Improvements in the treatments offered to people with HIV mean that it is now manageable as a chronic condition. HIV is mostly managed in secondary care but there are some aspects that GPs need to be aware of, which Dr Toni Hazell discusses in her article. You can also test your updated knowledge using the MCQs included in this issue.

Early diagnosis of HIV vastly improves prognosis, so it is important that GPs in high-prevalence areas take opportunities to offer HIV testing. Tests should be offered to all new patients at registration, to people having blood tests for another reason, and to those who have symptoms consistent with HIV infection.

Dr Hazell also highlights the issues surrounding contraception and fertility. HIV is generally not a contraindication to contraception; however, drug interactions reduce the number of available options in women on enzyme-inducing antiretroviral therapy. Discordant couples who are trying to conceive should be informed about conception strategies that reduce the risk of HIV transmission.

Confidentiality and legal issues are also highlighted because GPs may need to breach confidentiality if they become aware that a patient with HIV has not informed their partner of their HIV-positive status. 

Earlier this year, the Scottish Intercollegiate Guidelines Network (SIGN) updated its guidance on stable angina. In this issue, Dr Alan Begg compares the recommendations made by SIGN with those made in the NICE guideline, which was last updated in 2016. 

Chest pain is a common presentation in primary care and its diagnosis can be difficult. There are certain typical characteristics of angina pain that can help to elucidate the diagnosis. Dr Begg describes the clinical characteristics of angina, the risk factors that increase the likelihood of angina, and the investigations that can be used to assess patients if there is diagnostic uncertainty. The article includes useful algorithms showing the management options for patients with suspected or confirmed angina, as well as tables comparing the NICE and SIGN recommendations on medical therapy for symptom relief, and drugs used to prevent new vascular events. This article also includes a new regular feature: implementation actions for clinical pharmacists, which provide advice on how clinical pharmacists can support the implementation of guidance in general practice. 

Since CCGs came into being, it has become more necessary for GPs to get involved with business development aspects of primary care, such as commissioning, bid writing, and procuring services. General practice is very much patient-centred, so primary care clinicians will have a good understanding of their patients’ needs, and this knowledge is invaluable when designing and developing effective clinical services.

However, when bidding for contracts, GPs are often competing with private providers (who have dedicated resources for writing bids), and presenting information to non-clinical decision makers (who award contracts based on whether a proposal meets a specific set of criteria). 

Dr Satpal Shekhawat discusses why bid writing is challenging for GPs, and provides useful tips for writing a successful bid, including developing a shared vision, defining the workforce strategy, and keeping patients at the centre of any new service design.

Also in this month’s issue is a top tips article on the primary care assessment and management of adults with community-acquired pneumonia. The challenge lies in identifying which patients with a lower respiratory tract infection have pneumonia, and which of those with pneumonia require admission to hospital. Dr Sinan Eccles provides advice on diagnosing pneumonia based on examination findings and symptoms, differentiating pneumonia from other respiratory infections, and using CRB-65 to determine the need for hospital assessment. 

The article includes a useful algorithm, which summarises when point-of-care CRP testing should be used and when to prescribe antibiotics. Dr Eccles explains which antibiotics should be used to treat pneumonia, and the expected timeframe for resolution of pneumonia symptoms.

This month, our View from the ground is from Dr Caroline Begg, who describes her journey through GP training, how it influenced her career decisions, and how she feels about being an early career GP at the start of a lifelong journey.

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Being an early career GP

Dr Caroline Begg