NHSE cuts GP ‘golden handshake’ scheme due to budget pressures

NHS England has officially scrapped the ‘golden handshake’ GP recruitment scheme, citing a ‘need to prioritise budgets’. 

The Targeted Enhanced Recruitment Scheme (TERS), which incentivises GP trainees to work in under-doctored areas, will not be funded in 2025/26, a decision which NHS England said it had not ‘taken lightly’. 

In a letter to medical deans yesterday, NHSE senior leaders said the ‘record numbers’ of applicants to GP specialty training, including in historically low-uptake areas, means ‘there is not currently a need to financially incentivise trainees to train in those areas’.

The national incentive programme – which would cost £18.6m in 2025/26 – funds £20,000 salary supplements to attract trainee GPs to work in areas of the country where training places have been unfilled for a number of years. 

Last month, the RCGP spoke out against NHSE’s intention to cut funding for the ‘golden handshake’ scheme for GP trainees, telling the national commissioner that it would be a ‘major step backwards’.

In explaining its decision, NHS England pointed to the ‘very high competition ratios’ for general practice training, as well as the increase in GP trainees from 2,671 in 2014 to 4,000 last year. 

This means NHS England is ‘now consistently filling all areas’ across the country, according to the letter.

It said: ‘With very high competition ratios and the need to prioritise budgets, the decision has been taken not to fund TERS places for this recruitment year. 

‘This decision has not been taken lightly; we know that TERS has in the past proved successful in encouraging GP trainees to train in hard to recruit into areas of the country.’

The letter added: ‘With 100% of places filled in every area of the country the priority needs to be funding as many additional places as possible, rather than extending the TERS scheme at a cost of £18.6m.’

NHS England also suggested that ‘tough funding decisions’ like this arise from the ‘strict budget constraints’ within the NHS.

The decision follows confirmation of the NHS budgets through the 2025/26 planning guidance, which told ICBs to deliver a further 4% overall improvement in productivity.

RCGP chair Professor Kamila Hawthorne said it is ‘disappointing’ that TERS will be cut for 2025/26 since it has provided patients in more deprived areas with ‘much-needed access to GPs’.

‘TERS not only brought GPs to communities that desperately needed them, it also encouraged GPs starting out on their careers, who might be from these areas, not to move away but to play a vital role in their communities,’ she added.

Professor Hawthorne said the college understands that ‘funding is tight’, but she called for the money saved to continue to be spent in areas of higher deprivation, for example ‘by expanding the number of training places available in under-doctored areas’.

In 2023, NHS England committed to increasing GP training places by 50% to 6,000 by 2031, in its long-term workforce plan.

More recently, health secretary Wes Streeting committed to a ‘refreshed’ version of the plan, which will have a ‘laser-focus’ on boosting GP numbers. 

Pulse’s recent series on the GP workforce highlighted the issues around increasing GP trainees numbers, including trainer capacity and physical space.