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Over the last few months, healthcare has been well and truly disrupted. Screening, routine services, and non‑urgent procedures have been put on hold. However, as more is learnt about the virus, and restrictions are eased or adapted, people are starting to look ahead and consider what will be different in the post‑COVID era. 

For the health of the nation it is critical that some elements of care that have been put on pause are able to restart as soon as is reasonably practical, as long as it is possible to find safe ways of working to minimise risk of exposure to infection for patients and practitioners alike. 

The healthcare industry has demonstrated an immense ability to adapt and respond quickly. The next chapter will be a transitional phase, in which paused services will resume, with measures in place to contain the risk of contracting COVID-19. Since 15 June 2020, visitors and outpatients attending NHS hospitals have been required to wear face coverings. It seems logical that these measures should be compulsory in all healthcare settings, including primary care, but (at the time of writing) it is unclear as to whether mandatory face coverings will extend to patients attending GP practices.1

To date, NICE has published 19 COVID-19 rapid guidelines, designed to help clinicians to manage patients with specific medical problems, maximise the safety patients, and protect staff from infection during the COVID-19 pandemic. People with chronic respiratory illnesses, such as asthma and chronic obstructive pulmonary disease (COPD), are at increased risk of severe illness from COVID-19. This means that managing patients with these respiratory conditions is more important than ever, yet doing so safely presents challenges and requires adaptations to normal practice. Dr Kevin Gruffydd‑Jones discusses three respiratory-focused COVID-19 rapid guidelines on community-based care of patients with COPD, severe asthma, and managing suspected or confirmed pneumonia in adults in the community.

Consultations, including routine asthma and COPD reviews, will need to be conducted remotely via telephone, video, or email to minimise face-to-face contact and thus reduce the risk of infection. The article also covers initial assessment of patients with acute respiratory problems, how to differentiate between COVID-19 viral pneumonia and bacterial pneumonia, when to prescribe an antibiotic, and proactive review of those with symptoms. Use the multiple-choice questions to test your knowledge after reading the article.

Also in this issue:

  • Dr Kate Millar and Professor Mike Cummings describe how to diagnose and manage pancreatic exocrine insufficiency (PEI) in diabetes. Read the article to learn about the spectrum of symptoms of PEI, why it is important to diagnose and treat the condition, and how PEI affects glycaemic control in people with diabetes

3D illustration of Pancreas - part of digestive system_AS

Diagnose and treat pancreatic exocrine insufficiency in diabetes

Dr Kate Millar and Professor Michael Cummings

  • Dr Caroline Ward highlights common themes and important differences in the management of a range of infective skin conditions based on the recommendations made in some new and updated NICE guidelines. Dr Ward explains how to diagnose impetigo, cellulitis, erysipelas, leg ulcer infections, and diabetic foot infections; how to select appropriate antimicrobial treatment options; and when to reassess and refer
  • Dr Richard Roope shares top tips for GPs on prevention, screening, and diagnosis of colorectal cancer. Read about lifestyle factors that increase risk, eligibility criteria and thresholds for screening, and guidance to support diagnosis and management of colorectal cancer
  • In this month’s View from the ground, Dr Gail Allsopp describes the ‘yin and yang of COVID-19’ and shares some glimmers of light that have kept her going during this testing time.

I’ll finish with some MGP news—we are delighted that our annual conference Guidelines Live is a finalist in the PPA Awards Event of the Year. This year, Guidelines Live will take place on 17–18 November and cover 12 key clinical areas for primary care. Our expert speakers will examine the implications of COVID-19 on their particular clinical area. 

References

  1. British Medical Association. Hospitals and GP practices must have clarity and adequate supplies as new face covering rules come into effect, says BMA. BMA, 15 June 2020. www.bma.org.uk/news-and-opinion/hospitals-and-gp-practices-must-have-clarity-and-adequate-supplies-as-new-face-covering-rules-come-into-effect-says-bma (accessed 16 June 2020).