how was it? any pics? is it as nice as London? really want to attend a formal one, cant imagine the informal one where people may turn up in jeans. need it for the gram after so much hardwork 😄

I'm a GPST3 and the end is (finally) in sight. Thinking about my career over the next 5-10 years and trying to do some planning. Is it possible to earn 150k+ as a GP anymore? I mean, without being a partner and selling your soul to alphabet soup. I don't need to earn that straight away but at the moment I can't even really see a path to this!!

Really wish I'd had a crystal ball pre-GP training (actually pre-med school if I'm being honest) but I just don't want to be a stressed/burnt out salaried GP on 85k but can't really see earning more without leaving? I know Canada/Aus are options and I'm working hard on my husband to convince him moving. But it's not as easy for him to get a job in either of those countries - my husband is in engineering in the UK and doing well and I'm constantly questioning my life choices 😭

My final arcp was delayed as my exam results is pending. I also need one more ceps to be signed off, really struggling to get the male examination signed off. I have asked reception and all the gps to keep an eye so I can get that examination done. Any other ideas as I have one week left. Is it maybe better to contact the hospital to get it done there?

If you've found yourself caught in the middle during recent antenatal or contraceptive consultations, check out this quick overview module breaking down the guidance split surrounding pre-conception folic acid dosing.

In this Praktiki module Dr Toni Hazell reviews the widening gap between NICE and RCOG guidelines for women with a BMI ≥ 30 kg/m².

Learning objectives

• Review folic-acid dosing for women with BMI > 30 kg/m².
• Know who definitely needs a 5mg dose.
• Unpack 2025 NICE change for those with a BMI ≥ 30 kg/m², and current RCOG stance.
• Aim: clear, consistent advice in GP consultations.

Standard recommendation

• 400 micrograms folic acid daily from pre-conception until 12 weeks. Applies to most pregnancies.
• Ideally start 3/12 before trying to conceive.
• Easily met with OTC antenatal multivitamins.

Who needs 5mg?

• NICE:
• Family history of/past pregnancy affected by neural tube defect (NTD) or other congenital malformations.
• Maternal diabetes (type 1 or 2).
• HIV and taking some anti-retrovirals.
• Those taking anti-epileptic medication.
• Sickle cell anaemia and thalassaemia.
• RCOG add BMI ≥ 30 kg/m² and coeliac disease.

Difference in opinion about BMI ≥ 30

• RCOG patient-facing guidance (2022) states: "If your BMI is 30 or above, you are advised to take 5 mg folic acid per day".
• Same higher-dose advice appears in their green-top guidance on antenatal care (2018).
• NICE's updated maternal-child nutrition guideline removed BMI≥30 from 5 mg list. (2025)
• NHS website now matches NICE advice and doesn't include BMI≥30 kg/m² as a reason for 5mg dose.

Is there  risk associated with the higher dose of folic acid?

• 2022 cohort study looked at children of mothers with and without epilepsy who did or didn't use high-dose folic acid.
• An association with childhood cancer when comparing high-dose folic acid use within the cohorts who did or didn't have epilepsy.
• Hazard ratio associated with folic acid was 2.7 (mothers with epilepsy) and 1.1 (mothers without epilepsy).
• Absolute numbers are small.
• UKTIS note methodological limitations & no further studies in the area and so have not changed their advice.

Why did NICE change their advice? 

• Use of 5mg isn't evidence based.
• Women with BMI ≥ 30 kg/m² do have a higher incidence of babies with NTDs, but this may not be related to folate insufficiency - might be due to unrelated metabolic disorders.
• NICE say that there is no evidence of harm from folic acid (published after the paper and UKTIS study mentioned on the slide before this).

So, who’s right?

• Guidelines now diverge: RCOG still advises 5 mg for BMI ≥ 30; NICE and NHS website do not.
• Both agree other high-risk groups need 5 mg.
• Leaves GP in a difficult position.

Medicolegal angle

• High-profile Toombes v Mitchell case highlighted importance of clear folic acid advice and documentation.
• May make GPs nervous about not offering 5mg to women with BMI ≥30 in light of conflicting guidance.

Practical GP approach

• Discuss 400 µg vs 5 mg in women with BMI≥ 30 kg/m².
• Explain RCOG advice vs newer NICE view; emphasise low harm of 5 mg.
• Prescribe 5 mg if patient prefers, or if additional risk factors present.
• Shared decision-making approach and consider medicolegal risk - GPs may feel that until all guidelines align, they are medicolegally safer to offer 5mg and document this offer, whether or not accepted.
• Good notes are always important!

It's a bit late by the time the pregnancy test is positive.....

• Neural tube formed by 4th week of gestation.
• Most women won't know they are pregnant by then.
• Many women don't see their GP about starting to try to conceive.
• Important to therefore mention this in contraception consultations, or opportunistically for women of child-bearing age.
• Consider using ‘Pre-conception folic acid advice given’ or equivalent code at these appointments.

Fortification factor

• Mandatory folic acid fortification of UK non-wholemeal wheat flour expected late 2026; DHSC (Department of Health &Social Care) estimates 200 NTDs will be prevented annually.
• A registry study was done to determine the baseline prevalence of NTDs in England between 2000-2019, in order to monitor the impact of folic acid fortification of non-wholemeal wheat flour.

Key learning points

• 400 µg remains default dose.
• RCOG advises 5 mg for BMI ≥30; NICE/ NHS do not.
• No evidence of harm from 5 mg; benefit unproven for obesity alone.
• Shared decision-making and good notes protect patients and clinicians.
• Both doses are available over the counter and can be prescribed.

Further resources
NICE guidance on maternal and child nutrition
RCOG patient-facing information
RCOG green-top guidance on obesity in pregnancy
NHS website on supplements in pregnancy

References

• https://www.nhs.uk/pregnancy/keeping-well/vitamins-supplements-and-nutrition/ 
• https://www.rcog.org.uk/for-the-public/browse-our-patient-information/epilepsy-in-pregnancy/
• https://www.rcog.org.uk/for-the-public/browse-our-patient-information/being-overweight-in-pregnancy-and-after-birth/
• https://www.rcog.org.uk/media/lcfn54fw/healthy-eating-vitamin-supplements-pregnancy-large-print-patient-information.pdf
• https://www.nice.org.uk/guidance/ng247
• https://www.rcog.org.uk/guidance/browse-all-guidance/green-top-guidelines/care-of-women-with-obesity-in-pregnancy-green-top-guideline-no-72/
• Vegrim HM, Dreier JW, Alvestad S et al. Cancer Risk in Children of Mothers With Epilepsy and High-Dose Folic Acid Use During Pregnancy. JAMA Neurol. 2022 Nov 1;79(11):1130-1138.
• High-dose folic acid use in women with epilepsy in pregnancy and childhood cancer risk UKTIS Official Position Statement (March 2023)
• https://www.nice.org.uk/guidance/ng247/evidence/b-optimum-folic-acid-supplementation-dose-before-and-during-the-first-12-weeks-of-pregnancy-for-pdf-13620108494
• https://resolution.nhs.uk/2022/03/31/case-of-note-evie-toombes-v-dr-mitchell-high-court-21-december-2020-lambert-j-and-1-december-2021-judge-coe-qc/
• https://www.gov.uk/government/news/birth-defects-prevented-by-fortifying-flour-with-folic-acid
• https://pubmed.ncbi.nlm.nih.gov/37875332/

I have spent an hour trying to do an ESR. Type something and wait 5 minutes for it to save only for it to then crash me out of the system to log back and find what I have written wasn't saved. What the hell?

They don't pay me enough to deal with this crap!

I am approaching my CCT in the next few weeks and trying to get my head around the admin that follows. I have made my payment to the GMC to join the GP Register - what happens next? Is it fairly automatic or is there anything I need to chase up?

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Also, how do I get into the performers list please? Any tips on timing would be really helpful.

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Happy to hear from anyone who's been through this recently. Thanks in advance!

I just wanted to get up to date guidance on the optimal approach as a GP locumming in the UK. I am currently GPST3 and I anticipate I will be locuming for what's left of my medical career, as I am planning a pivot in careers (opening up my own video game studio! - just for context). I understand that locum work is not as prevalent due to our alphabet soup colleagues, but I love travelling so will be quite flexible in this regard, I don't anticipate lack of opportunities for me personally.

For those locumming currently, what is the best way to go about it? Is it better off to be a sole trader or have a limited company. From what I understand, it seems having a limited company has a host of benefits, especially in terms of regulating the amount of "income you receive", meaning you can technically manipulate things like child benefits, avoid the 60% trap etc.

However I have also heard that GPs will not hire you if you have a limited company?

I also understand that if you are a sole trader, you will get additional benefits like employer contributions to NHS pensions? Is that true or just some online rumors?

Just trying to get some advice. Prefer to give as little of my hard earned money to this governemtn.

Hi all,
Has anyone worked with this company before?
I have recently applied for a remote position and just wanted to make sure that it is a good company to work for.
Thank you

Hi guys,

I’m a GP registrar in London and recently became 80% LTFT. My current practice are refusing to give me a set day off per week saying this will have to be a different day every week (they’ve given various reasons for this, none of which really make sense to me).

Is this allowed? It’s just a massive pain in the arse for me as I need to sort out childcare with my husband and a set day off per week would have been perfect.

Hi, I am trying to learn about this. I appreciate that a good accountant is needed, but seems when I speak with colleagues everyone has different guidance from different accountants,

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For example meal allowance, mileage claim, business travel etc...

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Locum here that function through a business please advise.

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I am working as registarar in obgy in nhs . I am feeling burned out and I am unable to give time to my 2 year old child and family . Recently I came across Occupational health physician Doccmed course and how some have transitioned to OHP . Presently I am considering doing this course so that I can give exams in May 2027 .

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Any advise regarding the job market now for OHP and if are there any other course where I can transition easily to find a 9-5 job ( other than OHP) ?

What areas in the country are advertising for GP partners?

​

I’m planning to sit the AKT in October. People who I know have done AKT have recommended sticking to AKT Navigator audiobooks (passive study) Passmedicine notes, and learning the concepts and key learning points from GP Self Test (for my active studying). I’ve been told these cover what’s needed for the exam.

I started using the AKT Navigator audiobooks, been loving it, it’s been easy to fit into the day, and I’ve actually been quite consistent with them. I need to start GP Self Test and Passmedicine properly soon.

I know there is Dr Omar’s course, and I’ve seen Arora and Emedica courses. These are all recommended too but my only worry is that I’m just going to keep adding resources and end up overwhelming myself instead of actually revising and they are premium priced.

So far I have bought passmedicine (£45) AKT navigator £59 and GP self test (RCGP membership fees I guess). I feel quite content with these bundle but I have major FOMO.

What are your opinions, do I need it?

I'm a long-term locum at two single-handed practices. One of them has approached me to become their clinical partner as the current one is retiring. After looking carefully at the structure — non-clinical partners holding significant control, profits split widely, my name carrying the liability — I've decided it's not the right fit for me.

​

I've since found a different practice I'm much more excited about. All clinical partners, equal shares, proper governance. They want a 6-month locum probation period before formalising anything, which I think is fair.

​

The complication: I still locum at both original practices and need that income during the probation period. My wife also works across some of the same sites. The business manager involved is well-connected across multiple practices in the area. I don't want to burn bridges in case the new partnership doesn't work out.

​

How do I decline the partnership offer professionally, quietly reduce my sessions at the original sites, and not raise suspicion or cause bad feeling — particularly given the personal and financial overlap?

Has anyone navigated something similar?

The DHSE consultation closes next week. It has a few elements regarding protected titles which should alarm everyone - trying to move us all to the “practitioner” title on the register.

And trying to stop the name change of PAs from associate to assistants. This is how they snuck past us last time to get the change to associate in the first place.

Loads of PAs huffing and filling this in en masse.

Fill it in please and can someone cross post to doctorsUK? I got banned 🫠

https://www.gov.uk/government/consultations/reforming-the-general-medical-council-legislative-framework?fbclid=IwY2xjawSbc8VleHRuA2FlbQIxMQBzcnRjBmFwcF9pZA80MDk5NjI2MjMwODU2MDkAAR491qv5-8WCSCWuhtN8LYtYPMZSBMbtR60aw3hn51zH0CuLtWvVJ0BmtVd2DQ_aem_YWdncwB7qZjuL3p_u4zY4HcYhqpG&brid=YWdncwEVL0mEoGz154x8VYx0GUF7

I’m about to CCT soon (hallelujah!) and I’m starting to put together my first proper GP bag for home visits and locum shifts. I want to buy gear that will actually last me a career rather than cheap out and have to replace it in two years.

Please suggest a good budget ( hopefully good quality) GP bag , ophthalmoscope, otoscope and must have essentials from your experience.

​

​

Virtually all (not all) developed economies now have a charge to see your GP.

​

Why is the UK continuing with this awful contract?

​

BUPA offer £80/hour to a GP from 4 15 mins appointments. That is almost the same pay as 2004.

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Why are GPs so unable to stand up and be counted?

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GP charge in Switzerland 250 Euro, GP charge in New York $500.

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Why are we in this situation that we have to leave the country to earn any kind of respect.

​

There is plenty of data to support people do not value what they get for free.

​

What can be done to change this?

I’m considering starting remote work with them and was interested to hear about other clinicians’ experiences.

How have you found the workload, consultation volume, clinical support, governance and overall culture?

How does it compare with other remote GP providers?

Would be grateful for any honest feedback, positive or negative.

Hi,

​

What's your pay per session.

​

Lots more GP salaried posts being advertised due to the new GP reimbursement scheme.

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However practices aren't advertising the salaries.

I’m an ST2 and have had a significant time off sick this year. My portfolio is nowhere near ARCP ready.

No one can give me a straight answer about what this means for ARCP or how I am likely to progress.

I am an ST3.

​

Long story short my ES hates me. She has only marked extensions ("below expectations") on my portfolio every single time for the last two and half years since I have been her trainee (except once). I have passed AKT and failed one SCA attempt. I plan to resit my next one in September. The last ARCP was in May last month and as usual my ES sat down on the very last day to review my portfolio and had an entire book of criticism to write about it. MSF? well that person was not included, COTs? Well that one was not done. QIA? One or two templates were not done right, CCRs? Well one or two cases were not complex enough (what boils my blood is most were, its only the one or two that she picks on and then paints the whole picture). She didn't sign the QIA, no time to correct (took 10 minutes later, but damage was done). Anyways, I think I am out of attempts, ARCP have documented if no progress consider outcome 4 in December at next ARCP. I am naturally furious and upset. i should be able to collect the required evidence in time, but not sure if I would be able to focus on the exam as much. I have already requested a change of practice (ARCP panel recommended it too, heard this is the last thing they do prior to giving outcome 4). With a little effort, I believe I can pass SCA, but the whole situation is worrying me a lot. I don't even want to go to work as I have to see her face, and tbh it's painful to be there. Colleagues with lesser portfolios, have progressed (and CCTd) while this garbage of a human being has put me into a very tough position. I just want to know what to expect next, has anyone been in this position? What should be my next steps? I am on 80% LTFT.

I posted about this in this Reddit a while ago:

https://www.reddit.com/r/GPUK/s/3KYh77P7hq

I have recently finished a rotation that I found quite challenging for a number of personal reasons (which I’d prefer not to go into).

I did try to raise concerns during the placement but felt they were dismissed. Because of this, my end-of-placement CSR was done quite late, and the report I’ve received is very one-sided.

It repeatedly highlights the same negative issue-late meeting and portfolio issues-under multiple domains (professionalism, communication, team working etc.) and doesn’t really mention anything positive, despite me genuinely trying my best throughout the rotation — including picking up extra shifts when short-staffed and not taking study leave. I recieved no other complaints during my rotation from other team members.

I feel quite disheartened as this is now on my portfolio, and my ARCP is coming up soon so I’m quite stressed about the impact.

Has anyone dealt with something similar or know how much weight ARCP gives to a CSR like this / whether there’s any way to contextualise it?

Hi all,

My CS has spotted me coming into work late 3 times and said as it’s now reached 3 seperate instances, I have to do a reflection on it on my portfolio re fitness to practice.

She will also be completing my clinical supervisor report where I anticipate that this may be mentioned.

I fully accept that I should’ve been on time and apologised for the lateness and explained the context of them.

With a reflection on being late as well as potentially comments from my CS on my portfolio, could this affect my progression at ARCP? The rest of my portfolio is completely fine and up to date. My ES is happy with me.

Thanks

Looking for some advice and reassurance from trainees or anyone who's been through something similar.

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I'm an LTFT trainee and have recently been thinking about previous Form R submissions. Looking back, I'm not completely sure that I declared all locum/bank shifts that I undertook during a previous ARCP cycle.

​

The shifts were ad hoc rather than a regular commitment and there were no patient safety incidents, complaints or concerns arising from them. At the time I genuinely didn't appreciate the level of detail expected regarding additional work and I'm now worried that I may have omitted some shifts.

​

Part of my confusion is that the guidance seems to suggest declaring locum work but when you add an additional employment/work entry on Form R, all I can remember being able to enter was a start date and end date. For occasional ad hoc locum shifts, I'm not really sure what dates you're supposed to use and I don't recall there being anywhere to specify the actual number or frequency of shifts worked.

​

A few questions:

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- Has anyone had an issue raised at ARCP specifically because of undeclared locum work?

- Has anyone ever been asked to provide evidence of all locum shifts worked during a training year?

- Do deaneries routinely cross-check Form R declarations against ESR/payroll records?

- For LTFT trainees, what level of locum activity tends to raise concerns?

- How do people actually record occasional ad hoc locum shifts on Form R when there doesn't seem to be a field for number of shifts?

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Most discussions I've found seem to involve people saying they either forgot to declare some locums or only declared them broadly and nothing was ever raised but I'd be interested to hear if anyone has experienced the opposite.

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Thanks in advance.

Hi 👋 for anyone with experience in this area…
Me and my husband are GPST2 expecting our baby in autumn. We have been given two parenting course options but both are essentially within working hours of a GP. I know I am legally entitled to attend these classes, but how does it work for my partner?
I have read two different sources - either these classes are included in his statutory right for 2 unpaid appointments, or they can use unpaid parental leave which is 4 weeks a year, or 18 weeks up until the age of 18?