This month, I’d like to start my editorial with some exciting personal news—I’m having a baby. By the time this issue lands on desks, I will have reached that important 37-week milestone and will be on leave and preparing for the baby’s arrival. I hope to find time to read through NICE’s recently published guideline on postnatal care,1 but on this occasion it’s for personal reasons. 

I am handing over the reins to Angela O’Neill, who has recently joined the team and will be looking after Guidelines in Practice while I am on leave. Angela has extensive experience working on similar publications, and I know she will be a safe pair of hands and will be developing lots of interesting articles over the next few months. 

Now, on to the matter of what’s covered in this issue of Guidelines in Practice!

Across the UK, the easing of lockdown measures has started, bringing with it optimism for a return to some version of normality, at least for the summer months. One important factor that has played a part in making the easing of restrictions possible is the roll‑out of COVID-19 vaccines. At the time of writing, more than 32 million people in the UK have received a first‑dose COVID-19 vaccination.2 But not everyone is willing to receive a vaccine. Dr Claire Davies explores why vaccine hesitancy may arise and which patients are more likely to be unsure about vaccination. Dr Davies also describes motivational interviewing techniques for consultations with vaccine‑hesitant patients, and provides responses to common concerns and misconceptions about COVID-19 vaccines.

When we think of ‘respiratory’ and ‘primary care’, we typically think of asthma and chronic obstructive pulmonary disease, but there are other conditions that GPs need to be aware of when assessing patients with respiratory symptoms. Bronchiectasis is a chronic condition in which irreversible damage to the bronchi leads to a build-up of excess mucus and persistent or recurrent bronchial sepsis. Although a diagnosis of bronchiectasis is made in secondary care, primary care has an important role in recognising and referring patients with relevant symptoms, and also in ongoing management after a diagnosis is confirmed. Dr Kevin Gruffydd-Jones distils the relevant recommendations from a British Thoracic Society guideline on bronchiectasis into key learning points for primary care. Dr Gruffydd‑Jones describes the cornerstones of management in primary care, which include routine review of the patient’s bronchiectasis and any co‑morbidities, physiotherapy to improve airway sputum clearance, annual vaccinations, and prompt treatment of exacerbations. 

Dr Kevin Barrett shares 10 top tips for diagnosing and managing inflammatory bowel disease (IBD) in primary care. Diagnosing IBD can be challenging because of symptom overlap with numerous other gastrointestinal conditions. Dr Barrett describes the classical symptoms of IBD and explains which tests can be used to identify markers of inflammatory disease and inform the diagnosis. The article also includes practical tips on when to offer a colonoscopy, lifestyle advice that should be offered to patients with IBD, and how to support patients who are experiencing a flare. 

We often focus on specific conditions and how they’re diagnosed and managed, but in reality, patients usually present to their GP with symptoms. Dr Toni Hazell uses two hypothetical case studies to explore common causes of lower urinary tract symptoms (LUTS) in men. Urinary frequency, the presence of haematuria and/or dysuria, and symptom duration can all provide vital clues in identifying the cause of LUTS. Dr Hazell also discusses useful investigations that can help to reach a diagnosis, and red flags for referral for suspected bladder or prostate cancer.

Finally, in this month’s View from the ground article Dr Vasumathy Sivarajasingam describes the measures introduced by her practice during the pandemic to check on the wellbeing of vulnerable patients, which included the development of a personalised holistic care record for people with learning disabilities. 

References

  1. NICE. Postnatal care. NICE Guideline 194. NICE, 2021. Available at: www.nice.org.uk/ng194
  2. Public Health England. Coronavirus (COVID-19) in the UK. Vaccinations. London: PHE, 2021. Available at: coronavirus.data.gov.uk/details/vaccinations (accessed 20 April 2021).