The issues of excessive workload and workforce shortages, and their impact on the physical and mental wellbeing of healthcare professionals, have hit the headlines again, with the Health and Social Care Committee stating that workforce burnout is now at an emergency level.1 Although staff shortages have been a concern for many years, they have been exacerbated by the pandemic, throughout which healthcare professionals have shouldered a heavy burden and worked under extreme levels of stress. And there is unlikely to be any let up in the pressure as the focus switches from dealing with patients with COVID-19 to the recovery and resumption of other patient services.

Alongside this, healthcare professionals are also being tasked with implementing another organisational restructure of the NHS in England. As part of the new population-based health model, GPs are to be supported by a multiprofessional workforce with an enhanced skill mix; it is hoped that this will create a more seamless, targeted experience for patients. Dr Karen Kirkham takes a detailed look at the new NHS model, explaining the role of primary care networks within integrated care systems in the delivery of place‑based care.

Guidelines in Practice wants to hear your views on the reorganisation, how it is being implemented locally, and whether it will make a difference to your clinical practice—please take part in our survey and tell us what you think. Are you enthusiastic about the development of primary care networks and their potential to achieve integrated care and tackle health inequalities? Or are you daunted by the size of the challenge? Is the scale of change realistic given the backlog of care caused by the COVID-19 pandemic, and will primary care have enough of a voice in integrated care systems? Let us know whether you anticipate a smooth transition or a bumpy ride, and you will be in with a chance to win an Amazon voucher worth £100.

Away from the restructure, in this issue Dr Mark L Levy provides details of updated recommendations on asthma management from the 2021 Global Initiative for Asthma report.2 Among the changes are a clarification on the definition of severe asthma, revision of the treatment figures for adults and children, and a recommendation for primary prevention in children. There is also a new recommendation on primary prevention of asthma by identifying and treating vitamin D insufficiency in women with asthma who are pregnant or planning a pregnancy.

Dr Caroline Ward discusses NICE recommendations on the treatment of atopic eczema, with a focus on eczema complicated by bacterial or viral infection. Patient scenarios to accompany the article provide you with the opportunity to reflect on what you have learnt and earn 0.5 CPD points.

Cardiovascular disease (CVD) is a major cause of death and disability among people with diabetes, and reducing cardiovascular (CV) risk remains a significant goal in the treatment of the condition. In her article, Karen Bartha explains the Association of British Clinical Diabetologists position statement on the use of newer antidiabetic agents in the tailored treatment of patients with type 2 diabetes and CVD. She examines the evidence supporting the use of these agents, as well as the risks and benefits associated with their use, in those with CV complications of type 2 diabetes. Multiple-choice questions accompany the article. 

Finally, in this issue’s View from the ground, Dr Claire Davies outlines how GPs have risen to the challenges posed by the COVID-19 pandemic in continuing to provide support to their patients. Although primary care healthcare professionals have not always been celebrated in the mainstream media during the pandemic, they have delivered a storming success in the COVID-19 vaccination programme. This has been achieved while simultaneously developing innovative ways of working to maintain patient contact, and continuing to provide patient care. Looking beyond the pandemic, Dr Davies predicts that primary care will play a central role in rectifying the direct and indirect damage that the pandemic has wrought upon patients.

Dr Davies’ article is a reminder that we should celebrate victories where we find them, in the hope that there will be many more to come as healthcare structures evolve and develop, and as we all begin to pick up the pieces of our lives again.


  1. Health and Social Care Committee. Workforce burnout and resilience in the NHS and social care. Available at: (accessed 10 June 2021).
  2. Global Initiative for Asthma. Global strategy for asthma management and prevention (2021 update). Fontana, WI, USA: GINA, 2021. Available at: