Being a GP has never been particularly easy, but the oft-reported climate of rising demand for appointments, a backlog of delayed care, and workforce shortages is creating a perfect storm in primary care, which is now under severe pressure.1 However, not all facets of primary care are subject to national scrutiny—in the October issue of Guidelines in Practice, we focus on two important aspects of being a GP that are easily overlooked amid an abundance of other concerns.

With many claims on consultation time, GPs face a difficult task accommodating complex patient needs within a typical appointment slot. Dr Vasumathy Sivarajasingam offers five top tips on how to maximise the effectiveness of a 10-minute consultation. She provides advice on allocating and structuring appointments—of particular significance as calls grow for more face-to-face appointments to be made available—and on effective workload management, while ensuring that the patient’s agenda remains foremost.

Training the GPs of the future is also key to optimising patient care. Dr Nicola Moerdyk outlines the changes to training and assessment necessitated by the COVID-19 pandemic, and explains how trainee GPs can be supported to get the most out of their time in general practice. She provides 10 top tips on how to develop the next generation of GPs.

The roll-out of the autumn–winter vaccination programme is one area that is unlikely to be overlooked, and was the subject of feverish speculation before the details were finalised.2–4 As in previous years, primary care will play a central role in its delivery. This year, both flu and COVID-19 vaccines will need to be administered against a backdrop of concerns that the number of flu cases will be higher in 2021 than in previous years4—necessitating a swift, smooth rollout—and disruptions to the supply of flu vaccines. Dr Toni Hazell outlines the recommendations on flu vaccines,4 and the requirements around COVID-19 booster vaccines and third primary doses.2,3 She gives advice on addressing patient concerns, and details how to deliver the joint programme to patients.

The NHS long term plan established national requirements for the early diagnosis of cancer;5 subsequently, service specifications around early cancer diagnosis have been set out in the Primary Care Network (PCN) Directed Enhanced Service (DES).6 In practice, GPs must perform a tricky balancing act between the need to investigate at‑risk patients and avoiding unnecessary testing. Dr Anthony Cunliffe  outlines how the PCN DES can be put into practice, and explains how it fits with the Quality and Outcomes Framework quality improvement module on early cancer diagnosis. The overlap of themes between both ensures that work done for one will be relevant to the requirements of the other.

Also in this issue, Ian McKenna  reports on an initiative to reduce high medication usage in the View from the ground. A holistic assessment team was established to work with patients taking high doses of pain-relieving medications, such as opiates, and antidepressants, to empower them to reduce their medications use and improve their health and wellbeing. 

When the spotlight of national attention moves on, GPs still have many and varied obligations. To help you fulfil these, Guidelines Live takes place at ExCeL London on 30 November and 1 December 2021. Guidelines Live  has worked with professional bodies to inform the clinical sessions, which keep you up to date with clinical guidelines and evidence-based practice.

These include: the Primary Care Cardiovascular Society, ENT UK, the Primary Care Women’s Health Forum, the Primary Care Diabetes Society, Macmillan Cancer Support, the Primary Care & Community Neurology Society, NICE, and Soar Beyond. It’s not too late to book your place to attend on one or both days; healthcare professionals can attend for a registration fee of £48—for more details visit


  1. British Medical Association. Pressures in general practice. (accessed 7 October 2021).
  2. Public Health England website. JCVI issues updated advice on COVID-19 booster vaccination. (accessed 7 October 2021).
  3. GOV.UK website. Joint Committee on Vaccination and Immunisation (JCVI) advice on third primary dose vaccination.  (accessed 7 October 2021).
  4. Public Health England, DHSC. The national influenza immunisation programme 2021 to 2022. London: PHE, DHSC, 2021. Available at:
  5. NHS England website. NHS long term plan ambitions for cancer.  (accessed 7 October 2021).
  6. NHS Primary Care Group. Network contract directed enhanced service—early cancer diagnosis guidance. London: NHS, 2021. Available at:


Image 1: Monkey Business/

Image 2: Andrey Popov/

Image 3: Pormezz/

Image 4: Kateryna_Kon/