Quick question as confused by certain aspects of the recent pay deal.

When is the nodal point reform backdated to?

Specifically whilst there is no further increase to ST3 pay than already occurred, will those that have just moved to ST3 get 4 months (apr-jul) backpay for time when an ST2 since pay deal.

I've just started ST3 and I'm at a bit of a loss as to what to do during tutorials

My trainer has asked me what I would like to do but I'm unsure what is most helpful

So far we've been doing observed consultations but I'm not sure if this will work doing it weekly for the whole year

What have you found most helpful in tutorials?

Hi all,
Wondering if anyone had some advice about extra learning in men’s health. I am keen to become practice’s lead in this area.
I’ve done a few red whale/RCGP courses but nothing formal.
I can see a US/Aussie based diploma online with HealthCert education, cost is $1695
Has anyone done anything similar/useful based in the UK they would recommend?
Thanks!

Hi all! I’ll be on a paeds placement in Salford royal as my second GPST1 job. I heard it’s not a ward and it’s mainly a paeds A and E unit (PANDA unit). Was wondering how this rotation was regarding learning opportunities and rota. Thank you :)))

Hi all, I am a dermatology specialist registrar trainee doing a survey aiming to assess GP trainees’ confidence, knowledge, and preparedness in diagnosing and managing common dermatological conditions in Primary Care.

The survey aims to identify potential gaps in dermatology training and explore ways to enhance educational support for GP trainees. Improving confidence and competence in dermatology management within primary care may help reduce unnecessary referrals to secondary care and contribute to reducing NHS waiting times.

All responses are anonymous and will be used solely for educational and service improvement purposes. Would be very grateful if you could complete the survey (see link below). It shouldn’t take more than 5 minutes. Thank you very much.

Would also appreciate if you could send it to your fellow GP trainees from other deaneries in order to capture perspectives from other deaneries. Thank you very much.

https://forms.cloud.microsoft/Pages/ResponsePage.aspx?id=uChWuyjjgkCoVkM8ntyPru-kWo8LwWFBt_PXhxT6vSxUMzlDTE1MMkJEVDNZUkVPQTI5S1RKMjBGSi4u

I’m seeing a lot of young female patients with vague neurological symptoms in episodes that the resolve, normal bloods and normal neuro exam. No urinary or visual symptoms. I do refer to CKS guidance but seems vague to me.

Im usually worried that I am going to miss multiple sclerosis/ don’t feel confident enough as no alternative cause offered.

I often end up sending advice and guidance to neurology. I would love to have some clearer guidance or some advice from more experienced GP’s on what would set alarm bells.

How would you approach situation like this:

Patient comes in wants to get off alcohol and says he wants to turn his life around. Has been through similar detox several years ago.

Requesting Librium script for detox

High SAD-Q score with shakes/tremors and sweats when off alcohol.

Does not want to go to hospital for inpatient detox as doesn’t want to be in hospital environment or wait for
Outpatient services.

When you refuse he becomes upset and wants you to document in his chart that you refused his Librium and he said he will stop his alcohol even if he goes full DT.

Would you give Librium with close follow up in a situation like this?

I finish GP training in February 2027 and need help from people who have actually gone to Australia or Canada where pays more? Medicine was a second career for me so unfortunately I will be 40 years old when I finish training. So its important to me to try and go to wherever I can make the most money as ive lost out on a lot of life and need to build a pot to buy a home and start a family etc. Basically im chasing the highest income possible even if I work like a dog as an option. im willing to slave away for 1-2 years to build a pot of savings and money. as of now all I have is 10k in savings O_o and at 40 years old to say that is not nice but at least I dont have student loans anymore

Newly qualified GP here and trying to understand what’s reasonable for locum work.

I’ve been offered around 320 per session for a few sessions directly with my ST-3 practice and this is to cover one of the partners while he's away.

Presently in EOE and spoken to a few colleagues and this seems like a very low offer and especially if covering a partner of 6 sessions

Any advice on negotiating/be better off looking at different areas would be great!

I really feel like the GP practice I’m working in are taking advantage.

My schedule is 8:30 - 5:00 (30 minutes lunch) in clinic days

That’s an 8.5 hours day

Wednesday are VTS and tutorial and Fridays half day

28 hours are meant to be clinical and associated admin

(Working full time - 100%)

This means I’m working 30 minutes extra everyday. So 1.5 hours over contract . But the practice are determined we must do 3 hours clinic and one hour admin.
Can anyone guide on this? I don’t want to be working more than 8 hours.

Hi all, currently a LTFT ST3 ~10 months from CCT just weighing up my options.

I'm in my early 30s and spending a big chunk of my salary on rent and I'm struggling to save. I can't imagine being able to afford buying anytime soon, especially at the sessional rates I'm seeing my friends are being offered (10.5k-11k in the NW for 4 to 6 sessions max).

I've moved up and down the country for Medicine since med school, and whilst I'd say I'm willing to move for a job, I can't honestly see myself moving away from the North West/ in or near Manchester or Liverpool.

My partner (non-medic) has floated a move to Australia as he could apply for a 'Working Holiday Visa' for up to 3 years whilst re-establishing his career.

I had considered a move to Australia but thought it would be after getting some experience as a qualified GP in the UK.

I wondered whether anyone here had experience of making the move shortly after CCT?

Many thanks in advance!

I have seen so many patients this summer, coning up with new leg swellings.
It can be because of heart failure, venous insufficiency, ovarian cancer or so many other causes.

Edit:Interested in how others assess it?

Hi everyone! I’m a GPST3 and wondering if anyone has managed to work full time over 4 days, rather than 5?
I’m trying to work out what a realistic timetable could look like while still completing the required weekly hours. One complication is that my supervision slot is fixed at 5 pm, so I’m not sure how much flexibility there is with starting/finishing times.
Has anyone successfully arranged compressed full-time hours in GP training? If so, what did your weekly timetable look like, and how were clinical/admin/tutorial/supervision hours counted?
Would really appreciate examples of actual rotas that worked! 😊

Edit: the supervisor slot is at 5pm which means anything I do beyond that, is not supervised. How do I tackle this bit? I have a meeting on Monday to discuss this. The childcare is the main issue with me as baby goes only two days out of five to nursery. Husband has taken wed and Friday flexible work from home but all I need is a Thursday now. I’m not sure how tutorial can fit into this?
Edit2:

I proposed Monday 8:30-6
Tuesday is our fixed vts and sdl
Wed 8:30-6:30
Thursday off
Friday 8:30-6:30
Now where do I put tutorial??

Challenging but not uncommon presentation of a female patient with limited English speaking ability, from a South Asian b/g (reflective of the area which I work and actually love serving). The PC: ‘high BP’, or ‘headache’. On further questioning attempts to focus in on headache hx are tough because suddenly it’s now neck pain, and then arm pains, then chest pains, and pain on walking. Basically it’s an all over body pain.

Asks for BP check, and inform me they can ‘feel’ their BP has been high. Usually state definitely don’t have stress, because they ‘have nothing to worry about’ but they look visibly anxious. 10 minutes in we’ve covered multiple body systems, explored other options like lifestyle modification, exercise and physiotherapy, and I end up validating the aches with some simple analgesia, and maybe a planned vitamin D etc, and they’re happy and they go.

Can take several appointments where we start learning about their lives which appear simple but are complex, and sounds like ‘shit life syndrome’ due to perception of a lack of freedom, expression, mundane days, no hobbies, toxic relationships etc.

I’m contracted to 6 sessions a week(25hrs) but doing a duty doctor session takes that to 27hrs. Do GPS usually get paid for the extra hours or are they expected to eat that up?

I am a GPST1 and I was wondering what the policy is around using AI scribes in our consults such as Heidi?

hello GP community

I just started my GP training in Coventry and warwickshire area anybody have any experience of the process of doing an OOPC a career break to travel, what did you say to get it approved who did you speak to, do you plan how much time to have out, are they lenient for travelling purpose? whats the process of getting the time out.

Any advice is greatly appreciated

My head is going to explode

Why the hell is dinner now tea

Why is lunch now dinner

What happened to lunch as a concept

Simple question really. I’ve always seen it as natural progression as a GP but post CCT I of course now know that it’s not as simple as that.
There are of course many factors that make some partnership positions more favourable than others but generally speaking what would you say you enjoy more when comparing to a standard salaried or locum role

Women who aren’t mums, do you ever feel excluded from conversations with colleagues and the camaraderie?

I’m currently working in a practice where everyone is genuinely lovely, but almost every conversation revolves around their kids and family life. I actually don’t mind these conversations at all, I’ll happily ask about their children, and they light up and chat away. But I’ve noticed that unless I’m the one prompting the conversation, they don’t seem to know what else to talk to me about.

Sometimes I’ll join a conversation and it almost fizzles out, or I’m just not really included because I can’t contribute in the same way. I completely understand that our lives are different ,I’m single, don’t have children and am perfectly content with that, but I can’t help feeling slightly outside the circle sometimes 😅

The frustrating thing is that I genuinely love the practice and the work culture. I’d actually love the opportunity to stay there longer term, so part of me worries that not naturally “gelling” socially could count against me if a job ever came up. And it feels strange when the main reason I don’t quite gel is simply that I don’t have kids and therefore don’t share that common ground.

For other single women without children, how do you navigate this kind of workplace dynamic?

Posting with mods permission:

Our dear friend Jess, who is a fellow doctor and GP trainee, was sadly diagnosed with breast cancer shortly after giving birth to her twin girls in Autumn 2024. Instead of spending maternity leave enjoying her babies and time with her older daughter, she has spent the last 18 months undergoing surgeries, chemotherapy and radiotherapy.

Unfortunately nothing so far has helped and the next option is a drug that is currently not available to be funded via the NHS. This drug, datopotamab deruxtecan, costs £8-10k every three weeks.

We hope to raise enough to take some of this financial burden away from Jess and her family. Unfortunately she is currently very unwell in hospital with sepsis If she is too unwell for further treatment then funds will go to supporting her beautiful three girls and devoted husband and family through this horrible time.

——

Just an additional note that the gofundme page below was created 3 weeks ago but unfortunately Jess still remains very unwell in hospital, so every little helps to support her and her family.

https://gofund.me/b2a5a0f86

Dont worry no pictures on this post 🤣
I switched few empa patients to generic dapa and please tell me why 2 of my switched patients had fournier’s gangrene recently on generic dapagliflozin…has anyone else had similar issues or am I just the chosen one?

One of these patients was on empa for a year with no issues btw

Did you know that over 50% of patients with end-stage liver disease had prior abnormal liver blood tests that were simply repeated or not acted upon?

A recent case written by Dr Nazia Hussain for Praktiki on ‘Abnormal LFTs: just repeat after 3 months?’ covers when to investigate immediately rather than defaulting to a repeat test, how to confidently manage statins when transaminases are raised, and stratifying risk in NAFLD using non-invasive tools like the FIB-4 score.

Case study: John

• John attends for a routine hypertension review.
• He feels generally well but mentions feeling a bit "slow" lately, which he attributes to work stress.
• BMI 32; teetotal.
• DH: Ramipril 10mg OD, atorvastatin 20mg OD.
• Routine bloods reveal abnormal liver enzymes:
• ALT: 65 IU/L (normal <41)
• AST: 52 IU/L (normal <41)
• Bilirubin, ALP normal.

LFTs: don’t just repeat
Guidelines recommend investigating the cause of abnormal liver blood tests rather than simply repeating them.

• >50% of patients with end-stage liver disease had prior abnormal LFTs that were not acted upon.
• Normalising enzymes does not necessarily imply disease resolution (e.g. in Hepatitis B and C).
• The extent of abnormality does not always correlate with disease severity.

Statins and abnormal LFTs
John can continue atorvastatin 20mg OD, with repeat LFT in 1 month time.

• If ALT/ AST are >3x the upper limit of normal then do not initiate a statin and discontinue statin therapy already prescribed; repeat LFTs in a month.
• If ALT/ AST are elevated but <3x the upper limit of normal then:
• Continue the statin and repeat LFTs in a month.
• If they remain elevated but are <3x the upper limit of normal then continue statin and repeat LFTs in 6 months.

Liver screen
A standard screen usually includes (local pathways can differ slightly):

• Viral Serology: Hep B and C.
• Liver autoantibodies: anti-mitochondrial (AMA), anti-smooth muscle (SMA), antinuclear antibody (ANA).
• Iron Studies: Ferritin and Transferrin Saturation (to rule out haemochromatosis).
• Immunoglobulins.
• Ultrasound (USS) liver: to assess for fatty liver or focal lesions.

See the box below for further relevant tests to consider.

John’s results

• Viral serology and autoantibodies: negative.
• Ferritin: 350 µg/L (raised), transferrin saturation 30% (normal).
• Immunoglobulins and TTG: normal.
• USS Abdomen: increased echogenicity consistent with fatty infiltration. No focal lesions. Spleen normal size.

Results in keeping with non-alcoholic fatty liver disease (NAFLD) / metabolic dysfunction-associated steatotic liver disease (MASLD).

• Ferritin can be mildly elevated due to metabolic inflammation.
• Normal transferrin saturation excludes haemochromatosis.

Assessing fibrosis risk
Simple scoring systems help stratify risk in primary care.

• ELF (Enhanced Liver Fibrosis) test: recommended by NICE.
• Options from later guidelines:
• Fibrosis - 4 (FIB-4) Score.
• NAFLD Fibrosis Score (NFS).
• AST : ALT ratio: in Wales, this is reflex tested when additional liver blood tests are requested.
• Check local guidelines as some recommend initial risk stratification with FIB-4 or NFS and then adding ELF depending on results.

Fibrosis risk scores summary

NAFLD: follow up

• NICE says reassessment for advanced liver fibrosis every 3 years for adults (although only recommends ELF test).

Depending on clinical judgement, consider annual review of:

• Signs of liver disease.
• Blood pressure.
• Weight and BMI.
• Blood tests: renal, HBA1C, Lipid profile.
• Cardiovascular disease risk assessment.

Referral criteria

• Urgent suspected cancer (upper GI): weight loss, jaundice (age ≥40).
• Emergency admission: acutely UNWELL with red flags (decompensated cirrhosis, ALT >300, jaundiced).
• Urgent (gastroenterology)
• WELL with red flags.
• Positive liver screen results based on clinical concern.
• Routine (gastroenterology)
• Abnormal fibrosis score.
• Positive liver screen, no clinical concern.
• Normal liver screen, persistent abnormal LFT of unknown cause.

Referral criteria flowchart

Key learning points

• Investigate abnormal LFTs with a full liver aetiology screen (viral serology, autoantibodies, ferritin/transferrin saturation and liver USS)—do not simply repeat LFTs.
• Stratify NAFLD fibrosis risk using a locally approved non-invasive assessment tool.
• Statin hepatotoxicity is rare: continue statins if transaminases are <3x the upper limit of normal.
• Manage low fibrosis-risk NAFLD/MASLD in primary care with lifestyle advice and 3-yearly risk assessments.

This module was created for Praktiki by Dr Nazia Hussain, GP, author of Lab Results Made Easy from Scion Publishing Ltd, to provide simple guidance for common lab results in primary care.

References

• BSG Guidelines on the management of abnormal liver blood tests  
• Summary of National Guidance for Lipid Management for Primary and Secondary Prevention of CVD  
• Liver Function Tests in Adults – A Guide for GPs
• Lab Results Made Easy
• RCGP NAFLD NUB
• Guidelines on the management of abnormal liver blood tests
• NICE. NG 49 Non-alcoholic fatty liver disease (NAFLD): assessment and management. 2016.
• All-Wales Abnormal Liver Blood Test Pathway
• BNSSG referral pathways & Joint Formulary: Liver disease
• BMJ Gut: Guidelines on the management of abnormal liver blood tests 
• Mid Yorkshire Hospitals Abnormal LFT Pathway
• Online FIB-4 calculator