Here at MGP, guidance is our bread and butter. Through our publications, we aim to disseminate up-to-date information about all the latest clinical guidance to support healthcare professionals with the implementation of best practice. Our flagship event, Guidelines Live, provides healthcare professionals with the opportunity to learn about the latest clinical guidance and its application in primary care. 

As 2020 progressed, it became clear that we would need to run this year’s Guidelines Live as an exclusively virtual event, but the team is really excited about this new format. This year, Guidelines Live will take place using the vFairs virtual event platform—this is designed to give an immersive feeling, as though you are attending the event in person. By booking a place, you will be able to watch over 36 presentations on a range of topics, partake in live question and answer sessions with expert speakers, network with other Guidelines Live attendees, and discuss products and services with exhibitors. For more information and to book your place, visit: Guidelineslive.co.uk

A lot of what we have covered in Guidelines in Practice this year has been about coronavirus, and although it is an important topic, it’s refreshing to have an issue that looks at a range of guidelines on other topics. Here, I will briefly summarise what’s discussed in each of the articles in this issue.

Treating diabetes is not just about managing blood glucose levels—many patients have multiple other long‑term conditions that are associated with diabetes or complications of the disease that need to be managed. In June 2020, Primary Care Diabetes Europe (PCDE) published a position statement, that provides recommendations on the pharmacological management of people with type 2 diabetes and co-morbidities in primary care. Dr Samuel Seidu and Professor Kamlesh Khunti explain how pharmacological treatment options and glycaemic targets should be tailored to the individual’s circumstances and risk factors. The article also includes a table of prescribing tips for managing common side-effects associated with anti‑hyperglycaemic medications. 

Acne is a chronic inflammatory disorder that can have significant impact on the patient. Left untreated, acne can become more severe and permanent scarring may develop. Each stage of the pathophysiology of acne is a target of acne medicines but the challenge lies in recognising the variants and knowing which treatment is best suited to each type. The Primary Care Dermatology Society (PCDS) has recently updated its guidance on acne, including a pathway that summarises the management and guides treatment selection based on severity. Dr Kash Bhatti and Dr Bruce Pollock discuss the PCDS recommendations, describe strategies for managing patient expectations to improve treatment adherence, and highlight criteria for referral. 

Tinnitus is the perception of sounds in the ear or head that do not come from an external source. Its impact can vary from being moderately annoying to heavily disruptive, potentially leading to mental health problems. Earlier this year, NICE published a guideline on the assessment and management of tinnitus, which is the focus of Dr Emma Dickson’s article. Dr Dickson discusses possible causes of tinnitus, best practice in assessing and investigating tinnitus, key information that should be shared with people with tinnitus, and details of who should be referred and within what timescale. 

Upper airway inflammatory diseases, such as rhinitis and rhinosinusitis, are common in people with asthma, and if they are not identified and treated, they can lead to a worsening of asthma control. Dr Glenis Scadding presents an algorithm that has been developed to support primary care healthcare professionals with identifying and managing allergic rhinitis in people with asthma. The algorithm covers all stages of the pathway from initial diagnosis, through to medication and review, as well as when to consider referral to a specialist. 

Appraisals have restarted this month, having been put on hold in mid-March in anticipation of an increase in clinical workload caused by the pandemic. In its new format, the appraisal meeting will require minimal preparation and will focus on professional development and wellbeing. Dr Honor Merriman describes how the appraisal process has changed, what’s required in the new appraisal template, and where to access support.

And finally, in the View from the ground, Dr Jonathan Griffiths reflects on the last few months in general practice and how things have changed in response to the pandemic.