r/GPUK

I'm a nurse and recently started in CAMHS triage. Patients/families can self-refer but we still get a lot through from GPs.

We got one referral in a few weeks ago, where the content of the referral had been copy+pasted from the session notes into the referral form. There were a lot of valid concerns and both young person and mum seemed to have been very distressed in the appt. Halfway down the referral form, the notes said '10 minutes for a mental health crisis', and I think that was what made me realise how much you actually have to try and manage in a single appointment slot (plus the safety netting, documentation, and referral(s)).

I just wanted to express appreciation for what you're managing to do.

I’ve seen a fair few social media doctors online brand themselves as GP’s with specialist interest in various things.

I had always thought this required you to have some extra accreditation or qualifications. However, looking at some of their profiles, it seems many have just found something they’re interested in and told everyone it’s a “specialist interest”, perhaps to give them more legitimacy.

Is this technically allowed or are “specialist interests” only reserved to specific scenarios (e.g. diabetes, dermatology) where you’ve undergone specific, post qualification training?

Has anyone ever had assertiveness training? Any decent recommendations? I had a friend undertake some years ago and it was very helpful for him, but provider has since discontinued that particular course.

Thank you!

To my fellow ST3s/recent CCTers: I've done all my COTs, but they are all face-to-face consults (either video'd or supervisor observing).

Do we need at least one audio COT? I've found some guidance that says we do but want to know the status quo with what panel will realistically want!

Thanks in advance x

Not a doctor. I grew up in a house with multiple (maybe too many) and I've watched the annual appraisal ritual my whole life — including helping my mum through hers recently, which is what's prompted this.

Being upfront: I'm exploring whether there's a small tool worth building around appraisal prep, so I have an interest here. But I genuinely don't know if the pain is real enough or in the place I think it is, and I'd rather hear that honestly from you than build something nobody wants. Not selling anything, nothing exists, just trying to understand the actual problem before I waste months on a solution.

What I'm trying to figure out:

• What's the part you dread most / put off longest? The writing itself, remembering what you did all year, the toolkit, exporting and attaching stuff, or just the whole thing?
• When you sit down to write a reflection, is the hard bit knowing what to say, or phrasing it the way you want for the appraiser?
• Has anyone tried ChatGPT or dictation for any of it? Did it help, or not worth the faff / not something you'd trust?
• FourteenFish vs Clarity vs GP Tools — does the toolkit itself make it better or worse?

Happy to hear "it's fine, leave it alone" — that's useful too. Cheers.

I am GP trainee in primary Care placement currently. For afternoon de brief sessions, I have been staying 30 minutes than my usual working time every day because my supervisor starts debrief late due to his clinic list. I have been exception reporting for the time I am staying late. Will it create any problems in the future if I have done too many exception reports I have asked my supervisor to start the debrief early, but he has denied this without giving a reason.

I find consults with EUPD patients incredibly draining, had 2 in a row recently where I felt like I wanted to quit GP after …! Conversations are often circular and risk assessing is almost impossible as a lot of them say they don’t know what they might do. Even if they are under the mental health team (albeit they end up being discharged anyway for not engaging) they still make a GP appt about mental health

Does anyone have any tips on how to manage these patients or safely risk assess?

I try my hardest with patients but in my experience this cohort of patients can tricky to treat. I try to stick to recommended treatments but there’s often a negative view of pharmacological and psychological interventions, and I’m finding that a lot of the patients with this diagnosis also have a large amount of medication sensitivities. Often, they go from doctor to doctor- particularly registrars. I don’t really understand why some of them need regular reviews and the conversations seem more suited to something they could have with a friend and a cup of tea, rather than updating me with non medical information about their life since they last came it a week ago.

I came back from sick leave just under a year ago after 5 months off due to burnout, into a new practice. Things are going reasonably and I'm already LTFT with just under a year left until CCT. My worry is I'm seeing between 17 and 20 patients a day, 15 mins slots, and supervisor is looking to cut some of these to 10 mins prior to SCA. Fair enough for me. I do find 20 patients of mixed complexity and a fair few calls seems a lot better than 16 patients of quite high-ish complexity and no calls (some days I've had no calls). He is quite specific to the absolute letter, about following portfolio requirements. Textbook to a fault. He asked me to do the QIP I had signed off last year, again, as he felt it wasn't substantial enough. I am doing a bigger audit and I am halfway through collating data, and I'll be presenting to the practice, but I'm worried he'll change the goalposts. He felt what I wrote for a learning event analysis didn't meet the GMC threshold of a significant event and he wanted something more...serious I suppose. I had an ESR meeting a few months back which lasted several hours and was quite a rigorous dissection of my portfolio. It was signed off anyway but a 4 hour ESR meeting I felt was quite soul destroying. My documentation is very very long more to make myself bulletproof in debriefs, which adds cognitive load.

I have made some changes to help my day go smoother such as not dealing with things that should really be appointments, in my admin time. That was somewhat daft of me. I am averaging 15.9 mins per pt on a good day and making progress in that regard. I am learning a lot and getting through the day (just) but I am finding myself feeling absolutely fucked at the end of the day. The heat isn't helping either as the surgery is boiling and at best 27 degrees indoors, but I ignore it as best I can.

Work thoughts are beginning to leech into the weekends again, I'm starting to get that pre work anxiety again. Rest assured, I am working myself very hard and have responded to every bit of advice my supervisor has given me and taken it literally on board. I am already seeing a therapist, I am already on meds, I am already doing a huge amount of life management on my weekends to help me get through the week, but this doesn't feel wonderful. Not to mention the commute, the expenses I'm owed, and it feels like I'm giving away a lot and not getting much back.

I'm celebrating if I have a week like last week where I have time to have lunch (lol), don't have a house visit (lol) and have a balanced case load, which is just a tragically low bar to clear. I'm delicately trying to be boundaried as I am prone to overdoing things.

Any tips, tricks, hacks on making ST3 easier? :(

Had a little funny one today, not sure if this is a common thing in other parts of the country.

We have a few specialties locally now that are ‘econsult’ first, prior to a referral being accepted.

I referred a patient to endocrine through econsult for primary hyperparathyroidism. They replied stating they’d see the patient but asked if we could do a 24 hr urinary calcium.

Sure, sounds fair, will make the outpatient clinic go a little more smoothly.

I ask a colleague about where we get the bottles - apparently we have to request for a bottle to be delivered on ICE. This involves checking a chart to see exactly which type of bottle we need, then entering delivery instructions onto ICE to get them delivered to the practice.

Sounds like an administrative job that’s been pushed onto a clinicians lap to save on wastage of bottles. I get the premise, but surely this is poor use of clinician time?

I’m sure I could get a process in place where admin can do this task, but why should primary care have to make significant shifts in processes here?

Am I overreacting thinking this is a bit bonkers?

I appreciate this is a UK GP forum, but I know there are a few former UK GPs on here who have made the move to Australia, so I’m hoping someone might be able to offer some advice! I’m a UK GP about to start working in Australia and would be really interested to hear from anyone who has made the same transition.

How different did you find the patient population and expectations around consultations compared with the UK? Are there particular differences in presentations, health beliefs, communication styles, or patient expectations that caught you off guard?

Is there anything you wish you’d prepared for before starting? Any tips, anecdotes or general advice would be hugely appreciated — especially from anyone who has made the UK → Australia transition.

Edit: work location is south Melbourne 🙂

I did a GP placement in F2, but I was given almost exclusively emergency appointments. Much of it felt like assessing infections, deciding who could safely go home with safety-netting, and identifying who needed to be sent to ED, almost like working in a UTC without bloods

There were a handful of cases where I picked up really interesting things, and other parts were patients were very thankful and appreciative. those were probably the highlights of my placement. What I disliked most was the constant pace, I felt as though I was always racing the clock, with very little time to pause and properly think through a case.

For GPs who CCT’ed, how does the job feel for you? Does it usually feel like you’re constantly trying to keep up with appointments, or do you get enough time to stop, think, and investigate patients more fully?

Good day everyone, lately I’ve been facing a dilemma regarding my career. I am a medical doctor, and after finishing medical school, I started working at a primary care centre in a general practice clinic.

​A lot of my colleagues went to work in hospitals as FY2/trust grade doctors (unspecialised junior doctors), mostly in departments where they eventually want to specialise. The colleagues working alongside me in the outpatient clinics also have very clear goals about where they want to end up. I feel like I'm the only one stuck in place, lacking a clear direction.

​I am satisfied with my work and I make an effort to stay up to date with the latest medical guidelines relevant to my day-to-day practice.

General practice as a field isn't bad, but the patient workload and pressure are intense. Many patients visit unnecessarily, just to pass the time or for non-medical reasons. There is no proper triage for who actually needs medical care, advice, or an examination. On the other hand, I wonder if it’s even worth pursuing GP specialty training (GPST) when I can always work in primary care with my medical degree if I ever decide to take a break from hospital work (please correct me if anyone views this differently).

I’ve always had clear goals and desires in life, and I still do in other areas, but when it comes to medicine, I’m unsure which path to take. I’d like to achieve a good work-life balance, perhaps with a slight tilt towards my career.

I'm from Europe.

Hi all
I completely screwed up and asking if anyone has an advice or ideas?

I CCT’d at start of August and been away on holiday and came back this evening.
I thought I just had to apply for my cct and pay my fee with the GMC and didn’t realise about the performers list.

I am due to start work on Tuesday at my same practice but not completed the performers list form.
I am completing it now.

Am I just going to have to call my practice (it’s my same practice) and say I can’t work this week? How long does it take if I am able to submit it by the morning?

Thank you

Hi there, does anyone have any experience to share working for the provider ‘practice plus’? There’s a GP job going for them providing prison care locally.

Hello all!

I would appreciate people’s thoughts.

How confident are you with your fundoscopy skills being reliable enough to rule out raised ICP in primary care? In more equivocal cases of course.

I have a panoptic ophthalmoscope and still struggle and therefore it is unreliable.

Had a case recently where was querying a blocked VP shunt, spoke to neurosurgery who said look at the discs otherwise patient needs to go ED for a shunt series.

I had to ultimately send the patient to ED as felt unsafe in my ophthalmoscope skills.

Just interested in where others stand? Bolam Testing and all. Thanks !

I'm a trainee in a group 1 specialty so do plenty of GIM. Often, when I see patients in clinic, they mentions issues that are unrelated to my specialty but I feel confident assessing/investigating. Obviously, this means that I may need ask the GP to prescribe things or organise something like repeat bloods.

Is this something you find annoying or helpful? Do you mind hospital doctors looking into issues that might require further action from you or would you rather we ask the patients to follow up with you instead?

Just want to be helpful and not piss you off/create extra work for you and wanted to get some feedback!

Hi everyone. I was hoping to get some advice. I’ve been given extension in training as I failed in WPBA in my final ARCP. I need to show competence in 2 capabilities before I can apply for early release. These are communication & consultation skills and organisation, management and leadership. I had a job offer from my ST2 practice (after I passed my SCA) and they’re kindly willing to hold the job to be advertised until December. My extension will start from Mid-late September. I realise I’m likely not getting the job however would still like to know what’s the earliest realistic time I should be asking for early release and call an early panel? Thank you.