The continuing impact of the pandemic is being felt across all parts of society, and one area that has been severely affected is the population’s mental health. Our Hot topic this issue focuses on the eating disorders anorexia nervosa, bulimia, and binge eating. No doubt, the added stress of repeated lockdowns has contributed to the numbers of those who have gone on to develop an eating disorder. All three conditions can result in physical ill health, and the mortality rate of anorexia nervosa is the highest of any mental health condition.1 Patients require prompt referral to specialist eating disorder services; but, as is so often the case at the moment, there is currently great pressure on these services—waiting times for assessment were three times higher at the end of 2020 than they were at the end of 2019.2 In the meantime, responsibility falls on GPs to do what they can for patients who are awaiting assessment, particularly in terms of identifying those who need urgent specialist input. GPs are doing everything possible to mitigate the difficulties experienced by those in need of onward referral, and Dr Emma Nash explains how to recognise and support these patients, with information on red flags and signposting to sources of interim support.

This issue also features an in-depth focus on recently published NICE guidance, with expert articles on NICE Guideline (NG) 198 on acne vulgaris, NG202 on obstructive sleep apnoea/hypopnea syndrome (OSAHS), and NG203 on chronic kidney disease (CKD). 

Rebecca Penzer-Hick discusses the NICE recommendations on the management of acne vulgaris, outlining how skin care advice and treatment differs according to disease severity.

Professor A Niroshan Siriwardena assesses the NICE guidance on the sleep disorders OSAHS, obesity hypoventilation syndrome, and chronic obstructive pulmonary disease–OSAHS overlap syndrome, and explains the assessment and diagnosis, interventions and treatments, and referral criteria for these conditions. 

The NICE recommendations on CKD are comprehensively reviewed. Much has changed since the previous guideline was published in 2014, and the update takes into account concerns about adjusting estimated glomerular filtration rate based on ethnicity,3,4 trial data on the benefits of sodium–glucose co-transporter-2 inhibitors, and new tools for measuring those at risk of developing end-stage renal disease. Dr Patrick Holmes summarises the steps for assessing and monitoring CKD, and the lifestyle and pharmacological interventions required, emphasising the importance of prompt identification of the condition to minimise decline in renal function.

Dealing with the increasing pressure on general practice is the focus of our View from the ground. As demand for primary care services grows, and GPs are increasingly called upon to plug the gaps left by delays in care, Dr Vasumathy Sivarajasingam provides some valuable pointers to GPs on how to improve resilience. She outlines her personal strategies, and offers advice on managing stress within practices to promote resilience across primary care teams. Resilience can be a useful tool to maintain the standard and sustainability of services at this challenging time.

And here at Guidelines in Practice, excitement is building as the final preparations get underway for Guidelines Live on 30 November–1 December 2021 at ExCeL London. Featuring more than 36 hours of clinical content, it is sure to be an incredibly useful event. I look forward to seeing you there—it is not too late to book your place to attend on one or both days. Simply visit


  1. Galmiche M, Déchelotte P, Lambert G, Tavolacci M. Prevalence of eating disorders over the 2000– 2018 period: a systematic literature review. Am J Clin Nutr 2019; 109: 1402–1413.
  2. Beat Eating Disorders website. Support people waiting for treatment. (accessed 4 November 2021).
  3. Kidney Care UK, Kidney Research UK, National Kidney Federation, UK Kidney Association. Removal of the ethnicity adjustment for kidney function testing and the NICE chronic kidney disease (CKD) guideline: a joint statement from professional, patient, and research kidney organisations. Bristol: UK Kidney Association, 2021. Available at:
  4. Eneanya N, Yang W, Reese P. Reconsidering the consequences of using race to estimate kidney function. JAMA 2019; 322 (2): 113–114.


Image 1: terovesalainen/

Image 2: frank29052515/

Image 3: kudosstudio/

Image 4:  yodiyim/