COVID-19 has already caused significant disruption to healthcare so far this year and the wider implications are likely to continue for months (and probably, years) to come. Those working in primary care will be at the forefront of dealing with some of the issues. The mental health of both patients and healthcare professionals is a concern. There are people living in isolation who are experiencing chronic loneliness, people coping with grief and loss, and with work or financial worries. Key workers, including healthcare professionals, have faced incredibly challenging times, and some will be experiencing burnout as a result of the extra pressures on the workforce. In terms of physical health, there will be late diagnosis of serious disease because some patients have avoided consulting their GP despite having worrying symptoms, and many services have been on hold. Then there are the long-term complications of COVID-19, about which little is currently known. And there will be more differential diagnoses to consider—are a patient’s symptoms long-lasting effects of COVID-19, or something else? At what point should other possible causes of breathlessness be investigated in a patient who previously had COVID-19? What impact will lung tissue damage caused by COVID-19 have in people with pre-existing chronic respiratory illness? 

Dr Mark L Levy summarises some important changes to the management of asthma following the 2020 update to the Global Initiative for Asthma (GINA) Global strategy for asthma management and prevention. Dr Levy explains why GINA no longer recommends short-acting beta2-agonists for first-line therapy in patients with asthma, and why GINA recommends that all patients with asthma should be treated with inhaled corticosteroids either regularly or as needed. The article includes a number of updated figures from the GINA 2020 report, including one that summarises the approach to diagnosis and initial treatment of people with asthma and/or COPD. Dr Levy also highlights recommendations from GINA about the management of people with asthma during the COVID-19 pandemic. 

Dr Toni Hazell summarises recommendations from the recent NICE guideline on managing COVID-19 symptoms including cough, fever, breathlessness, and delirium. The article includes tables detailing treatments and dosages, practical tips for assessing symptoms remotely, and discussion about the potential long‑term complications of COVID-19. The demands on primary care relating to COVID-19 are wide ranging, and include triaging patients with relevant symptoms, caring for those who have tested positive for coronavirus, managing those with long-term sequelae, and supporting the mental health of patients. Dr Hazell highlights: ‘COVID-19 remains a marathon not a sprint, so make sure that you look after yourself and your colleagues so that we can stay fit enough to help our patients over the months to come.’

As the number of COVID-19 cases started to rise in the UK, it was anticipated that every doctor would be needed to care for affected people. In March 2020, appraisals were suspended so that more time could be devoted to clinical work. Dr Honor Merriman explains what has happened to appraisals throughout the COVID-19 outbreak, the implications of ‘approved missed’ appraisals for revalidation, and how to access online learning and support while appraisals are suspended. Dr Merriman also looks ahead and considers what will be required when the appraisal process resumes. The appraisee’s health and wellbeing are an important part of the appraisal discussion, perhaps particularly so given the changes and challenges that GPs have faced over recent months. 

Mental health problems are more prevalent in patients treated for cancer than in the general population, and there are many explanations as to why this is the case. Dr Sadaf Haque provides top tips for primary care on identifying and assessing mental health problems in adults with cancer, such as recognising the psychological effects of cancer and its treatment, assessing and supporting patient’s psychological needs, and identifying those at increased risk of mental health problems. The COVID-19 pandemic has significantly disrupted cancer care, impacting not only patients currently undergoing treatment, but also those with symptoms who are likely to have a delay in diagnosis. The article also includes advice on how to encourage people to present to their GP if they have worrying symptoms.

Lastly, in this month’s View from the ground, Dr Kathryn Hayman writes about her experience of burnout and how she made changes to her personal and professional life to prevent its recurrence.