Despite high hopes, 2021 has not got off to the best start. The new, more transmissible variant of COVID-19 has pushed the UK back into lockdown. Hospitals are overloaded and struggling to cope with the highest number of COVID-19 patients seen throughout the pandemic. Primary care services are also in extreme demand as the mental health burden of COVID-19 grows and the long-term effects of COVID-19 become more apparent, on top of delivering the COVID-19 vaccination programme. But at least this means that there is now a reason to be optimistic; the approval of the COVID-19 vaccines and subsequent rollout of the vaccination programme are providing a glimmer of hope. We’re not through the tunnel yet, but we can now see some light at the end of it. 

The pressures currently faced by the healthcare system in delivering the COVID-19 vaccination programme are significant. Dr Claire Davies shares practice pointers for primary care. The article focuses on the COVID-19 vaccines currently in use in the UK and highlights special considerations for specific patient groups. Dr Davies also discusses logistical aspects such as inviting patients for vaccination, funding, staffing, and liability and indemnity, and touches on the complications and controversies surrounding the campaign.

Primary care is also seeing a rise in the number of patients presenting with new, unexplained symptoms weeks or months after acute COVID-19. Dr Ashish Chaudhry and Dr Harsha Master share top tips on managing patients with long COVID in primary care based on clinical experience. Dr Chaudhry and Dr Master describe common symptoms of long COVID, explain what a clinical assessment should include, and highlight red flag symptoms that warrant referral. As well as the physical implications of long COVID, it is also important to consider the functional, emotional, and psychological impacts—readers are directed to some useful sources of information to support patients to self‑manage their long COVID symptoms.

COVID virus visualisation two tone

Top tips: managing long COVID

Dr Ashish Chaudhry and Dr Harsha Master

Alongside COVID-19, primary care is still managing patients with other conditions. Dr Pam Brown and Dr Colin Kenny explain how to manage diabetes in people with chronic kidney disease (CKD) in line with the latest recommendations from Kidney Disease: Improving Global Outcomes. The new guideline emphasises the importance of comprehensive care because people with diabetes and CKD are at high risk of acute complications of diabetes, and targets should be individualised based on the patient’s risk factors. Dr Brown and Dr Kenny summarise the recommendations and describe lifestyle interventions and pharmacological management strategies for people with diabetes and CKD. After reading the article, you can test your updated knowledge using either multiple‑choice questions or hypothetical patient scenarios.

Nausea and vomiting in pregnancy (NVP) is very common and is often self-managed without GP input. However, some women experience severe symptoms that can have a significant impact on their life—for example, difficulties with working, caring for children, or mental health. Dr Samantha Robinson provides top tips for primary care on supporting and treating women with NVP. Dr Robinson lists common risk factors for NVP, highlights possible differential diagnoses, and describes non-pharmacological and pharmacological treatment options.

In this month’s View from the ground, Dr Sarah Merrifield explores the perks and pitfalls of being a portfolio GP—read about how, at times, her roles can both complement and conflict with one another.

Over the last 12 months, we have learnt a lot about COVID-19. Globally, there have been enormous efforts to understand more about transmission, treatment, risk factors, and the impact on specific population groups. A continuing theme of the pandemic is the unanswered questions this virus continually presents. Current questions that need answers include how long will immunity last after vaccination? What will a long-term vaccination strategy look like? What are the long-term effects of COVID-19, and how many people will experience them? Perhaps another year from now, these questions will have answers, but what unanswered questions will we be faced with then?