It seems that winter is truly upon us; the dark evenings are illuminated by twinkling fairy lights and inflatable seasonal characters, and GP surgeries up and down the country are preparing for busy season. I don’t know about you, but I cannot believe how quickly the last year has gone by. Here in the office, it is with great pride that we look back at the last 12 months of Guidelines in Practice. But for now, and for the last time this year, please allow me to introduce the articles in this month’s issue…

Dr Clare Taylor and Dr Jim Moore highlight five key recommendations that GPs need to know following the recent update to NICE guidance on the diagnosis and management of chronic heart failure in adults. Diagnosis of heart failure is made by a specialist, but GPs need to be familiar with the signs and symptoms so that they know when to arrange natriuretic peptide testing. Monitoring patients with heart failure also falls into the remit of primary care, but only once the patient is stable and their treatment has been optimised by the specialist multidisciplinary team (MDT). The authors discuss the roles of the MDT, collaboration between the MDT and the primary care team, and how the type of heart failure influences management.

Damaged heart tissue, fluorescence deconvolution micrograph.

Key learning points: NICE chronic heart failure

Image source: © R Bick, B Poindexter, UT Medical School/Science Photo Library

Dr Claire Taylor and Jim Moore

GPs look after patients from cradle to grave, but in reality this journey starts before the patient has even reached the cradle. Unplanned maternities are associated with a higher risk of poor outcomes for both mother and infant, so women should be supported to have control over their reproductive lives in order to prevent unplanned pregnancies and optimise health prior to, and during, pregnancy. Dr Sue Mann discusses Public Health England guidance on reproductive health and preconception care, and explains: why preconception advice is important for all women of childbearing age; when, where, and how preconception care can be offered; and what should be included in a basic preconception check.

A child with a rash is a common presentation in general practice, but elucidating the cause of the rash can be challenging. In this month’s Differential diagnoses article, Dr Jennifer Parkhouse uses hypothetical case studies to illustrate four possible causes of rashes in children, including molluscum contagiosum, hand, foot, and mouth disease, and scarlet fever. Dr Parkhouse describes characteristic clinical features that can help confirm a diagnosis, discusses appropriate treatment and management strategies, and highlights when to involve secondary care.

molluscum01

Rashes in children: what’s the diagnosis?

Image source: © Prof Raimo Suhonen, DermNet NZ

Dr Jennifer Parkhouse

Alcohol is a leading risk factor for ill health, early mortality, and disability. Although assisted alcohol withdrawal is not usually provided in primary care, GPs have a role in making the patient aware that their drinking could be harmful and signposting or referring them to sources of help. In his article, Dr Stephen Willott provides practical tips for assessing and managing alcohol dependency in primary care, including questions to ask to help patients realise the impact of their drinking on their health, tools that can be used to assess alcohol dependency and its severity, and pointers to help identify patients whose alcohol-use disorder may be masking an underlying mental health problem. Alcohol misuse does not only harm those who drink; Dr Willott highlights the need for safeguarding vulnerable people affected by alcohol dependency, and raising concerns about a patient’s alcohol problem with the Driver and Vehicle Licensing Agency.

alcohol_AS

In this month’s View from the ground, Tamsyn Crane describes how her recent experiences have affected her mental health, and why self-care is vital to being a healthy healthcare professional. 

Finally, I would like to wish you season’s greetings and all the best for 2019.