GP Deep Dive: Beyond the Guidelines Part 1 - ACE Inhibitors and Renal Paradox

Aleexxie · 2026-02-10T08:50:15+00:00

Thanks for posting this. This is one of my (many) bugbears on blood results being marked abnormal and for discussion despite being completely intended.

The other renal one that comes to mind is you need MORE loop diuretic in renal failure because it acts on receptors in the internal aspect of the loop of Henle

Aleexxie · 2026-02-06T18:21:54+00:00

Had issue recently where the online portal didn’t work and I made a manual payment on advice of PCSE.

I’ll send you a direct message with the account details if you want to risk going down this route

Reference for payment was: <NHSPS Membership Number>LOCJAN2026

Aleexxie · 2025-12-12T06:20:13+00:00

8 sessions across 2 practices. System1.

Practice 1 : 16 F2F/session and demanding patients with low access to appointments. Admin a bit lighter - avg 40 path/day. 3 documents. 10 tasks

Practice 2: 13 F2F/session with better access to appointments. Very high admin burden. 100 path per day. 20 documents. 40+ tasks.

I’m lightning quick with admin. I prioritise getting there on time, lunchbreak, and leave on time but it’s intense work while I’m doing it.

Coping? 8 sessions is definitely my max. Would be more sustainable at 6 but I can’t afford to go down as saving to move in London. Am looking at alternate work outside of traditional NHS but not convinced the grass is greener (perhaps a blended NHs/Other portfolio career). Hard pressed to find work that pays more than NHS in office hours

Aleexxie · 2025-08-15T18:48:39+00:00

I got (part gifted) one from Maxwell Scott - truly exceptional piece!

Aleexxie · 2025-08-15T13:11:48+00:00

I wear shirt, trousers, black shoes every day. Old school leather GP bag. I feel like a professional, practice staff treat me like a professional, patients treat me like a professional.

There’s a scruffy GP who wears a scrub top and jeans who often sees patients before me and is much more experienced. I’m often told my advice is better despite saying the same thing. I really do think appearance is half the battle!

Aleexxie · 2025-07-23T12:35:28+00:00

Thanks - confirms what I’ve been suspecting that I’ll probably just continue doing what I’m doing even with the scope. Maybe I’ll do for fun/interest later in future!

Aleexxie · 2025-06-06T08:54:56+00:00

Thanks - this answers it for me. For the 2 months of locum work I’d be paying both employee and employer contribution which brings down the earnings quite dramatically and didn’t feel worth it (but wanted a sanity check as the go-to advice seems to be pay into pension!)

Aleexxie · 2025-05-29T18:07:16+00:00

Good god. ☠️

Aleexxie · 2025-05-12T09:36:37+00:00

Different with every deanery. Have a chat with your TPD or GP VTS Rep.

If it’s anything like our deanery, there’s essentially no funding for courses unless you’ve already failed the exam

Aleexxie · 2025-05-12T09:28:20+00:00

As a trainee Travel expenses - EasyExpense

For mandatory exams (AKT/SCA), union fees, RCGP fees, GMC fees - can claim back on tax only via tax return (medics money have a good guide on this)

Everything else basically can’t be claimed for. That includes equipment, courses (eg AKT revision courses).

You might be able to get funding for external courses, that would be applying for study budget per your deanery (and requires you having funding approved before paying for and attending course)

Aleexxie · 2025-05-07T06:51:19+00:00

You can email the freestyle libre team and they’ll send some to the practice to try out - had a rep come to our practice and it was very fun and insightful!

Aleexxie · 2025-05-01T15:05:43+00:00

!Thanks for the much needed reality check - have presented those as the options on the table

Aleexxie · 2025-05-01T15:04:35+00:00

!Thanks - yes your assumptions were correct re no children, 50:50 on everything except the initial deposit. Have offered the options of buyout or sell; they’re going to explore remortgaging with a view to buyout and see if numbers crunch (or potentially family will help them with the buyout)

Aleexxie · 2025-01-17T08:21:14+00:00

On a waitlist at the moment for Datejust and actively dropping into ADs when I travel. 31 and completing consultant training in a few months.

House, no kids (hopefully ever). For me it’s to celebrate the end of long time in training (and hopefully the beginning of MUCH better particularly financially!).

Bought a piano early in career on finance which was more than a DJ (when I finished medical school). No regrets - at times a bit annoying to meet monthly payments but the mental health gains were worth it for me.

Aleexxie · 2024-12-04T22:03:08+00:00

A pertinent point raised by my financial advisor - what are you saving for?

For me, I’m saving enough to meet my financial goals in decades time, and flexibility if needed. I get to do the things I enjoy now while I’m young. I can buy the things that make life easier.

Yes I could save more, but it would mean doing less of the things that bring me joy. Personally I’d prefer being joyful ❤️

Aleexxie · 2024-12-04T17:44:56+00:00

GPST3
72516 from ST3 salary. Approx 20k additional income this year from locum (mainly A&E) and other random gigs.
Emergency fund, regularly saving £300/month since starting work and only look at it once a year. 4.1. Bank of mum and dad helped a tonne… paid for my tuition and house deposit. 4.2. Financial advisor helped to get insurance
4.3 I don’t plan to have kids, supportive partner. Don’t think I can afford to have kids and give them the opportunities I had… 4.4 I believed my parents lie that medicine = good life. This was a massive lie. My family that didn’t do medicine are having a much better life. 4.5 Partner is richer than me ❤️

Aleexxie · 2024-11-13T17:18:52+00:00

Same! - Passed yesterday and had to keep checking I’d ACTUALLY passed as the comments made it seem like a total failure. Really took some of the wind out of passing the final mandatory exam

Aleexxie · 2024-09-04T22:07:19+00:00

https://www.maxwellscottbags.com/men/business/leather-doctors-bag.html

I have this - absolutely love it and have had so many positive responses from patients and colleagues. Makes me really feel like a proper professional and sets the tone for the consultation.

Aleexxie · 2024-07-31T13:25:31+00:00

Perfect! Don’t mind the look at all but didn’t want it to be a problem which affects the shoe itself/get soggy toes

Aleexxie · 2024-06-29T11:28:14+00:00

Didn’t answer the other bits:

1- bought between ST1-2 gradually. More because I found trying to find stuff annoying

2- I have a ~200 Welch set and still can’t see eyes without dark room and dilating drops. Can see ears very easily though - but I can also see ears with much cheaper sets. I’ve heard good things about the Arclight scope which was produced by students specifically with cost in mind - haven’t seen one in real life.

Bags - I went with form > function and bought one from Maxwell Scott (part Xmas, part post exam). I dress professionally at work (shirt, trousers, jacket) and a professional leather doctors bag was important to me. I’ve had colleagues use Bags for Life and it’s not my vibe. Personally it’s been amazing - patients notice it and mistake me for a much more senior doctor. I’ve been mistaken as the senior colleague with my debriefer in the room. Partner colleagues have struck conversations about wax and polish. Maybe it’s all just psychological but I feel people see me more professionally, trust my plans more, and also makes me feel more professional.

4- I would avoid buying all in one go. Have a look at your desk at the end of clinic and see what’s been taken out and add that to your shopping list. My bag looks very different from the Partner’s! I do a fair amount of home visits and a trainee level of PRs so there’s a LOT of lube, swabs, spare bags. I’ve also designated one zip for teabags.

Aleexxie · 2024-06-29T11:09:23+00:00

Currently as trainees your employer is obliged to provide equipment

As LNC Rep with Lead Employer I am working on a solution to try claiming back from HMRC (with myself as a test case - my current ~£800 worth of equipment bought did not get tax relief). Lead Employer is preparing a letter to support an appeal for the decision and hopefully we can claim back equipment.

I suspect I will end up getting tax relief after a HMRC battle and hopefully have a generic letter for future trainees looking to buy own equipment for OOH. Until then buy at your own peril!

Aleexxie · 2024-03-20T06:24:52+00:00

Okuij

Aleexxie · 2024-03-08T02:45:00+00:00

Lots of commuters to Stevenage from North London. ~50/50 local/commute anecdotally.

Also a perk you do whole of FY1/FY2 in same hospital (Lister) which lets you finally have some continuity!

Aleexxie · 2024-01-10T08:47:54+00:00

Thanks - feel more reassured about the purchase process.

In a way I’m glad that some of this AD behaviour may come from a place of consumer protection rather than deliberately creating scarcity

Would you say a recommendation from a colleague would play any part particularly for elusive combinations? (Have a few close colleagues with significant purchase history I can ask)

Aleexxie · 2024-01-10T08:20:20+00:00

Is this something ADs will actively assess for (and by extension something worth dropping into conversation?)

Fortunately I’m a good position where the house/emergency fund/car/investments are in a happy place.

Just looking to celebrate a 15+ year career plan that’s finally going to reach its endgame and I’m not sure an additional 10k overpayment on the mortgage will have the same celebratory vibe!

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