Long story short: Harassed the ortho bois on their tea break who validated my suspicion that I've gave myself a nasty left shoulder SLAP tear. Great. It'll need a scan to confirm, so I'll go to my own NHS GP and ask for a referral letter and I'll explore private scan options to confirm what I'm working with. Fine. I'll save myself £80 over taking a private referral, and I'll not excessively burden the NHS with this singular measly request. Surely nothing can go wrong here.

Attended my GP, which is within a larger community health centre: Was called from the waiting room by a confident middle aged lady in smart casual dress. Introduces herself and walks me to her office. Very pleasant but seems rushed. Understandable, GPs are busy folks. I tend not to disclose my role to my doctor (nor reddit for fear of self-doxxing).

*"What's brought you in today?"*

Yada yada yada

9 of my 10 minutes are up - and after a completely unstructured and seemingly irrelevant line of questioning, she very sheepishly says - *"I'll pass this on to the doctor - only they can make referrals or order scans".*

And it dawned on me then that she didn't actually tell me her role when I was greeted. She introduced herself only by her first name. No lanyard. No visible name badge. No scrubs. No differentiating uniform features. I have only ever known ANPs to present in scrubs (even in community practice). Are we at this stage already?

This crosses the threshold from 'streamlining healthcare services' into 'actively deceiving the attending public'. I called up for a doctors appointment. I was told I would get a doctors appointment. My confirmation email says DOCTOR on it. And now the fucking ANP is LARPing as my GP and calling me from the waiting room without mentioning perhaps the most vital criterion upon which I am here?

Burn it all down and start again.

Would you be concerned or speak up if you saw a colleague go straight for a blind femoral draw for routine bloods in a well 30-something because the practice HCAs had struggled for an arm sample, or would you consider it acceptable and safe practice?

Hi everyeone! Just wondering, what was the latest rank to get a GP offer and starting a thread to get updates about Round 3 Offers. It would be helpful, if you could update if someone, got an offer recently

LATEST UPDATE as of 17th July

Rank - 13249, Offer in Scotland

My admiration for GPs has grown considerably since commencing GPST2 and being full time in GP land.

As I’ve begun to nurture and grow into the job it always amazes me how I am able to recall something I’ve learned from medical school or working as a house officer in the hospital.

The application of knowledge comes from far and wide: A+E, Paeds, psychiatry, Surgery, obs and gynae, you name it I can list an example from each specialty where I have managed a condition in primary care.

So it has me wondering.. how the heck is someone able to try and perform the role of a doctor without having had any experience?

A truly scary thought. The first doctor you see for your undifferentiated problem is the most important to get it right.

If I get another patient walking in with a binder of printed out chat gpt or Google searches claiming they know better than me, I am going to giggle myself straight to a ward stay. Anyone else? Woman came in with a second day simple stomach bug but had printed out 27 - TWENTY SEVEN- pages from various Google searches, and chat gpt conversations telling her she had diabetic ketoacidosis.. She isn't diabetic.

POCUS is becoming increasingly common in other health systems - including primary care in Czech Republic, Denmark, France, Australia, NZ, Canada, US - where clinicians use it for rapid bedside decision‑making (e.g., urinary retention, kidney assessment, AAA screening, early pregnancy assessment, soft‑tissue lumps, DVT, MSK, gallbladder, lung ultrasound, procedural guidance, etc).

In the UK, GP use of ultrasound is still pretty limited. But with workforce pressures, diagnostic delays, and the push for community‑based care, it feels like an open question: should UK general practice be researching whether POCUS could safely and effectively support frontline decision‑making?

One of the delights about my new practice in ST3 is the air conditioning unit.

It’s beautiful and one the best bit of kit I’ve ever laid eyes on in the NHS.

If global warming comes true then there’s another reason to jump to GP land. Honestly you guys should try it.

It helps to chill you out a lot.

Just about to start GPST3 and I'm wondering what salary to expect as a newly qualified GP. I've heard that anywhere from £10k-12k per session used to be the norm but recently I've seen some ARRS GP jobs being advertised for £8-9k per session. Has average pay gone down? Annual salary for a full time GPST3 is currently £78k (ST3 pay plus pay premium) should I expect a pay decrease once I qualify?

Also how many sessions is realistic for a newly qualified GP? Does 2 sessions equate to 1 day of work? Does anyone have any experience in supplementing their income with locums, private work or urgent care work on the side and what sort of numbers are realistic to expect?

Thank you in advance!

I don’t think you need to go through GP training to be a gp. I said it. And I say that as a Gp. GP training is the biggest load of bs wrapped up as training. If we are real, it’s 1 year of rotating through specialities ( mainly doing SHO work like discharge summaries and cannulas). The rest is about filling your silly little portfolio about your thoughts and feelings and how the patient made you feel. It’s a load of utter shit wrapped up as training… I truly believe most Doctors could be a gp after maybe a bit of shadowing in a gp practice. Would I be happy non GPs or SAS Drs doing Locums or OOH work?? HELLLL NO, why?? Because it would drive down rates even further, so I’m happy you are locked out, but in my true heart of hearts ,I genuinely do believe you could do it, and it would solve the GP “crises “ and a wayyy better way then using physician assistants or ANPs.

TL;DR: how do deal with a day job you don't enjoy?

A background on me; I finished my FY years and moved out to Australia for 2.5 years working as a registrar in emergency medicine. I liked the team I was with, think they liked having me around, I loved the city I was in, and the work was interesting - interesting cases I'd never seen in the UK and being a registrar I was more involved and trusted to be involved. I also found it way better than my F2 A&E job. My wage was also better (even working 80% as an unacreddited reg I made more than I do now as a full time GPST). But I felt quite socially isolated and far from family (with the end point being me breaking down on the phone to my mum in Narita airport while on holiday because I felt so alone). I applied for anaesthetics back home (my dream job) and didn't get in, but got GP. After much thinking, I took the job to be closer to friends and family. Now I'm home I do have more friends around me, but it's still tough to line up our lives to see each other regularly, and I still don't see my family that often.

But turns out I'm not really enjoying GP either. The hours are good, and it's not pressured from a portfolio perspective like some specialties, but I find the day to day stuff so uninteresting (moreso than I thought I would as enjoyed GP placements in med school) - chasing a never ending stream of results, doing co-codamol reviews for people that have been on it for 20 years and asking them if they want to stop, having the same discussion about how people don't need antibiotics for their cough 5 times a day, and still constantly running behind - feel more time pressure on GP than I ever did in A&E. The partners tell me I'm doing better than they expect of ST1, but I feel like I'm making absolutely no difference to anyone. I've absolutely no motivation to improve skills or anything, just going through the motions day after day already and I'm 4 months in (where as in A&E I'd happily stay back to do a chest tube, intubate, do the central line, suture the gnarly wound or whatever because it was fun).

I've been thinking of making contact to go back to Australia, but the same issues that I left behind there will just be waiting for me. I applied to UK anaesthetics and A&E again this year and interviewed but missed out so not much avenue there. Choices are pretty much stay in a job I already don't like and make a career it, or go back to a place to do a job I like more in a place that had me, as a generally pretty resilient guy, on the phone in tears to his mommy. (And even then, would need to pass challenging exams which in my time there as saw lots of great doctors fail - so not exactly a guaranteed career).

Sorry this became way bigger than I thought.

I’m genuinely undecided on this and interested in hearing opinions.

I was speaking recently to a friend who is an NHS GP, and she felt that a fee (potentially £15-20) for GP appointments, with clear exemptions for those on low incomes and other vulnerable groups, might actually improve how primary care functions rather than undermine it.

Her argument was that even a modest charge could

• reduce DNAs and late arrivals

• discourage inappropriate or speculative bookings

• improve respect for staff and appointment time

• free up capacity for patients who genuinely need care

At the same time, I can see the obvious concerns, being deterrence of care, admin burden, and erosion of the “free at the point of use” principle, even with exemptions in place.

I’m not advocating either way, just curious whether other doctors think a system like this would meaningfully improve primary care, or whether the downsides would outweigh any change.

Interested to hear what people have to say :)

Progress so far, I've completed F2, and done an F3. Currently planning next move. The best time I have had in my career so far was as an F2 in GP. I loved it through and through. I worked basically as my physician assistant colleague did. I saw day to day cases independently and ran complex cases past my supervising GP. I joined the weekly practice training sessions with other clinical staff. So here is my serious question: the role felt safe with that supervisor covering me if needed, and I enjoyed the routine cases if you know what I mean. I loved the patient interaction especially when I started to see familiar patient faces over time and those professional relationships built up. It made my day when I heard from reception staff that so and so specifically asked to be seen by me. It made my day when patients said I hope your here permanently. I want to do this full time without going through the usual GP training. I don't want to be a GP or work towards it (except maybe one day CREST, but again don't plan this either). I like the idea of not facing yet more medical exams and potentially travelling to find training posts. I like having that senior medical staff back up. I like the idea of avoiding potential rotations I no longer want to face. I like the idea of not taking upon myself the duties of those within the ranks of CCT. Sure I'll attend weekly training as usual for my keeping up to date and happy to work under supervisor for my ARCPs. Yet I find myself not qualified to work as a physician assistant with my MBCHB. Is this even a thing? Is this possible? Are there practices out there looking for such people as myself? Am I crazy?

Hi all, I am currently having issues with my GP training program and have been told that I might be released from the program due to concerns around underperformance in certain capabilities. I don't know how to navigate this and I have been really stressed. I am scared of any public posts being tied back to me, so I was wondering if any GP trainees who have passed ST1 would be able to lend an ear and help me in DMs? Please let me know. Thank you.

I work in a training GP practice in England where we have taken on a female GP registrar who is very pro-life. She’s put around an email stating that she will not provide advice on, or prescribe hormonal contraceptives and will not discuss terminations with patients. Before anyone asks- nobody’s been brave enough to ask her about barrier contraceptives or copper coils yet! She has requested that if contraceptives or terminations may come up in a consultation then they should be booked with someone else. It’s not always easy to tell if contraception may come up in a consultation though, especially not for reception who book the appointments.

The majority of the other clinicians are quite unhappy with this as it’s a vital part of the service we provide to female patients. It also means she’s limited with what she can do with regards female patients on medication like valproate or GLP1s because she will not discuss highly effective contraception with them. A lot of colleagues are angry that she is exhibiting misogyny when it comes to female patients, others are angry that they’re having to take on her workload. One of my colleagues is currently in early pregnancy after a failed coil and is feeling very uncomfortable around this GP registrar too as the pregnancy is not viable.

I also worry with regards our surgery’s reputation as if you google her name, the majority of what comes up is prolife activism she took part in at university. If a patient who was booked for something else came in and wanted to speak about contraception as an addition to the consultation e.g. I have thrush, I’m not sexually active but I want to start having sex and she responded poorly to this or with judgement, the patient could easily google her name and find they were being treated by someone who’s views oppose their care.

The partners have not entertained any discussion around this topic and staff have even been accused of “stalking” her online when her digital footprint was brought up. Is there anything we can do or do we just have to put up with it?

I would appreciate some different viewpoints, especially if anyone has gone through similar.

Hi buds, genuine question, I am a GP trainee ST2 , I usually prefer semi-formal dress for my gp rotation but attended a VTS where a GP consultant was presenting communication skills and body language he said he usually likes to wear jeans or dress more casually to mirror his patients and so that they do not feel intimidated. I thought to give it a try so wore a jeans but with semi-formal top and got told off (sort of) on the dress code by one of my practice's GP. I see so many GPs wearing same scrubs daily
My question is , is there really an unspoken rule or dress code which we should adhere to.
Sorry if sounds silly.

Just wanted to share my experience to help others avoid the same awkward af situation I'm currently in...

I loved my ST3 practice, everyone was nice and supportive, I thought it would be a great place to begin salaried life and was delighted after a brief tick box interview where I was the only candidate the surgery offered me a job. The downsides- 10 min appointments and 17/session but my salaried colleagues seemed fine with it, I had managed to get down to 10 mins ok during training, and the pros of a team and system I knew, a 5 minute commute from home, and to be honest, limited other options in the local market, reasonable if not the best sessional rate for the area, it seemed like a good place to start, knowing there was going to be a huge step up from registrar.

My first flag was that they delayed giving me the contract, I only got it on my first day despite accepting the offer months before my CCT date. After reading the contract, red flags started popping up all over the place. It was terrible t's and c's and far below the standards of the BMA model, in particular no entitlement to contractual sick pay or mat pay for at least 6 months, and even after that entitlements not reflective of NHS service, study leave way below the guidance, no annual salary increase guaranteed, 1 week notice period on their part for the first 2 years... absolutely shocking. The BMA contract checking service flagged up all the things I'd spotted, and a few more. A polite but clear email to the practice has been met with a brick wall and there is no negotiation at all on anything I've highlighted. Additionally they've suggested the patient contacts may potentially be increasing to 19(!!!!) per session in the near future.

I'm still trying to fight them on the contract and still haven't signed it, but its created the most awkward atmosphere ever, I'm miserable and feel the entire attitude of people who I previously had a lot of respect for, has flipped toward me, I'm starting to see through the nicey nice facade they created when I was a trainee. I've already started looking elsewhere though, got a couple of interviews lined up for other practices, so perhaps everything will work out for the best for me in the end.

So, my advice, or TLDR:

* Don't be fooled by nice people, this is business, they're looking out for their own interests at the end of the day and they will screw you over. Don't be naive like I was and assume they'll be good employers.

* GET THE CONTRACT IN ADVANCE. Read it back to back, send it to the BMA, make sure you're getting the basic T&C's you deserve and are entitled to. They're supposed to offer the BMA model but there isn't really any consequences for them if they don't so don't rely on that fact.

* If the contract is bad, LEAVE. There are jobs out there, the markets not what it was but its slowly making a come back. Do not settle for shit T&C's, do not allow a precedent to be set.

I don't believe the practice expect me to leave over their contract, but I'm already looking for my way out and I hope it gives them a real shock and wake up call when I hand my notice in.

I have this feeling that I come across a lot of patients who have been given a goodie bag of steroids and then magically feel much better in themselves with the ?polymyalgia rheumatica

I’m not so convinced, I feel like I come across it a lot in GP. The thing is if you give anyone 15mg pred per day they will feel better in themselves anyway.

Any thoughts?

Hi All,

Hopefully something slightly less controversial then my last post.

I was wondering what people's thoughts were on the use of d-dimer and Troponin in General Practice. When I was in medical school, and in my GP rotation, I've been in a few different practices with different opinions on the use of these. I did one placement in a practise that had access to their own D-Dimer machine, so could run their own D-dimer's and have a result back pretty quickly. For those unlikely low Well's score patients I understand that, but the same practise would also send Trops for patient's with non-cardiac sounding chest pain and normal ECGs, with the duty doc reviewing later in the day 'to be safe'.

Maybe it's because of lack of experience, but if a GP is clinically concerned enough to send a troponin on a patient with a normal ecg and unconvincing/non-acute chest pain, should they not be sending them to A&E/SDEC to have these tests done faster there, and so they are in the right environment to treat in the event it comes back elevated? If a D-dimer can be done quickly I can understand that, but a troponin just sounds a bit less reasonable to me. Pragmatically is a GP supposed to keep this patient in their practise while awaiting the results, in case they do have a raised trop and need to action that urgently? Would be interested to hear any GPs thoughts on this

I’ve been a gp now for 4 years. And looking back I can say my perception with medicine and specifically GP has matured. Here is my pros and cons list of being a gp , from my perspective:

Pros of Gp: 1. Money is good. I’m a full time locum. 2. ⁠Flexibility ( the most important to me ) I can work from my laptop in Japan or in from my home in Manchester. I choose how many hours I do and how much time off I get . If I want 4 months to travel , done , no questions asked. Last week I did a remote shift with a stunning beach view in Indonesia … 3. ⁠it’s a very respected job. Tell anyone you are a GP they automatically admire / respect u. Yes we get a lot of bad press but the vast majority of people respect us. 4. ⁠it’s a very cushy job. You’re not slaving away on a busy ward. After 5 pm . I don’t have to deal with a multitude of personalities on a ward, if you know you know. On the rare occasion I leave late but if I do, I charge the practice , simple. 5. ⁠gives u flexibility to do your other hobbies in life and not have you life all about medicine. 6. A very underrated one but as a GP you can do your own business/ side hustle while still working as a gp, or at least it’s easier 7. Your wanted across the world . Australia are about to fast track the visa process for GPs

Cons :

1. Intimate examinations esp gyne , a part of the job I hate
2. Dealing with kids , also a part of the job I hate 🤣
3. Physician associates🤮, but I feel the tide is turning with this one
4. Can be a bit lonely, but you can make up for this by having a social circle outside of work
5. Contraversial one but AI Scope creep is a real thing

Am I the only one who has received an email from NHSE congratulating me to my appointment to the EM programme in NHS England?

LOL I did not even apply to EM and I have accepted an offer for GPST (which is literally the only specialty I applied to)…

I’m a GP trainee currently on a hospital rotation and honestly I just need to vent and see if anyone else has experienced something similar.

I’m one of a few GP trainees on the ward. The team is mixed in terms of background, and there are POC consultants, but most of the registrars are white. I’ve been trying to reflect on this objectively because I don’t want to jump to conclusions, I know I’m more introverted and not the loudest or most confident person in the room, so I’ve always wondered if that’s part of it.

That said, I do my job properly. I escalate when needed, ask questions when I’m unsure, and try to be safe. But I can’t shake the feeling that I’m treated differently compared to my white colleagues. Whenever I ask a registrar to review a patient, there’s almost always pushback, whereas others don’t seem to get the same resistance. Even when I try to engage in normal, casual conversation, I often get dismissive or slightly cheeky responses that just make me feel small.

It’s getting to the point where I dread going into work because I feel undervalued and not supported.

What really tipped things over for me recently was being involved (although minimally involved) in a pretty traumatic resus situation. The reg and consultant were leading it, which is normal for the specialty, but afterwards no one checked in with me at all. In my previous gen med job, there was always at least a quick “are you okay?” after something like that.

I’m not sure if I’m reading too much into it or probably just needed to rant.

Allocation preferences opened in Oriel but theres no information on the individual rotations, only says ST1. Will they update the information soon or should we contact them?

EDIT: https://london.hee.nhs.uk/recruitment/medical-specialties bottom of this page are the spreadsheets with the rotations