Primary care currently has the challenging task of continuing to deliver quality care in all areas, while also manging coronavirus infection risk and adapting to new processes. This issue of Guidelines in Practice includes two articles that focus on clinical guidelines, and two articles that look at the impact of COVID-19 and how to maintain services under the new ways of working.

The diagnosis and management of asthma in the UK is complicated by differences in the recommendations made by the two main UK asthma guidelines—the British Thoracic Society (BTS)/Scottish Intercollegiate Guidelines Network (SIGN) guideline and the NICE guideline. In 2019, NICE, BTS, and SIGN announced that future UK-wide guidance for the diagnosis and management of chronic asthma will be produced jointly by the three organisations. Development of the guideline has stalled and it is now expected around 2023. However, in August, the All Wales Medicines Strategy Group (AWMSG) published interim guidance for NHS Wales on the management of asthma in adults, which will be superseded by the NICE/BTS/SIGN guideline when it is published. The AWMSG guideline offers pragmatic advice to primary care in light of the conflicting existing guidance. Dr Sinan Eccles describes the key differences between existing asthma guidelines, the recommendations made by the AWMSG, and strategies to support asthma self-management. Test your knowledge after reading the article using the multiple-choice questions.

Professor Ian Giles and Professor Caroline Gordon present the recommendations from a working party guideline that describes the best practice management of women of child-bearing age with inflammatory rheumatic diseases (IRDs). Active rheumatic disease is associated with a number of adverse pregnancy outcomes, but improved treatments mean that many women with these IRDs are achieving disease control and are more likely to be considering pregnancy. The article discusses holistic management, contraception and unplanned pregnancy, pre‑pregnancy counselling, as well as prescribing considerations during and after pregnancy. There is also a two-page algorithm that summarises the management strategy and a table that details drug compatibility with pre-conception, pregnancy, and breastfeeding.

Primary care plays an essential role in the diagnosis of cancer; GPs are the first clinicians that most people will present to with concerns about cancer or with signs and symptoms. Dr Anthony Cunliffe discusses the impacts of COVID-19 on the cancer pathway, including a decrease in presentations and referrals, reduced access to diagnostic tests, changes to ongoing cancer treatment, and the pausing of screening programmes. During the first lockdown, primary care saw a significant reduction in people seeking care for concerning symptoms. Patients need to be reassured that healthcare professionals remain able to safely review and investigate any concerns about cancer, to ensure that they seek care if suggestive symptoms arise. 

The pandemic has also impacted patients’ access to contraception. Dr Toni Hazell provides top tips on how to maintain the provision of contraception despite the reduction in face-to-face consultations. Dr Hazell also highlights the efficacy and practicality of long-acting reversible contraceptive (LARC) methods, how recommendations about the duration of use of LARC methods have changed, and how to go about restarting LARC fittings. After reading the article, test your updated knowledge using the multiple-choice questions.

And finally, in this month’s View from the ground, Dr Sarah Merrifield writes about her experience as a newly qualified GP having started a salaried role just before the start of the pandemic.

Correction notice

In the article Acne vulgaris: manage patient expectations and optimise treatment by Dr Kashif Bhatti and Dr Bruce Pollock, October 2020 issue of Guidelines in Practice, there was an error in the caption for Figure 2: Comedones (p.22). The caption should have read: ‘Closed comedones (left) and open comedones (right).’ The online version of the article has been corrected and is available at: