Hi everyone,
I’m a GPST3, due to CCT at the end of this month, and I’m seriously considering retraining in another specialty.
To be honest, I’m really struggling with the workload in general practice, particularly the amount of admin, the constant pressure and trying to manage complex patients within 10-minute consultations. I’m finding it quite overwhelming, and it’s making me question whether I want to continue in general practice long-term.
I’m wondering if there are any specialties that are mainly outpatient or clinic-based, with little or no hospital on-call commitments, particularly nights and weekends.
I wouldn’t mind doing another few years of training, ideally entering at ST3 level with MRCGP rather than starting all over again.
Has anyone made the switch from GP to another specialty? Or does anyone have suggestions for specialties that might offer a more manageable workload and better work-life balance?
I’d really appreciate any advice or personal experiences.

Anyone else use old medical words or phrases in their notes? Being th autistic that I am and medicine being my special interest, I have a fascination with the history of medicine and how clinical notes and letters are written.

I use things like:

"No stigmata" for the general exam and "HS dual & pure" for the heart (which I was pleased to see a cardiologist used in a letter!).

I do like a nicely written referral letter but I think these are being replaced by forms.

At my surgery there are still some very old notes in storage, one I read recently said "1971.....Feels quer after attending (could not read the next five words.....O/E NAD".

Im an ANP hopefully heading to GEM.

😁

Again for those that can't be bothered to access

Physician associates (PAs) working in GP practices can assess ‘limited groups of undifferentiated patients’ under heavy supervision from GPs, according to draft guidance produced by the Government.

Under the proposals, GPs would be expected to take the role of clinical supervisor, available for ‘prompt review of a patient on any given day’ and providing ‘day to day oversight and supervision’ of up to three PAs at a time. 

GPs would be asked to spend 30 minutes per day after surgery reviewing all patients seen by each PA, according to the document seen by Pulse.

And practices employing PAs ‘must run an effective triage system’ that ensures PAs are only allocated patients ‘presenting with minor ailments’.

PAs ‘should not hold sole responsibility for making a final diagnosis’, the guidance stressed.

They can see patients ‘with known conditions’ or those requiring specific tests or interventions, ‘with approval of the named supervisor’.

However, they ‘may see or observe’ the assessment of other patients with new signs and symptoms ‘when directly accompanied’ by a GP throughout the appointment to support learning and provide effective follow-up, but should not see these patients alone.

The ‘clinical protocol’ was created following the Leng review, which last year recommended that PAs should not see undifferentiated patients ‘except within clearly defined national clinical protocols’. 

The document was created by the review’s author Professor Gillian Leng, and has been shared by the Department of Health and Social Care with ‘stakeholder organisations’ as part of a consultation.

It describes the approach that has been taken to ‘build’ on the review recommendations and sets out guidance on ‘effective teamworking’, together with a national clinical protocol for the ‘consistent, safe and effective’ deployment of PAs across settings.

It said that PAs working in a primary care setting should assess only limited groups of undifferentiated patients because primary care does not represent an environment where ‘immediate in-person review can easily take place’. 

It defines an undifferentiated patient as ‘a patient with new signs and symptoms who has not yet had an initial clinical assessment’. 

The guidance also said that ‘in line with Jess‘s Rule’, if a patient re-presents to the service with the same ‘unexpectedly unresolved or worsening’ symptoms:

• On a second presentation the PA should discuss the patient with their supervisor either: i. before the patient leaves the surgery for in person consultations or ii. by the end of surgery for remote consultations, with consideration to arranging a face-to-face assessment by a GP.
• On the third presentation the patient should be given an appointment with a fully qualified GP.

To be effective as a triage system, all appointments booked with PAs must be either triaged directly by a GP ‘who has knowledge of the PA’s individual scope of practice’ or by a trained member of staff or an electronic system which has been approved for use by the practice.

In this case, there should be an initial review of the patient list assigned to the PA by the clinical supervisor available on the day, in advance of the patients being seen by the PA, the document said.

Supervisory roles

PAs must have a named supervisor responsible for ongoing oversight, training and development, who does not need to be physically present each day. In primary care, this must be a fully qualified GP; in other settings, a consultant.

They must also have a clinical supervisor available for prompt patient review and day-to-day supervision, who must be a fully qualified GP, consultant, or an ST4-level or equivalent resident, clinical fellow or specialty doctor.

Source: A clinical protocol for physician assistants, their supervisors, team members and employers: Teamworking and undifferentiated patients

The document said: ‘The clinical supervisor should review and approve the list of undifferentiated patients with minor ailments assigned to the PA, ensuring the allocation matches the PA’s capability and experience.

‘The restrictions on assessing undifferentiated patients [in primary care] relate to the relative lack of immediate supervisory support in primary care, the lower level of training received by a PA compared to a GP, and the risks to patient safety of a misdiagnosis.’ 

It pointed out that when the clinical supervisor is ‘confident’ in the PA’s ability, they should still discuss all patients with the PA ‘at the end of each morning and afternoon surgery’.  

During the PA’s first year in primary care, the supervisor should spend ‘a minimum of 30 minutes after each surgery’ to discuss with the PA all the patients they have seen, and a minimum of 15 minutes after the PA’s first year. 

In addition, the supervisor should allow additional time during the day to discuss any patients which present in the PA’s practice and may require immediate consideration or review, as well as manage any prescribing requests which cannot wait until the scheduled slot after the surgery.

Published in July 2025, Professor Leng’s review also recommended that PAs should be renamed as ‘assistants’, and that they should have at least two years’ training in secondary care before being allowed to practise in primary care. 

While the review made the recommendation on undifferentiated patients, it did not set a broader ‘scope of practice’ for PAs or anaesthesia associates (AAs) to work within.

The RCGP and BMA both published guidance on PAs in 2024 severely limiting their scopes of practice, and both organisations have called on the Government to introduce a nationally agreed scope of practice.

In 2023, Pulse reported on a GP practice which stopped employing PAs after a coroner found that ‘poor quality care’ had contributed to the death of 30-year-old Emily Chesterton. The coroner concluded that Ms Chesterton ‘should have been immediately referred to a hospital emergency unit’ and that ‘if she had been, the likelihood is that she would have been treated for pulmonary embolism and would have survived’.

Physician associates trade union United Medical Associate Professionals (UMAPs) was granted permission to challenge the legality of some aspects of the review and its implementation by the Government, though not on the specific recommendation about undifferentiated patients. 

A Department of Health and Social Care spokesperson told Pulse the finalised protocol would be a ‘nationally consistent framework’ but would not create ‘statutory requirements’ or ‘directly enforceable legal duties’

They said: ‘The protocol is intended to provide a nationally consistent framework for the safe deployment of physician assistants, particularly in relation to seeing undifferentiated patients.

‘Once finalised, it will be published alongside implementation guidance and used by employers, supervisors and clinical teams to inform local governance arrangements, supervision models, workforce planning and clinical pathways.

‘The protocol will be advisory guidance rather than legislation and will not create new statutory requirements or directly enforceable legal duties. However, organisations and professionals would be expected to have regard to it alongside professional standards, clinical guidance, local governance arrangements and the needs of individual patients.’

So if I employ a PA, I get the pleasure of paying to train them and I have to find an additional 30mins after their surgery to debrief them?? 😄

Whose still employing new PAs under this guidance??

The PCSE website is giving me an aneurysm. Is navigating this shitheap supposed to be a secret test of one's ability to be a GP in England? I'm never getting onto the performer's list

My gf completed IMT with pending exams (ARCP U5) and had other competencies achieved. She now wants to apply for GP training. Will she need a "Support for Re-application to a Specialty Training Programme" form from her previous deanery?

Thanks!

Currently GPST2 and have always been pretty set on moving to Australia after CCT.
However, now that I'm halfway through training, I'm starting to seriously question my own competence and whether I'll actually be ready to work as an independent GP, especially in Australia.
I've been stuck doing mostly hospital rotations throughout training, with very little actual exposure to GP clinics. I'm currently revising for the AKT. It’s not even the theoretical knowledge that worries me the most. It's the practical side of things.
I have very little to almost no experience with minor procedures, wound management, suturing, suture removal, skin lesions, etc.
From what I've read, Australian GPs seem to do a lot more hands-on procedures compared with UK GPs, and I'm worried about what will be expected of me as a newly qualified GP moving over there.
I know I still have GPST3 ahead of me, but I can't help feeling quite behind, especially when I think about being expected to practise independently after CCT.
For those who have moved from the UK to Australia after CCT, did it get better? Did you feel underprepared initially?

Like the title says. My region's training is almost entirely focused on communicating with almost no time dedicated to the actual clinical aspects of GP. I know how to talk to patients, that's never been an issue, but sometimes dealing with simple complaints is difficult when I don't know the mechanisms for handling them in primary care.

For instance seeing a patient with a rash - rashes almost never look exactly like reference pictures on line, so diagnosing the exact nature of a skin complaint is tricky. Say I don't think it's an urgent or emergency complaint - then what? Just try treating it? Investigate? What?

I know this sounds daft but I feel like I'm not being taught how to deal with the vague stuff and I want to improve my confidence around diagnostic uncertainty.

Just out of curiosity how long are blood test appointments at your surgery? Our are 10 minutes (or double if child, special adjustments, etc). We also have a long wait for blood tests. 10 mins seems a lot. Keen to explore what’s ‘normal’ across the country.
Ps I know there are individual circumstances but I’m just wanting a broad general consensus.

Has anyone had any success with question banks other than passmed and GP self test when prepping for the AKT?

I’ve managed to work my way through both (gave myself plenty of time) and wondering what’s a solid 3rd option.

Not looking for any AI created garbage. Ideally also a smaller question bank which I can get through in the next few weeks.

I’m currently an ST3 in England, due to CCT next year, and planning to move to South Wales due to family commitments.
For anyone working in Wales, what should I know about moving from England? Do I need a separate performers list, and how do pay, contracts and job opportunities compare?
Any advice appreciated!

Just seen this article on another SM platform, and the comments were interesting. Lots of likely hospital specialists saying GP training isn't long enough or the job is not comparable to consultants in terms of difficulty to be able to justify comparable pay. Some even suggested GP training should be 4/5 years or GP trainees should have to do IMT1&2 then MRCP before GP training.

I'm still in training, but I have a lot of newly CCT'd colleagues and it seems the biggest let down at the minute is pay and working conditions. I know colleagues saying that their sessions are more like 6 hours worth of work on 4 hours pay, and many starting on a measly £10k per session (some even only getting £9.5k on ARRS). Lots say 9 sessions just isn't viable with the workload, and if you count actual hours worked 6 sessions is probably more like full time, so this often creates a glass ceiling on pay.

I do personally think GP pay should be comparable, and should increase with experience, akin to the consultant payscale. I disagree with the arguement that we don't do enough years of training, because every secondary care speciality differs in that regard too and they all start on the first step of the consultant payscale regardless. I also think we need to reconfigure a session, and realise the job we are being asked to do doesn't fit into 4 hours 10 minutes anymore and this needs adjusting too. Maybe I'm naive as a trainee, but I do think something needs to change.

What are people's thoughts on this? Is this something you support? What issues could this bring? Genuinely interested.

Do you guys notice a real difference between a newly qualified GP and one 3, 5, 10 years later? Perhaps more of a difference than you'd see in other specialities?

Asking as a slightly bitter resident who could have been a GP 2 years ago but instead has several years more training left 🙃

How much for 12 patients? And which part of the UK is that?

What else can I do . Gp for 1 year and hate it. Everything is utterly bad. But It's all I know

Taking supervision, checking and follow-up into account, what effect has clinical pharmacy support had on your own workload?

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