As the UK starts to move cautiously towards a more normal existence, some of the after-effects of the pandemic—and its associated lockdowns—remain with us. These include a healthcare workforce that is suffering from burnout and stress, soaring demand for primary care services, record waiting lists for secondary care treatment, and a rising incidence of mental ill health across the nation.

Humans are generally social; we enjoy the comfort and stimulation of others’ company. When our social needs must be stifled to prevent the spread of infection, unintended consequences may arise. Dr Emma Nash examines the effect of the COVID-19 pandemic on the experience and management of mental health. In the context of COVID-19, symptoms of mental illness may differ from those seen typically, and practitioners must also be aware of the potential for relapse. Dr Nash provides an invaluable cut-out-and-keep information leaflet that can be adapted to suit your local area. In addition, patient scenarios accompany the article to help you reflect on what you have learnt.

Also in this issue,Dr Umesh Dashora and colleagues from the Cardio–Renal–Metabolic (CaReMeUK) Partnership present a joined-up approach to the management of people with diabetes and co-morbidities. The CaReMeUK Partnership—a collaboration between the British Cardiovascular Society, the Renal Association, the Association of British Clinical Diabetologists, the Primary Care Cardiovascular Society, and the Primary Care Diabetes Society—developed its consensus guidance in response to the often fragmented nature of the management of patients with diabetes and co-morbidities. The authors point out that recent improvements in outcomes for many patients with cardiovascular disease have not been replicated in individuals with cardiovascular disease and concomitant diabetes.1 The article outlines a comprehensive strategy to implement best practice for patients with diabetes and co-morbid conditions—test your updated knowledge using the multiple-choice questions and patient scenarios.

diabetes blood test

Manage diabetes and co-morbidities with a joined-up strategy

Dr Umesh Dashora  and colleagues from the CaReMeUK Partnership

Prescribing is a key part of general practice, and updated guidance on Good practice in prescribing and managing medicines and devices has been issued by the General Medical Council. In addition to prescription-only medicines, the guidance covers devices and dressings, and activities such as exercise, and also gives pointers for advising patients on the use of over-the-counter medicines and other remedies. Not only is it helpful for routine practice, but it also provides recommendations on remote prescribing that are particularly relevant in the current climate. And, importantly, it gives advice on when not prescribe. Dr Toni Hazell summarises the key learning points.

One obvious impact of the pandemic has been the additional healthcare spend, which has lent greater urgency to efforts to reduce avoidable expenditure in other areas. One such area is the diagnosis and management of constipation, which represents a significant burden on the NHS. A primary care survey conducted in June 2019 suggested that GPs, nurses, and other healthcare professionals see an average of 6.3 patients every week with constipation.2 Rates of hospitalisation are rising every year, increasing by 16% in 2018–19 compared with 2014–15, and by 7.7% in 2018–19 compared with 2017–18.3 The belief that constipation is not serious, and patients’ hesitancy to discuss the issue have contributed to the problem. Professor Anton Emmanuel shares his top tips on how to manage the condition in primary care.

And finally, in the View from the ground, Dr Vasumathy Sivarajasingam writes about the efforts her practice has made to reduce its carbon footprint. The initiatives introduced include attempts to cut waste, decrease the environmental impact of travel associated with the practice, and dispose of unused medicines safely. Their mantra is: ‘If it’s good for the planet, it’s good for you too!’ —a sentiment that has assumed extra significance in light of the events of the past year.


  1. Bauters C, Lemesle G, de Groote P, Lamblin N. A systematic review and meta-regression of temporal trends in the excess mortality associated with diabetes mellitus after myocardial infarction. Int J Cardiol 2016; 217: 109–121.
  2. Bowel Interest Group. The BIG constipation survey. Arlesey, Bedfordshire; BIG, 2020. Available at:
  3. Bowel Interest Group. Cost of constipation report. Arlesey, Bedfordshire; BIG, 2020. Available at: