCG/GMC/BMA ARE HARBINGERS OF DROSS that make a GP's life miserable!! Pay cuts, pension changes , media bashing, incessant patient demand are driving doctors abroad. Also the UK has an extremely sick culture that shows contempt for those who are successful and hard working. Doctors are vilified with constant inaccurate and exaggerated reports of their earnings!! Who in their right mind would want to sacrifice at least 10 years of their lives to become a gofer for an imbecilic manager with a polytechnic certificate???

    Team GB Can't compete with what's on offer worldwide for its workforce in terms of work conditions, pay and lifestyle. No amount of money would tempt me back there because I simply no longer trust those that really run the system!!

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  • These are the 10 points they make?

    Its like adding 10 sticking plasters onto a leaking artery.

    They address none of the actual issues that are driving GPs away.

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  • I wonder how the Daily Mail will cover this story?

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  • Ggolden handshakes are totally unnecessary as Dan Poulter has said there is no crisis in recruiting. Maureen also says now is the best time in a generation to be a GP. Given that these prominent, well respected people know what they are talking about - it is clear that the GPs posting in pulse are all wrong and actually everything is fine - it is just a matter of perspective and I just need to keep taking my tablets.

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  • This is after dear Maureen went on a junket with Mr Hunt, who imposed Contracts and said if only GPs would only see their patients since casualty officers know them better.
    Shh, we do 90 % of all face to face Consultations compared to 4% in A+E.
    Please, please do NOT become a GP, no matter what Maureen says.
    I thought in these days of Candour, Maureen should have pointed out how utterly terrible GP land really is.

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  • This is a current "campaign" in Scotland by the charity Alzheimer Scotland. I fear that it will furter medicalise ageing, cause harm, stigma and increase referrals to General Practice.

    Here is my response:

    When forgetfulness becomes pathological

    Peter J. Gordon

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  • No where in this 10 point plan I see any effort to reduced the crap which if being piled on GPs daily which is what putting people from joining general practice or leaving general practice in the 1st place.

    NHSE is deluded more than I like to imagine. Their plan WILL NOT work

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  • Nobody sane would attempt to come back, the bureaucracy is impossible.

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  • I've never felt compelled enough to reply to these sorts of things in the past but enough is enough! I'm currently a GP registrar and am contemplating the idea of an MBA qualification - even better if it would be paid for as part of my GP training. however, the way I am feeling about working for the NHS, the likelihood is I would take this qualification with me and go and work in industry where the pay, conditions and resulting morale are likely to be far better. Sad really as I worked in industry before becoming a doctor in the first place.

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  • We have 26 LES and 20 audits to do before 31st of March. In spite of this paperwork nightmare increase in workload my pay per item has fallen by 50% in 10 years.
    I say to anyone even remotely considering entering GPland - you are not valued at all. Look at all the newspapers and politicians throwing garbage at you everyday. If you have no value or worth in society and if there is no appreciation of the years of training and hours and hours of work, then truly it is time to leave.

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  • I moved to BC in Canada 6 months ago. Offered $50,000 golden hello, plus $10,000 recruitment incentive, $15,000 expenses for the move. Work life balance improved, stress level decreased, enthusiasm for my job improved. £20,000 golden handshake and none of the actual issues afflicting UK General Practice addressed? Try again, team GB.

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  • The government will not able attract GPs with money only.

    Job satisfaction is missing .where NHS do not follow evidence based medicine to help save the public's health and mortality as certified by Prof Tony Barnet.and all,endocrinolists I spoke to
    GPs are obliged to blindly follow directtives of prescribing cheap top prescribe ,bit whose side effects are exhorbitantly expensive as far as patients well being and National economy opes>this is is exaplified by Sulphonylreas who experts proclaim shou;ld be only restricted to MODY type of DM,which NHS demands as 2nd line in Ty[e 2 Diabetes.

    The GMC MPTs by blindly following NHS's lead will make working as a GP hazardous for public and profession.It is best in these circumstance to collect british degrees and migrate when you can

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  • Ha ha ha. I couldn't stop laughing as I read this.
    I tried to rejoin General Practice last year. I could get no funding help whatsoever and the hurdles, hoops and red tape were a tangled Everest. I just couldn't be bothered in the end. I am due to lose my License to Practice next week so that's that.
    How I long for the days when you could just go and do a few locums in a friendly supportive practice and then fly solo again.
    Most of my female colleagues from medical school don't practice at all any more. Why didn't they utilise us in part time interesting jobs when we had young families. I would have loved to have worked at some kind of mid level in A&E or practically any hospital job, but it was never really possible. The whole system is stupid. Think of the expertise of these doctors would have after a few years. This potential has been wasted as there were no jobs like that for us. Some of us went into Genral Practice even though we didn't like it as it was easier to fit round a family. But that has become so unappealing now that we don't even want to do that. I doubt I'll work in medicine again and yet I love medicine. I mean medicine though, ie genuinely sick patients who respect you, are polite and grateful. Nurses and managers who treat you as if you deserve respect and have some authority. Oops I just started laughing again,

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  • 5:40:Thats pathetic . This should be exposed to the media. this is the best time as the general election is looming....somehow politicians who come and go just mess up the system...Time to educate people!!!

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  • Excellent summary from poster 5/2/15 @4.10 pm

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  • lol politians don't want gps, they are trying to abolish them and replace them with volunteers with no training, slaves of the starte

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  • 5/2/15 4:10 pm could not have put it any better. I have decided to retire next year and am not going to change that no matter how much cash NHSE throw in to keep experienced GP from retiring early. I should have listened to my Australian wife 10 years ago and pack up and head to the Antipodes.
    This golden handshake is not going to work. Like any business the best advert for succesful recruitment comes from those already in the business and I for one will advise trainees to steer clear of GPland. 20 years ago my 3 year old daughter at the time told me she did not want to be a doctor, when asked why, her reply was " we never see you as you are always at work". We are all putting in more and more hours for a diminishing reward. Enough is enough.

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  • There is little in the 10 point plan that will reduce the workload of GPs or bring back recently retired GPs. Why don't we offer the latter something more enticing- perhaps a role in managing local care homes?
    See ;
    for more details of how this might work.

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  • i fully empathise with the above comments towards my hard working colleagues and then there are the dirty fishes who hold single handed contracts for 10,000 patients and who have exploited funds in the past and only keep salaried GPs from the retired pool
    there are also practices which have over 6,000 patients with only one GP holding the contract doing 2-3 sessions rest done by retired GPs on a sessional locum basis-the reason they donot employ partners because their children are in the training process-so this becomes like a family corner shop-WHAT IS THE DAILY MAIL OR NHS ENGLAND DOING against these people who are using the public funds to only their benefits and not patient care???

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  • Took Early Retirement

    But you have to admit: it is funny watching them starting to panic- what do they do so close to an election? Let the problem get worse or start to throw money at it in the hope no one will notice?

    Before long they will be thrashing around like a brontosaurus with renal colic.

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  • Vinci Ho

    He says: ‘A few years ago, policymakers and NHS managers had their heads buried deep in the sand, denying there was any crisis in general practice and particularly with the workforce.'

    So who are these idiots? Are they still here instead of being sacked by now ?

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  • Everybody and their dog knows how to do my job better than I do, so I am leaving in 6 weeks to collect the pension. So long and Thanks For All The Fish.

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  • ps but do come back to me if Appraisal ever becomes voluntary.

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  • Before Xmas ,NHS England had an advert in our Australian equivalent of Pulse magazine advising UK GPs that the UK would like them to come back & how they could help..
    I've replied twice, expressing an interest.
    However they never got back to me.
    Not good first impressions.
    I have elderly parents back in UK & I'd love to be near them in their remaining years
    However, comments from Pulse & its readers over the past few years make me concerned that nothing has changed in the UK, that it has become worse.

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  • Took Early Retirement

    Too RIght Mate! Stay away! It's toxic here currently!

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  • Una Coales. Retired NHS GP.

    US physicians are staying away from the NHS equivalent called Obamacare...'X had a hip replacement in December. The whole process took about 6 months because of us being automatically enrolled in to Obamacare without our knowledge or consent. San Diego is a huge medical area and it took 6 months to find a Doctor that would take the plan and have the time to schedule him for the surgery. It was going to take 4 months just to get the MRI, so we just paid out of pocket and only had to wait 1 day!!! Amazing. Many Doctors here are just choosing not to accept Obamacare at all. Not sure what the press says about our president in the UK but many people here can not wait until he is gone….The problem is who will replace him and that is very scary.'

    So Obama wanted to do a Labour Nye Bevan on US physicians with his Obamacare equivalent of the NHS. Those waiting times sound very reminiscent of NHS rationing which may not be best medicine?

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  • A bronze handshake maybe but definitely not golden...

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  • Once again we see attempts to mend a bigger problem with small useless and misdirected solutions. It never fails to surprise me that the RCGP who should know better and press for real changes in our working conditions, instead acts as if there are no problems. I would like to see questions being asked as to why the general practice has become so unattractive in the last 10 years and why the trained well respected GPs are leaving the profession or choosing to work as locums. The Clever People at NHS Eng and in government offices do not understand that it is not about the money! but the working conditions, you can not give me enough money to make me work in such worsening working conditions, constant changes, political interference, increasing patient demands, increasing unfunded work, lack of support, and mountain of paperwork, targets,....i can go on for ever, Once again the opportunity to fix the problem is lost and the GLOSS is being put on to fool new recruits to enter a demoralized profession and it is a TRAP! general practice is not an attractive profession any more!! Unless someone is prepared to have an open and honest discussion with the REAL GPs who are battling out day in and day out and be prepared to make changes to improve the working conditions Quickly, I am afraid no 10 point plan will be enough to attract new GPs into the service.

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  • NHS and GMC MPTS should first of allstop draining doctors numbers on questionable grounds,putting tremendous impossible pressures on general practitioners.Plug the hole in kettle before trying to fill it up.

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