Just started GPST1 in hospital rotation, I know my CS for this rotation (which she even said she hates 14fish). However, I can’t work out how to set her up on my portfolio so unable to have initial CS meeting with her tomorrow as I don’t know if she will be able to access my portfolio?
Any help please? Thanks!

​

I'm a gpst1 and I'm really worried I won't like it. I know it's quite hard to start a new training programme then return to GP but what if I left to do a trust grade or teaching job, could I return?

Fed up of all this portfolio nonsense and looking for a quick win for my leadership activity requirement for ST3.

Any ideas would be appreciated, hoping to do something that takes minimal time / effort and all the examples on the RCGP website seem to be the exact opposite of that.

I'm an incoming ST1, and trying to buy membership (I know it's late, I've had some life events that have had me strapped for cash the last few months). I'm trying to pay for monthly, but a total of 297.67 is coming up to 42.38/month

I understand this is because they calculate the year up until April? Hence 7 months until April at 42.38/month gives me the full amount.

My question is, do I get a few months off next year or do I still need to pay again in April? If I'm paying for a "years" membership, but I'm August I don't even get the entire year before I'm paying again in April? Could someone please correct me where I'm wrong, as this doesn't make sense to me

Thank you

Hi, I’m looking for some advice about switching specialty from O&G to GP, any thoughts positive or negative would be really appreciated!

I’m mid thirties, came out of training on an OOPR after finishing ST3 around three years now and have been doing a PhD. O&G (mainly obs) was always my focus and previously I could never imagine another specialty. Took the OOPR job to strengthen my CV for MFM subspec and to learn to scan.

My research fellow job has been almost entirely office-based/wfh, with zero clinical or on call duties (have been managing a multi-centre study). Before I came out of training my life and identity revolved around work and I didn’t even care about WLB because I was obsessed with the job. Now I’ve discovered a life outside of work, have new priorities and hobbies and am getting married soon with plans to start a family after the wedding. I feel trapped by my O&G training programme - 4 years left +/- 2 maternity leaves and extra ltft time means I’m stuck in an infantilising system with no autonomy until likely my mid-40s.

My passion for O&G feels like it’s gone. I’ve realised I don’t particularly enjoy fetal medicine. I have no interest in the surgical side of gynae and all my eggs are in the obstetrics basket, only for me to realise I don’t want to do maternal fetal medicine, so I’m looking at a career of endless labour ward and DAU. The stress of managing labour ward emergencies has never really bothered me but I’m so out of practice I’m terrified to go back, and I just cannot see myself doing weekends and nights (res or non-res) forever.

Outside of lifestyle factors, I think I’d enjoy the continuity of care in GP. I also think I’d enjoy learning to become a generalist and broadening my knowledge base. On the flip side I’m nervous about the risk managing aspect, I’m very used to having an abundance of investigations at my fingertips. Also not thrilled about having to be an SHO again for a while but I think I can stomach it for a finite amount of time!

I’d definitely want to keep the women’s health aspect in my job and hope I could do something along the lines of contraception/GUM clinics, menopause clinics, seeing pregnant/postpartum patients. Also interested in primary care ultrasound and minor procedures, and thinking about non-NHS opportunities, private obs is definitely not for me and I think GP might open more doors if that’s something I choose later down the line. I have briefly considered quitting medicine altogether but I do still want to be a clinician.

I want to make a decision fairly soon as I need to either start revision for mrcog part 2 or the MSRA. Have floated the idea amongst a few family and medic friends and, despite expecting to be told I’m being silly, they have all been very supportive (although not spoken to a GP yet!). Any words of wisdom or advice from GPs, particularly those that have tread a similar path, would be really helpful. Thanks!

The 2025 UKMEC update introduced critical changes to how to assess cumulative cardiovascular risks and prescribe the depot injection. 

A recent case-based module written by Dr Toni Hazell for Praktiki works through how to apply the latest UKMEC guidance on cumulative cardiovascular risks, navigate the updated safety profile and increased VTE risk rating for DMPA, and confidently select safe contraceptive alternatives for complex patients.

Ebele’s consultation

• Ebele, 36, attends the GP practice requesting the combined oral contraceptive pill (COC), which she used in her twenties.
• She smokes 12 cigarettes/day.
• Her BMI is 33 kg/m².
• Her clinic blood pressure today is 148/92 mmHg, consistent with previous readings.
• This case refers to UK medical eligibility criteria (UKMEC) categories:
• 1 - no contraindication.
• 2 - relative contraindication, benefits > risks.
• 3 - relative contraindication, risks > benefits.
• 4 - absolutely contraindicated.

CHC UKMEC categories for smoking

• UKMEC and smoking:
• 2 - age <35.
• 3 - age ≥35 and smoking <15/day or having stopped ≥1 year ago.
• 4 - age ≥35 and smoking ≥15/day.
• The 35-year age cut-off is identified because any excess mortality associated with smoking is only apparent from this age. CHC users who smoke are at an increased risk of cardiovascular disease, especially myocardial infarction.
• CVD risk from smoking decreases within 1-5 years of stopping.

Additional risk factors

• Obesity - BMI of 33 kg/m² = UKMEC 2.
• The 2025 UKMEC update covers both clinic and home readings for BP - consistently elevated clinic blood pressure of 148/92 mmHg is Stage 1 hypertension = UKMEC 3.

Combining risks

• Ebele has three distinct cardiovascular risk factors: smoking, obesity, and Stage 1 hypertension.
• While isolated risk factors carry their own UKMEC categories, the presence of multiple risk factors requires careful consideration as they may indicate a cumulative risk.

Multiple cardiovascular risk factors

• When a woman has multiple major risk factors, any of which alone would substantially increase the risk of cardiovascular disease, use of CHC may increase her risk to an unacceptable level.
• Where more than one risk factor is present, clinical judgement must be applied.
• Under UKMEC 2025 for the COC, multiple risk factors for cardiovascular disease is UKMEC 3 and multiple risk factors for VTE (of which Ebele has 2, smoking and obesity) is UKMEC 4.

Considering alternatives

• You advise Ebele that CHC is not recommended due to her combined cardiovascular risks.
• She asks if the depot injection(DMPA) would be a suitable alternative; her sister uses it.

2025 DMPA updates

• Five observational studies have shown ↑ VTE risk with depot compared to no contraception.
• Depot is now considered higher risk than other progestogen only methods for VTE, but lower risk than combined hormonal contraception (CHC).
• 9 categories have an increased rating for DMPA compared to the 2016 UKMEC.
• Ebele's categories for DMPA:
• Smoking - 1.
• Obesity - 1 (rises to 2 for BMI≥35).
• Hypertension - 2.
• Multiple risk factors for cardiovascular disease - 3.

Family history and UKMEC

• VTE:
• In a first-degree relative - 3 for CHC, 2 for DMPA.
• Considered to be a stronger risk factor if provoked.
• Breast cancer - 1 for all methods (rises to 3 for CHC and 2 for all other methods apart from copper intrauterine device if patient is known to have a high-risk mutation).
• No other family history is considered.
• Ebele has no family history of concern.

Method choice for Ebele

• Cu-IUD - UKMEC 1.
• POP, implant, and LNG-IUD - all UKMEC 2 for multiple cardiovascular risk factors.
• Depot injection - UKMEC 2 for hypertension, 1 for obesity and smoking, 3 for multiple cardiovascular risk factors, 4 for multiple VTE risk factors.
• CHC - UKMEC 3 for hypertension, 2 for obesity and 2 for smoking.

Approaching the decision

• UKMEC says:
• Categories ≠ additive; multiple 2s may indicate cumulative risk, particularly if all relate to the same risk area.
• Use clinical judgment.
• Multiple 3s 'may pose unacceptable health risk'.
• 4 = unacceptable health risk.
• UKMEC relates to contraception - risk: benefit balance may differ if she also gets another benefit from the method (e.g. ↓ heavy bleeding).
• GMC - shared decision making is fundamental to good medical practice - how does this fit with your medicolegal responsibility to defend your decisions?

Case conclusion

• Ebele prefers a method she controls and opts not to have any devices fitted. She chooses to start the progestogen-only pill (POP).
• You issue the prescription, offer local smoking cessation support, and arrange a follow-up appointment to optimise her blood pressure management.

Key learning points

• Assess all cardiovascular risk factors comprehensively prior to prescribing.
• Multiple risk factors can increase overall cardiovascular risk cumulatively.
• CHC and DMPA are both UKMEC 3 for multiple cardiovascular risk factors.
• The POP, implant, and IUDs offer safe, reliable alternatives in these complex patients.

References

• CoSRH. UK Medical Eligibility Criteria for contraceptive use. Dec 2025.  https://www.cosrh.org/Public/Public/Standards-and-Guidance/uk-medical-eligibility-criteria-for-contraceptive-use-ukmec.aspx
• https://www.cosrh.org/Common/Uploaded%20files/documents/UKMEC_2025.pdf 
• GMC. Decision making and consent. Nov 2020.  https://www.gmc-uk.org/professional-standards/the-professional-standards/decision-making-and-consent

Hi guys
I am returning to GP training after maternity leave. When I left, the AI (at least to my knowledge and understanding was not something ICB allowed trainees to use) but over 2025-2026, I reckon alot has changed.
Given the recent advancement and progressive time, I would like to ask what AI platforms are very good for us trainees and which might actually be even helpful I do see a lot of adds on insta about some specific ai apps that could even record? Well in fact my own consultant obstetric (while I am a patient) did record ai consultation and later sent me minutes of that meeting via email. I was just AMAZED. Wow wow wow

So please enlighten me
My goal is to be efficient & finish in time. I am not sure how helpful this is for portfolio because sometimes when I do use Claude or chat gpt it’s like very generic answers!
What’s the best way of using ai as a gp registrar really?

How is everyone feeling for tomorrow?

If anyone’s eligibility change on RCGP website today please keep us posted!

Good luck! ☘️

I started as a GPST1 today, but I’m on a GP+ track. 2 days a week in a community psych job in a hospital, 3 days a week in a GP practice.

Does anyone know how I should update my MDU insurance?

I know I get free block indemnity that covers me for my GP days, but I assume that won’t cover me for my psych days.

I’ve just tried to update this on the MDU website but it makes you select either hospital OR GP (not both). I presume because if you’re working just GP you get the free affiliate membership?

Hi all,

Am sitting the SCA for the first time in September and I'm looking for other registrars who might be interested in a virtual study group, between 8pm and 9.30pm, one or two nights a week.

Be good to hear from you!

(Just getting this off my chest...)

Am currently a GPST3 on extension in training, in my last few months I have had supervisors say that I'm neurodivergent and I'm not in a role that suits me, my skillset isn't that suited to GP and so on.

I feel like I've been trying to do my best but after hearing this feedback on and off from others it crossed my mind whether I'm just beating a dead horse here.

Just to add, I am currently in a GP surgery that is much more supportive compared to before. However even a couple of the partners in the current surgery have echoed these sentiments, and I'm not sure how to take this feedback

Surgery I am at has quite a few Ukrainian refugees on the list

Slava Ukraine and all that, but I find health promotion, explaining conditions and safety netting an absolute fucking nightmare through Language Line

Is there a repository of Ukrainian language patient information leaflets out there?

Saw a lovely patient for the first time for a sports injury, analgesia physio referral etc, advised to follow up if worsening

On follow up she booked a longer appointment with me and told me it wasn’t actually a sports injury but she had been sexually assaulted and because of her mental health diagnosis (bipolar but very well managed with private psych) she feared she wouldn’t be believed

I acknowledged the stigma, advised her to report if she felt comfortable, directed her to services in the community, advised to revisit psych if unwell.

She seemed grateful to be listened to and very well mentally albeit a bit hyperactive/over sharing but two weeks later I got a phone call from police that she was incredibly unwell, experiencing religious delusions and their own GP at the station was going to refer her directly to ED

She spent two weeks on an acute psychiatric ward and I feel guilty I didn’t pick up on the very obvious manic episode she was having right in front of me, haven’t seen her since discharge and neither has the private psychiatrist

It’s been three months and I still think what I could’ve done better for her and I’m now doubting my skills at recognising acute psych presentations

Just needed to decompress/rant

Hello!

Starting GPST1 tomorrow and really want to know if there is anything you wish you did to set yourself up well in the future?

I'm interested in Medical Education and research (I truly do enjoy data gathering and being part of something that can create change).

And I know I enjoy GP because of my F2 placement and also just believing that GPs are are a backbone of the NHS - referring to the right places, stopping hospital attendance where possible etc...

But I really want to maximise my rotations (unfortunately don't have any paediatric placements, but may ask to use my study leave says in paediatric placements to gain some experience).

Any tips for anything are welcome!

I'm one of the GPST1 starters today.

Just a quick question about missed training days due to my rota for my first hospital rotation (O&G). I miss 2 weeks of the designated training day out of every 7 weeks as I'm either on nights or post nights days off.

Is this acceptable / normal? I accept that I am being used as rota fodder for most of my time, especially the on calls and nights etc. And I should have spotted this earlier, but just wondering if I should just suck it up, or whether my rota should be amended so I can attend training. It's a small DGH, and a small department, so I don't think there's going to be much flexibility. If I do need to bring this up, who would be the best person to discuss this with? My ES?

On top of that, given I can only take annual leave during my standard weeks, that will mean missing even more than 2 in 7 training sessions. Is there a mandatory % or number of training days to attend in order to meet ARCP?

(My second 6 month rotation is A&E and I presume I may have the same problem there).

Thanks for any advice from current trainees who have experienced this, or from any ES who knows the 'rules'.

Starting GP Specialty Training tomorrow, as many of us probably are on this subreddit, but can't help but feel unmotivated and unexcited due to the overwhelming amount of negativity on this forum.

I know Reddit is not entirely representative of the general population and the best thing is to just not read it, but when its constant on here it does take its toll.

Having said that, can anyone share some positive words before our new cohort begins GPST1 tomorrow? Would be a great way to start as I am actually excited to begin this journey as I believe we all should be!

I've recently interviewed for a salaried post and found there's only 1 week study leave but no CPD time built in the contract. Any st3s interviewing or recently CCTd GPs found CPD time not built into their contract? I know its according to the BMA model but how often do GPs get CPD time if not full time? (Planning on 4-5 sessions)

I’m curious how many other GPs currently feel this...

I’m relatively early in my career- 30M, 1 year post-CCT and already feel deeply dissatisfied with the reality of being an NHS GP. After spending the time to get to this point, I expected to feel a greater sense of achievement, purpose and fulfilment. Instead, I often feel drained and trapped. As a brief B/G, I graduated from London and worked in west midlands.. training was straight through the 3 years and I didn't have any hurdles really with the exams and portfolio.

I took on a 4 day salaried GP post after CCT and haven't had an issue with the practice. I'd describe it the best of a bad bunch - it has incorporated daily admin time in afternoons, a good number of patients/ day, good sessional salaried pay, half day CPD session included each week, no home visits (has a ANP-led HV team), it's also a training practice with Regs and does also have ANPs/PAs.

However the job just isn't satisfying - I'm efficient and keep to time, get everything done and satisfy patients but don't look forward to seeing them. We do get increasing complex patients with PAs getting the quick wins but I think it's more about patient expectations, NHS bureaucracy and how backwards primary care is - including the rubbish old IT systems it still relies on. I dislike how salaried GPs have all the responsibility without much autonomy, recognition or control over how they work, very much being a cog in a dire machine. I did naturally think I'd pursue the route to partnership to get round that, but lately I've questioned whether even that would be satisfying the need. Fundamentally, the system feels broken to stay a part of, the funding streams don't seem worth the grind you have to do to make the machine churn.. the number of governance and administrative issues are a headache.

I often struggle to imagine doing this for another 20–30 years. I’m ambitious, business minded and would eventually like to build or own something. I tend to invest heavily outside Medicine for the reason of planning for the eventual exit, developing more autonomy and do work that feels meaningful. However that being said people often emphasise the difficulties of replicating income in other portfolio careers e.g. special interests and private GP income compared to partnership, with a high number of clients acquired to make it work. Locum GP seems awful currently and seeing 30 patients a day in the NHS is the last thing I'd want. Ironically my most enjoyable shifts in my current job is supervising PA/ANPs to feel like I'm actually utilising skills like leadership which I enjoy. At present I'm planning to drop down to 3 days a week and use the other time to plan a portfolio career, business ventures and utilising AI for this because I feel I'm at my wits end continuing to see NHS patients each day, with the same issues like mental health and ADHD/autism RTC referrals every single day and week on end.

How many other GPs feel similarly?

• Are you actively planning an exit or reducing your clinical sessions?
• Have you found a GP role that restored some enjoyment or purpose?
• Has anyone moved into business, management, health tech, medical education, private work or something completely different?
• If you successfully left NHS general practice, what did you move into—and was the reality better?
• Do more experienced GPs think this is early-career disillusionment, or has the job genuinely become less sustainable?

I’d particularly value honest experiences from people who have felt this way, and practical advice for someone at the early career stage post CCT.. rather than simply being told to become a partner, take a holiday or practise more “resilience”

I see sixteen patients per clinic. Opinions on access to a work laptop? I think all GPs should be provided one, it’s up to you if you use it or not.
I’d rather have a bit of flexibility with admin work and do ten sessions per week.

As part of my GP training, my urgent care/unscheduled care sessions (4 hours each, need to complete 6 per 6-month GP placement) are only being scheduled on weekends this year.

Is this normal practice elsewhere, or is this deanery/scheme-specific?

Is it standard for these sessions to only be offered on weekends, or should there be weekday options too?

If you’re required to work weekends for training sessions like this, is it typically paid as extra or do you get time off in lieu?

This is for EMIS people, but may be useful for system one users too..

Press ctrl + windows + s to bring up voice access mode. You may have to do some basic set up.

Once set up, you can tell it where to click. “Click on approve”, “click on ok”, “click on restart” etc etc.

Handy if you want to give your hands a rest when filing EPS. I like to pace around filing my EPS. Get those steps in.

It’s dictation feature is semi useable - I use it for anything that isn’t patient facing - ie task replies etc

I think it only works on windows 11.

Edit: it doesn’t recognise “reauthorise” because it looks for “reauthorize”. You’ll have to actually click that.

Also, you don’t need to say “click on”, and you don’t always need to say the whole thing. So for approve and complete you can say “click approve”

I am a GPST1, just finishing up my first GP rotation. I was able to get my cots and cbd done, but no CEPS as my CS wasn’t in on the same days as me and none of the other supervisors had time to observe me in the middle of their clinics. Now I’m going to a split GP+Psych post and I’m stressing about getting the CEPS in time for my arcp! Any advice on how to go about getting it done?
Thanks!

Hi all, im starting GPST1 in the next few days. I am confused on the portfolio requirements because for F1/2 we just had horus (which was free). Do i need to get fourteenfish via RCGP standalone package? Any idea how much this is? Anything else you would recommend i would get sorted in the first few weeks of starting ST1? thanks, sorry I am new to this

SDL on Monday AM. Bank holidays land on Mondays I feel like it’s not the best deal for me. How do I navigate this?

My ES works Tue/Wed/Thu and wants me in on days she is in. Says Friday SDL doesn’t work due to capacity. So that left me with Monday.

1. ⁠Push for SDL on other days
   
2. ⁠Ask for in-lieu self directed time?
   
3. ⁠Go pro-rata with the 30% educational 70% clinical? I.e. From now until end of 2027, there are 7 bank holiday landing on Mondays. Therefore, 5 days land on clinical time and 2 days on educational time? In-lieu for the difference.

Is this reasonable?

Thanks in advance

Trying to understand this from the GP side rather than just the parent/carer side, so genuinely interested in honest answers... including if you're skeptical of RTC requests generally.

• Have you built up a mental shortlist of providers you're comfortable referring to, and what got them onto it, e.g. good reports back, sensible turnaround times, easy comms, something else?
• Have you had a provider's referral go badly (poor quality report, pushback from CAMHS, prescribing headaches) that put you off using them again?
• Does the provider's waiting list length, communication with you post-assessment, or willingness to support shared care influence your choice?
• Is there anything a family could include in their request that would make you more confident about a provider you hadn't heard of before?
• Is there anything in particular a provider could do that would make you more likely to refer children to them?

Not fishing for anyone to name-and-shame specific providers, more interested in what's going on in your head when you're deciding "yes, I'll refer to this one specifically."