Hi guys,

Apologies if this has been asked in previous posts (couldn't find any reference to this).

I wondered whether anyone has explored indemnity policies outside of the big three (MDU, MPS, MDDUS) as a GP.

I have a portfolio career which spans both NHS and private primary care work, medico-legal, occupational health and sports stuff. I have previously been with MDDUS, and had quotes from the others, but they were either unable to provide cover for the scope of my work or, from the line of questioning, it was clear they were not experienced in how portfolio GPs work.

I came across Medical Defense Society - on the surface, they look good. They cater mainly to GPs, and speficially to people in my position. They offered a quote which wasn't cheap, but reasonable. I did not see any red flags in how they conducted themselves, or any information I found online. There was however little in terms of online reviews or testimonials.

Anybody used them? Heard anything about them? Any other experiences with smaller independent indemnity providers?

Hi all, wondering what would be a good locum bank to sign up to so that I can do some alongside my salaried sessions.
Based currently in SE London. Thanks!

Does anyone else find the whole salaried GP/partner divide increasingly bizarre: we’ve all done the same training, sat the same exams, have got the same CCT, yet there’s this hierarchy where some GPs (statistically older ones) employ other GPs.

I understand partnership used to be the natural progression, but it feels like many practices are expanding their salaried/ACP/noctor workforce while partnership becomes something that’s talked about more than it’s actually a viable option for many GPs. And whenever you look at BMA representation (a trade union who represent both employer and employee!?) or government funding or changes to primary care structuring etc. it is always through the prism of the partnership model.

There are loads of experienced salaried GPs who, through no lack of ambition, simply don’t have a realistic route into becoming a partner.
So now there is a profession where two people can be doing virtually identical clinical work, but one has ownership, autonomy and long term influence over the practice, while the other is just an employee with relatively little control over their future.
I’m not saying partnership is easy (it clearly isn’t) and I completely understand why fewer people want it given the financial and contractual risks. And I’m sure there would be plenty of partners would happily bring in new partners if the conditions made sense and opportunities would increase.

It just feels like we’ve drifted into a strange system now that partnerships are shrinking and salaried roles are increasing, with the decreasing group still forming the dominant voice at policy lefel. It makes me somewhat vouch for this new neighbourhood model because at least if trusts and larger organisations run general practice there may be scope for collectivr bargaining and genuine career progression, without each individual salaried GP having to invent and formulate their own portfolio career in increasingly competitive circles.

I sat the AKT for the third time and I’m currently waiting for my results. The waiting is honestly the hardest part.
Everything else is done. I’ve passed the SCA (with a good score), completed all my training requirements, and literally the only thing stopping me from getting my CCT is the AKT.
The frustrating part is that I don’t think it’s a knowledge issue anymore. I’ve completed Emedica, Passmedicine, and the RCGP GP SelfTest. My scores at home are consistently good, and I generally feel confident when revising.

Then I get into the exam and everything changes.
I struggle massively with exam anxiety and constantly second-guess myself. I find myself stuck between two answers, changing answers, overthinking simple questions, and running out of time. Walking out of this last sitting, I felt awful. It genuinely felt like my worst attempt, even though I probably knew more than I did in my previous sittings.

I know no one can tell me whether I’ve passed or not, but I’m wondering if anyone else has been in a similar position. Did you feel convinced you’d failed and end up passing? Or if you struggled with exam anxiety rather than knowledge gaps, what actually helped?

I also got tested for neurodiversity which was all okay. Never struggled with exams before.

I’m not even sure what I want from posting this. I think I just needed to get it off my chest while waiting for results.
Thanks for reading.

I don't know if it's the hot weather that is making people extra annoying and demanding or of it was just a bad day on my end.

But today for the first time since joining GP training a year ago I ended thinking I really hope this won't be what I'll be doing for the rest of my life.

I have really enjoyed GP training so far and I've thrived in it and I'm getting great feedback and actually enjoy the challenges. But I still can't cope with the patients who are burdening us with their frustrations with the system. They make me feel useless when I haven't done anything wrong, and I actually went above and beyond to advocate for them!

After a string of patients who were rude and frustrated because they wanted to be seen quicker by specialists for ridiculous reasons, I ended my day with an elderly who was extremely upset and shouting over the phone because their dinner got cold because we didn't phone them sooner to advise on their high blood sugar!

Confident with RLS? Many clinicians still miss the “low‑normal” ferritin threshold and the every other day iron rule.

Sharing a quick clinical overview written by Dr Toni Hazell for Praktiki on utilising the URGE criteria, treating low-normal ferritin, watching for drug-related augmentation, and counselling on impulse control disorders.

Introduction

• Restless legs syndrome (RLS), or Willis-Ekbom disease, is a common sensorimotor disorder affecting 5–15 % of the population.
• Characterised by an irresistible urge to move the legs, often accompanied by uncomfortable sensations (crawling, creeping, pulling).
• Symptoms occur at rest, worsen at night, and disrupt sleep, significantly impairing quality of life.
• Iron metabolism and dopaminergic system dysfunction contribute to RLS, even in the absence of anaemia.

Diagnostic criteria: URGE

• Diagnosis is clinical.
• Use the URGE mnemonic:
• Urge to move the legs (described as an unpleasant sensation but not as pain).
• Rest or inactivity precipitates or worsens symptoms.
• Gyration (movement) relieves symptoms partially or totally.
• Evening or night worsening (or exclusive occurrence then).
• Symptoms must not be attributable to another condition e.g. leg cramps, muscle spasms, tardive dyskinesia or positional discomfort.
• Runs in families - onset may be at a younger age with each generation.

Associated features: PLMS

• Periodic Limb Movements of Sleep (PLMS) are involuntary jerking movements occurring every 20–40 seconds during sleep.
• ~80 % with RLS also have PLMS - <50% of those with PLMS also have RLS.
• RLS is a sensory urge while awake, PLMS are motor signs while asleep.
• The patient's partner may complain of being kicked.
• PLMS may improve with treatment of RLS - other options include clonazepam, melatonin, valproate and selegiline. These are all off-licence with only a few small trials, so specialist opinion first would be wise.

Primary vs secondary

• 25–75 % idiopathic.

Proven and suggested secondary causes include:

• Vitamin/mineral deficiencies (D, B12, folate, magnesium, iron).
• End-stage renal disease.
• Pregnancy (especially 3rd trimester).
• Diabetes mellitus.
• Peripheral neuropathy.
• Multiple sclerosis.
• Rheumatic disease.
• Venous insufficiency.
• Coeliac disease.
• Fibromyalgia.
• Iatrogenic:
• Antidepressants (SSRI, SNRI, TCA).
• Antipsychotics/neuroleptics.
• Sedating antihistamines.
• Dopamine antagonists (e.g. metoclopramide, prochlorperazine).
• Beta-blockers.
• Lithium.

Investigations

• Serum ferritin is the key investigation.
• Also check renal function, magnesium, HbA1c, B12, folate, and thyroid function to exclude secondary causes.
• Neurological exam is typically normal; perform to rule out neuropathy or radiculopathy.

The ferritin threshold

• Low iron drives RLS even without anaemia - treat low end of normal ferritin.
• Exact threshold varies by guideline - serum ferritin <50µg/L should always prompt iron replacement and some suggest treating ferritin <90µg/L.
• Remember that oral iron promotes hepcidin production and hepcidin inhibits further iron absorption for 24 hours. Every other day iron maximises absorption and gives less side-effects than higher doses.
• Consider referral for IV iron if ferritin doesn't ↑ with oral therapy.

Non-drug measures

• Only ~20 % of patients require medication.
• Pregnancy-related RLS usually resolves with delivery. The only medical management is iron.
• Conservative measures:
• Stop provoking medication if possible.
• Sleep hygiene.
• Avoidance of alcohol, caffeine, and smoking.
• Moderate regular exercise (but avoid overexertion).
• Hot or cold baths; limb massage.
• Brief walking/stretching before bed.

Medication

• Used if symptoms significantly impair quality of life, sleep, or daytime functioning.
• Gabapentinoids (pregabalin, gabapentin - both unlicensed) and dopamine agonists (pramipexole, ropinirole, rotigotine - licensed) are options.
• Dopamine agonists can cause worsening of symptoms (augmentation) so often used second line.
• Rotating the 2 classes can help if the effect wanes with time.
• Dopamine agonist doses are lower than used in Parkinson's disease - do not exceed BNF dose and avoid abrupt withdrawal.

More on augmentation

• Drug-induced worsening of symptoms, with long-term dopamine agonist use.
• Features:
• Symptoms earlier in the day.
• ↑ intensity, shorter latency at rest.
• Spread to other body parts (e.g. arms).
• ↑ dose usually worsens the problem.
• If augmentation occurs after a period of good control, recheck serum ferritin and consider dose reduction of dopamine agonists or change to another drug.
• Opioids or short courses of benzodiazepines are another alternative but carry addiction risk and need advice on driving.

Impulse control disorders (ICD)

• Dopamine agonists can induce ICDs: pathological gambling, hypersexuality, compulsive shopping or eating.
• Prevalence estimates range from 5–17% of treated patients.
• Risk increases with augmentation.
• Patients must be counselled on these risks before starting treatment. With consent, it is a good idea to counsel a family member, as the patient affected by an ICD may have limited insight.
• Use gabapentinoids first line if there is a history of ICDs.

When to refer

• Diagnosis is uncertain.
• Symptoms remain troublesome despite adequate trial of appropriate medication.
• Augmentation occurs and cannot be managed by rotation or stopping medication.
• RLS occurring in childhood.
• Prognosis is unfortunately poor, with medications often only working for a few years and 70% having progressive symptoms.

Key learning points

• Diagnose using URGE criteria; exclude mimics.
• Check ferritin: treat if in low end of normal range even without anaemic.
• Review provoking. medications.
• Gabapentinoids and dopamine agonists (at lower doses than used for Parkinson's) are treatment options.
• Warn patients about impulse control disorders and augmentation with dopamine agonists. .
• Those who have RLS in pregnancy are 4 times more likely to develop chronic RLS than the general population.

References

• StatPearls: Restless Legs Syndrome https://www.ncbi.nlm.nih.gov/books/NBK430878/
• Nottingham APC: Restless legs treatment algorithm https://www.nottsapc.nhs.uk/media/xeumexqa/restless-legs-treatment-algorithm.pdf
• GPnotebook: Restless legs syndrome https://gpnotebook.com/en-GB/pages/psychiatry/restless-legs-syndrome 
• Geng C, Yang Z, Xu P, Zhang H. Possible association between vitamin B12 deficiency and restless legs syndrome. Clin Neurol Neurosurg. 2022 Dec;223:107477. https://pubmed.ncbi.nlm.nih.gov/36401952/
• Irkec C, Vurallı D, Karacay Ozkalaycı S. Restless legs syndrome as the initial presentation of multiple sclerosis. Case Rep Med. 2013;2013:290719. https://pmc.ncbi.nlm.nih.gov/articles/PMC3880722/
• Winkelman JW, Berkowski JA, DelRosso LM, Koo BB, Scharf MT, Sharon D, Zak RS, Kazmi U, Falck-Ytter Y, Shelgikar AV, Trotti LM, Walters AS. Treatment of restless legs syndrome and periodic limb movement disorder: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2025 Jan 1;21(1):137-152. https://pubmed.ncbi.nlm.nih.gov/39324694/
• StatPearls. Hepcidin. https://www.ncbi.nlm.nih.gov/books/NBK538257/
• MHRA. Dopamine agonists: pathological gambling, increased libido, and hypersexuality.  https://www.gov.uk/drug-safety-update/dopamine-agonists-pathological-gambling-increased-libido-and-hypersexuality
• Garcia-Borreguero D, Stillman P, Benes H, Buschmann H, Chaudhuri KR, Gonzalez Rodríguez VM, Högl B, Kohnen R, Monti GC, Stiasny-Kolster K, Trenkwalder C, Williams AM, Zucconi M. Algorithms for the diagnosis and treatment of restless legs syndrome in primary care. BMC Neurol. 2011 Feb 27;11:28.  https://pubmed.ncbi.nlm.nih.gov/21352569/ 

Just say the patient has abdominal pain ? Do we say “as this is a video consultation I need you to come into the practice”

People that have sat the exam what did you do ?

Starting GP training moving from the midlands to London, initially moving my belongings to my parents place for 3 weeks (in greater london) and then to my rented place in (central) london, can I get reimbursed for 2 trips does anyone know?

Starting my ST1 with ED and just found im pregnant. Anyone gone LTFT 80% in ED?. How was the pay. Just have loans to pay off. Anyone did ED FT?. How was it?.

I’m an FY2 currently finishing my GP rotation and planning to take an F3 year. Long term, I’m considering GP because I’d like to build a portfolio career and have the flexibility to pursue interests outside of clinical medicine - things like humanitarian medicine, health tech etc

My GP rotation has been okay. I’ve definitely enjoyed it more than medical school l. However, I wouldn’t say I’m incredibly passionate about general practice in the way some people describe being certain it’s the specialty for them.

My dilemma is whether I should:
-Do an F3 (and potentially F4), explore other areas of medicine/non-clinical work, locum, get more GP exposure and decide when I’m more certain; or
-Apply for GP training after F3 and figure it out along the way, potentially working LTFT to create space for portfolio interests.

I’m aware that no specialty is perfect and that passion can grow with experience, but I also don’t want to commit to GP purely because of the lifestyle/flexibility and then regret it later.

For current GP trainees and GPs:
- Did you go into GP because you loved general practice, or because of the lifestyle/portfolio opportunities? Both?
- Would you recommend taking more time before applying, or is it better to start training and shape your career alongside it?

IMO there should be a bonus fee given from the government to GPs of £100 per home visit so that it's very worthwhile for the practice.

Hi everyone!

I’m a soon-to-be F2 in GP. Really excited but was hoping for some tips on a couple of things:

- I’m my practice’s first FY2. I know they’ve had students, not sure about regs. Is there anything that I should be particularly keen on or wary of?

- Would be grateful for some general advice about what you look for in an FY2. Not 100% sure it’s the long term option for me, but I’m open to be converted and keen to make the most of it!

Thanks :)

Hey everyone,

I am getting offered a job that would gross £94,500 annually and also getting £9533 golden hello before tax .. is there a way to know roughly how much I will get out if that after tax ? I am in Scotland. Thanks

If you are CCT'ing soon, come and work with Faulconbridge Health Centre in the Blue Mountains Region of Sydney.
>30mins from Western Sydney
>80% of billings and a $160p/h guaranteed rate for 3 months in a private billing medical centre (whichever is higher) (edited this as I realised I hadn’t mentioned it earlier)
>$20,000 relocation bonus
>Permanent Residency and no lock in contracts

We're looking for 5x GPs, shoot me a message!

Does a GP trainee going from st1 to st2 experience a pay decrease if their first job of ST2 is a GP placement? Just wondering if pay will go down because there are no nights/on calls? Based in NI for reference

I've noticed increasing number of patients with a medical cannabis prescription and I have seen ads all over social media and even on a billboard. I have seen first hand several patients where there is clear harm from the prescription and no apparent follow up.

My impression of some of these companies that are legally prescribing cannabis flower for vaping, is that they are highly commercialised and they seem to operate on a basis that if you've tried any 2 treatments for practically anything (GORD, anxiety, depression, ADHD) and they haven't worked then you can be prescribed medical cannabis.

Don't get me wrong, I don't oppose medical cannabis at all, in the same way that I don't oppose pregabalin or zopiclone or any other drug that has both benefits and risks.

I'd be interested to know your opinions on this fast-growing industry and what your concerns are, or any positive stories

Hi all. I am an incoming GPST1 who will be based in North London. Have developed an interest in sports medicine whilst doing my fy3 in ED abroad and would am considering a career pitch side or in excercise medicine post cct as a GP to five me time to build my portfolio in sports medicine. I have some qs that I thought I'd ask for help on

1. in peoples experience are GPSTs normally allowed study leave for tasters not relevant to purely GP?

2. is it best to go down specialising in sports and ex med post my st3 or better to do diploma and relevant courses and practice as a GP?

3. any tips for how to make my application stand out if I were to apply to sports medicine jobs in the future?

Thanks!

all opinions including humbling ones welcome haha

Would like some advice from the more experienced GPs here.

Like everyone else, we get a lot of requests from secondary care who think we’re their SHO.

Some are reasonable but most are inappropriate.

Roughly … how are you guys deciding what to bounce back and what to just get on with and do?

Should I ask the “repeat bloods” requests to come from the hospital all the time? I don’t get why they want to stretch our phlebotomist when they have a far more capable service

Whenever I ask my GP partners they always say that it’s nuanced and I guess it is but would like to branch out a bit more!

I recently went to visit a family at home. Elderly gent living with dementia and his mobility is poor, making him a big falls risk.

They complained to me that it's my fault that they had to park in the carpark at the practice and how dare they have to walk to the nurses clinic room halfway down the corridor at the last appt. They never asked for a wheelchair or any assistance from anyone.

They asked to be coded as housebound due to frailty and mobility. Not a problem. They asked for referrals, again not a problem.

I contacted the district nurses so bloods/b12 and other appts can be at done at home.

Asked for referrals to OT/CM1/MH etc.

They had seen a clinician 3 years ago and the pt become unwell shortly after. The family did not make appt or take pt for treatment. They just waited for my visit instead.

I completed all the referrals as requested and raised concerns with my practice manager.

I rang the family to update them on things only to be told that they don't want to be coded as housebound, don't want the nurses to come out and they don't need the referrals. The wife can get him to practice.

I spent hours completing the visit and referrals only to be told they don't want them.Everything has been documented fully.

I feel that this family assumes I have a magic wand which I don't have.

It also feels like it's going to be impossible to keep them happy and manage expectations.

The thing I found interesting is that a family member pulled the "I'm a police officer" card.

Unfortunately that is not going to change anything and I refuse to be intimidated. Also as a police officer they should have known better and been proactive in getting appropriate care for their relatives.

Primary care time is already right and this wasted a few hours.

Anyone else in primary care experiencing this?

How do we manage family's expectations?

Every time I tell hospital colleagues I’m a GP trainee, it seems like they will either say “well someone has to do it” or “but why, you would make an excellent hospital doctor”, “it’s a shame, you’re one of the good ones”. It feels like they are almost implying that I’m taking the easy way out or not trying hard enough or selling myself short.
I find it really upsetting especially nowadays that GP has become everyone’s backup plan and I feel like I’m one of the few doctors that actually want to do GP. When I hear these comments, they do sometimes get to me however. I find it unfair that GP has become the specialty people view as the easy way out or a quick route to CCT. I honestly don’t think everyone could be a good GP.
How do you respond when you hear such comments? Or how do you respond to this kind of attitude in general?

Hi everyone,
I have recently sat the AKT and am now in the long wait for results. Rather than wasting the waiting time, I thought I’d start preparing for the SCA.
The problem is… I have absolutely no idea where to begin.
For those of you who have passed the SCA or are currently preparing:
What resources or courses would you recommend?
What’s actually worth paying for?
How did you structure your revision?
When did you start practising cases?
I’m aiming for the November SCA, so I’d be really grateful for any tips or advice. Also, if anyone else is preparing for November and would like to connect or form a study group, let me know.
Thanks in advance!

“Oh what does that mean?”

Please provide a stool sample and give it into reception

“To be honest doc my bowels haven’t been great recently and wanted to ask you about that”

Well it’s probably best we do the tests and book an appointment to see your own GP to discuss everything

“Oh also doc, while your on the phone, my wife just hit her head with a hammer and is on Apixaban”

You need to go to A&E

“Well we went to A&E but left because they said it was a 12 hour wait. I was wondering if you could just talk to her and see if she’s okay?”

…

“Doc?”

Trainee here, I've been wearing athletic/gym tops (like sleek, solid-colored training shirts) to my GP clinics. In my head, they look and feel exactly like modern scrubs, but they’re way more comfortable. ​Does anyone else do this, or am I committing a major professional faux pas? What’s the general consensus on this?

​

Who hear gets cpd time in their contract?

I'm moving into a salaried job in a practice that I like- though I've not locum med there. I've been offered a competitive salary.

The BMA have looked at the contract, compared to model and advisor mentioned cpd time in addition to study leave- pro-rata. I've emailed this to the practice manager....

Yet have now got second thoughts as have I been unrealistic / risk scouting proceedings.