Dry skin is an extremely common condition that occurs in all skin colours and ethnic groups; however, differences in skin colour can cause significant differences in the incidence, presentation and treatment of different skin conditions. Although dry skin may cause similar symptoms among different skin tones, the appearance may make it more challenging to easily recognise – a fact highlighted by hospital admissions linked to eczema being up to six times more likely in people of colour than in people with light skin.In this podcast, Dr Roger Henderson looks at the reasons for this, what impact skin of colour can have on both diagnosing and managing dry skin conditions and how best to manage dry skin in people with skin of colour.

Although pityriasis capitis (dandruff) is not a serious medical condition, it causes significant embarrassment and self-esteem issues in many people who suffer from it. It is extremely common, affecting up to half the global adult population, and its recurring nature is often a source of frustration. It can impact on primary care workload and can also be mistaken for other scalp conditions such as scalp psoriasis, seborrheic dermatitis or atopic eczema. In this podcast Dr Roger Henderson looks at how to distinguish dandruff from these conditions as well as how to effectively treat dandruff to stop patients from needing repeated consultations.

Lyme disease can present a number of particular difficulties in primary care, and these are often linked to clinical findings and the availability and timing of testing. In this podcast, Dr Roger Henderson discusses those and looks at Lyme disease’s three stages — early, disseminated and late — and whether it can be diagnosed clinically if erythema migrans is or is not present. He also looks at diagnostic difficulties and whether acute or convalescent serological testing is helpful. Treatment with antibiotics is also discussed along with prognostic indicators.

With tourism having now rebounded from the declines during and after the coronavirus pandemic, our patients are once again travelling globally. But what happens when their destination is 5000 metres above sea level? Many GPs will have been faced with a “travel consultation”, but it can be a daunting prospect when carried out infrequently. What are the risks of high altitude? What medication might be needed? And why might beer taste funny at high altitude? In this episode, Dr James Waldron asks Dr Rashbal Ghattaora about his experiences working at high altitude in Tibet. They discuss how to approach a travel consultation, relevant medications, counselling and much more.

The number of young people struggling with anxiety and depression seems to be on the rise and resources to help these young people are increasingly stretched. In this episode, Dr Kate Chesterman and Dr Dave Ledward (GP with an interest in mental health) discuss the growing problem of managing the mental health of children. They focus on the vital role that parents and caregivers play in supporting young people through emotional turmoil and discuss the educational sessions that Dave has run for the families of young people with mental health issues. Dave discusses some of the pitfalls and traps that caregivers can fall into when trying to support their young people and shares his top tips for parents and professionals to help manage an emotional crisis.

In this episode, Dr Hannah Rosa is joined by Dr Shan, a GP colleague and father to Oscar, an 8-week-old baby. Together, they go through the 6-week baby check, while discussing the recently updated guidance from Public Health England. They also explore the key role that the examination plays in screening for a variety of physical conditions, which, if picked up early, can make a huge difference to the future health of a child.

In this podcast, Dr Kate Chesterman discusses recurrent urinary tract infection (UTI). She covers the pathophysiology, some risk factors for UTI recurrence and treatment options including lifestyle changes and the use of antimicrobials. She also focuses on non-antimicrobial management, including the current advice regarding the use of probiotics, cranberry products, D-mannose and methenamine hippurate.

In this follow-up to episode 52, Dr James Waldron and Mr Sam Dobson (Consultant Gynaecologist, Sub-specialist in Reproductive Medicine and BMS-accredited Menopause Specialist) consider the impact of menopause on libido. They talk through the physical and psychological features of menopause that can lead to a reduction in libido, the conversations and initial investigations in primary care, and consider available options for the management of menopause-related loss of libido, including topical and systemic hormone replacement therapy (HRT) and testosterone.

The call to adventure is felt by many and general practice is a career that can take you there! As GPs grow their portfolios, they look for interesting and unusual ways to forge their own paths. This can take them all round the world (and back again). In this follow-up to episode 71, Drs James and Rebecca Waldron continue their discussion about Rebecca's 3-month voyage with the marine conservation charity Sea Shepherd. As the boat's medic, she tended to crew members' daily illnesses, performed infection control during a COVID outbreak, and provided emotional support.

In this episode, Dr Kate Chesterman is joined by Dr Alex Brightwell (Consultant Paediatrician with a specialism in allergy) and Liz Ingham (Lead Paediatric Allergy Dietician), both of whom work at the Norfolk and Norwich University Hospital. Together, they explore paediatric dietary allergies. They discuss cow’s milk protein allergy (CMPA), including: its different types, how to differentiate it from other causes of unsettled infant behaviour and the importance of de-challenging and rechallenging to make the diagnosis. Furthermore, they offer practical advice for breastfeeding mothers, as well as covering the indications for the different formula milks. They highlight the importance of maintaining balanced nutritional intake for infants and breast-feeding mums and avoiding unnecessary exclusion diets. They finish by discussing the current evidence and advice regarding early introduction of potentially allergenic foods in infants at risk of food allergies.

In this episode, Dr Kate Chesterman talks to Dr Briony Arrowsmith, who is a Consultant Paediatrician at the Haven, a sexual assault referral centre in London. They discuss the many and varied ways that sexual abuse can present, as well as the considerations surrounding who the abuse should be disclosed to. They talk through the physical health concerns that need to be addressed and the role of the sexual assault referral centre in the care of abused children and their families. Finally, they discuss agencies that can offer ongoing psychological support to children, families and healthcare practitioners who have been affected by cases of abuse.

In this episode, which has been recorded for Chronic Conditions Month 2023, Dr Yassir Javaid (GP with a Specialist Interest in Cardiology) discusses auscultation of the heart sounds. Auscultation is an important aspect of the cardiac examination and can give an indication of significant underlying structural heart disease – particularly valve disease, which is becoming increasingly prevalent as the population ages. But which patients should be auscultated and what specifically should clinicians be listening for? Dr Javaid answers these questions with reference to audio examples of heart sounds and murmurs, and it is highly recommended to listen to this episode using good-quality headphones.

The call to adventure is felt by many and general practice is a career that can take you there! As GPs grow their portfolios, they look for interesting and unusual ways to forge their own paths. This

In this episode, Dr Roger Henderson discusses an approach to the assessment of epicondylitis. Elbow epicondylitis is more common than is often thought and can cause significant pain and movement restr

In this episode, Dr Hannah Rosa looks in detail at the maternal side of the postnatal 6-week check. NICEs quality standard on postnatal care is explored and topics, such as contraception after childb

Vitamin D is a fat-soluble vitamin that is essential for human health. It regulates calcium and phosphate homeostasis and is therefore vital for musculoskeletal functioning. In the UK, up to 50% of th

Actinic keratosis (AK) also commonly known as solar keratosis is a very common dermatological presentation in primary care, affecting large numbers of older people. It has the capacity to transfor

In this podcast, Dr Kate Chesterman discusses constipation in children. She takes us through the clinical features associated with idiopathic constipation and red flags that would cause concern. She d

Obstructive sleep apnoea (OSA) is a very common problem affecting around one and a half million adults in the UK, most of whom are undiagnosed and untreated. OSA has significant health consequences, i

In this episode, Dr James Waldron and Dr Thuva Amuthan (GP with an Extended Role in Dermatology) explore dermatological presentations, treatments and complications in skin of colour. The topics that t

Oxygen is essential for our survival and is a powerful medical drug. Treatment with oxygen increases blood oxygen levels and helps to reduce cardiovascular workload. In this podcast, Dr Roger Henderso

In this podcast, Dr Kate Chesterman discusses cluster headaches. She talks through the clinical features that would lead to a diagnosis, the initial investigations in primary care and indications for

In this episode Dr Hannah Rosa and Dr Nicky Mulgrew discuss autism and the role we play within general practice. They focus on when we should refer children and adults to specialists to get a possible

Chronic spontaneous urticaria (CSU) is a common problem, often affecting younger people. It refers to chronic urticaria that has no obvious cause or trigger and which causes weals to occur on the skin

Dermatology is a vast subject and accounts for a significant proportion of the workload in general practice. Managing dermatological conditions can be a challenge and staying up-to-date is equally so.

After smoking and diet, hypertension is the biggest risk factor in the UK for premature death and disability. One in four people have hypertension in the UK, with around one in three treated to target

Malnutrition can have significant adverse effects for patients with chronic obstructive pulmonary disease (COPD). In this podcast, Dr Kate Chesterman discusses how to identify and categorise those at

Dry skin conditions are one of the commonest skin problems that present to primary care physicians, but their psychological impact and psychiatric comorbidities are often underestimated. In this podca

In 2019, vaccine hesitancy was listed as one the top ten threats to global health by the World Health Organization. In this episode, Dr Hannah Rosa explores vaccine hesitancy further, thinking about h

Back in 2009, the conclusion of the first Lancet Climate Change Commission was that Climate change is the biggest global health threat of the 21st Century. In response to this, in October 2020, the

In this episode, Dr Roger Henderson discusses the common problem of insomnia. He looks at what it is, how it is assessed, what causes it and ways of treating it. He also discusses simple tips patients

Menopause and hormone replacement therapy (HRT) can be a source of anxiety for both patients and clinicians. Menopause is frequently in the media and is at the forefront of many consultations. Its on

Using electronic cigarettes (e-cigarettes), or vaping, has become the most popular form of nicotine replacement therapy in the UK. In this podcast episode, Dr Roger Henderson looks at why this is, t

In this podcast, Dr Kate Chesterman discusses post-sepsis syndrome. She talks about the long-term implications for physical and mental health following sepsis and highlights the considerations for pri

Heat-related illnesses are increasing as a result of climate change. In this episode, Dr Roger Henderson looks at various aspects of heat exhaustion and heatstroke, including why they are different co

In this episode, Dr Roger Henderson discusses the treatment pathway for people suffering from hay fever. This comprises options ranging from simple measures for allergen avoidance to the treatments to

In this episode, which has been recorded for Chronic Conditions Month 2022, Dr Peter Bagshaw (Clinical Lead in Dementia and Mental Health, South Glos CCG) and Dr Rob Hampton (Portfolio GP, Leicestersh

In this episode, which has been recorded for Chronic Conditions Month 2022, Dr Rob Hampton (Portfolio GP, Leicestershire) and Dr Yassir Javaid (Cardiovascular and Diabetes Lead, Northamptonshire CCG)

In this episode, which has been recorded for Chronic Conditions Month 2022, Dr Steve Holmes (GP, Shepton Mallet and Clinical Respiratory Lead, NHS England South West and NHS Somerset) and Dr Sarah Dav

In this episode, which has been recorded for Chronic Conditions Month 2022, Dr Yassir Javaid (Cardiovascular and Diabetes Lead, Northamptonshire CCG) and Dr Patrick Holmes (GP, Darlington) examine the

In this episode, which has been recorded for Chronic Conditions Month 2022, Dr Anthony Cunliffe (Macmillan National Clinical Adviser for Primary Care) and Dr Peter Bagshaw (Clinical Lead in Dementia a

In this episode, which has been recorded for Chronic Conditions Month 2022, Dr Yassir Javaid (Cardiovascular and Diabetes Lead, Northamptonshire CCG) and Dr Steve Holmes (GP, Shepton Mallet and Clinic

In this episode, which has been recorded for Chronic Conditions Month 2022, Dr Sarah Davies (GPwSI in Diabetes, Cardiff) and Dr Peter Bagshaw (Clinical Lead in Dementia and Mental Health, South Glouce

In this episode, Dr Kate Chesterman discusses binge-eating disorder. She explores the defining characteristics of the condition and highlights the importance of referring to eating disorder services f

In this episode, Dr Kevin Fernando and Dr Jim McMorran discuss the ongoing NHS-Galleri trial. The study, which is being conducted among 140,000 asymptomatic patients in England, will assess whether th

In this episode, Dr Kate Chesterman discusses the finding of an undescended testicle at the 6-week baby check. She considers the possible diagnoses and associated risks. Kate also takes us through the

In this episode, Dr Kevin Fernando considers the case of Juliana, a 43-year-old journalist who requests a cholesterol check because her father experienced a heart attack in his early 50s. She has no p

In this episode, Dr Kate Chesterman discusses the role of the primary care practitioner in the long-term follow-up of people who have undergone bariatric surgery. She highlights the current variabilit

In this episode, Dr Kevin Fernando discusses diagnostic and management tips – as well as pitfalls to avoid – related to subclinical hyperthyroidism. Fatima is a 71-year-old woman who presents in primary care with non-specific malaise and a past medical history of atrial fibrillation, ischaemic heart disease and osteoporosis. On examination, there is no evidence of thyroid swelling. Her blood tests reveal a suppressed thyroid-stimulating hormone (TSH), but normal free thyroxine (FT4) and free triiodothyronine (FT3). Given Fatima's comorbidities, what should we do next?

In this episode, Dr Kate Chesterman discusses the case of Lauren, a 32-year-old lady who is 30 weeks pregnant. Lauren presents with dysuria and increased frequency. Kate talks us through the current guidance on urinary symptoms in pregnancy and considers who to investigate, when to treat and what to treat with. She highlights physiological changes in pregnancy, important obstetric and non-obstetric causes for urinary symptoms as well as relevant red flags.

In this episode, Kevin considers the diagnosis and management of superficial venous thrombosis. Lesley is a 64-year-old woman who presents to us with a sore, itchy right leg and no past medical history of note. On examination, she has a tender, hard, erythematous varicose vein extending from her thigh to ankle. What should we do next? Should we be worried about underlying deep vein thrombosis? Access show notes at: https://gpnotebookpodcast.com.

In this episode, Kate discusses gynaecomastia and its investigation and management in primary care. She talks us through an infographic produced by The Association of Breast Surgery called Guidance on Gynaecomastia and considers the following important questions: “who do I need to be worried about?”, “what investigations should I consider?” and “when should I make a referral?”.

In this episode, Kevin discusses the case of Louise, a 19-year-old who has been living with type 1 diabetes for the last 12 years and hypothyroidism for the last 8 years. She presents to us in primary care with a history of recurring unexplained hypoglycaemic episodes despite proactive adjustments to her insulin regimen. In addition to her insulin, she is taking levothyroxine 150 μg/day. She has not recently made significant changes to her diet or daily physical activity. Louise has also been experiencing light-headedness when rising from a sitting position. She has a BMI of 19 kg/m2, and a recent HbA1c value was 63 mmol/mol (7.9%). You record her sitting blood pressure as 119/67 mmHg and her standing value as 99/72 mmHg. You notice some patches of vitiligo on her face. What should we do next?

In this episode, which has been recorded for Chronic Conditions Month 2021, Dr Peter Bagshaw (Clinical Lead in Dementia and Mental Health, South Gloucestershire CCG) and Dr Rob Hampton (Portfolio GP, Leicester) explore the use of opioids for musculoskeletal pain and examine alternative approaches to treatment. Do opioids have a role in managing musculoskeletal pain? How are guidelines in this area evolving? In what ways is our understanding of psychosomatic contributors improving? What should GPs be looking at in consultations, especially when time is limited?

In this episode, which has been recorded for Chronic Conditions Month 2021, Dr Yassir Javaid (Cardiovascular and Diabetes Clinical Lead, Nene CCG) and Dr Kevin Fernando (GP Partner at North Berwick Health Centre and Education Director for GPnotebook Education) discuss the detection of chronic kidney disease in primary care. What do the different tests tell us? What are the most up-to-date guidelines on investigations for CKD, and what do they recommend we do? How often should we be conducting tests for renal function and albuminuria?

In this episode, which has been recorded for Chronic Conditions Month 2021, Dr Steve Holmes (Clinical Respiratory Lead for NHS Somserset) and Dr Peter Bagshaw (Clinical Lead in Dementia and Mental Health, South Gloucestershire CCG) explore the impact that COVID-19 has had on mental health, including among people who have not been infected. How has self-isolation and shielding affected different people? What is the particular impact on children and younger people? What has the toll been on carers? Which people may struggle with "returning to normal"? How can we support people with "long COVID"? What is the potential role for talking therapies in this area?

In this episode, which has been recorded for Chronic Conditions Month 2021, Dr Steve Holmes (Clinical Respiratory Lead for NHS Somserset) and Dr Anthony Cunliffe (National Lead GP Adviser at Macmillan Cancer Support) discuss cancer as a long-term condition from a primary care perspective. How is the landscape of cancer care changing, with respect to the role of primary care clinicians? Why is accurate coding so important? In what ways can clinicians better individualise care in this area? What resources are available to support difficult conversations?

In this episode, which has been recorded for Chronic Conditions Month 2021, Dr Peter Bagshaw (Clinical Lead in Dementia and Mental Health, South Gloucestershire CCG) and Dr Kevin Fernando (GP Partner at North Berwick Health Centre and Education Director for GPnotebook Education) discuss the interplay between diabetes and severe mental illness (SMI). What exactly is meant by SMI? How prevalent is mental illness in people with diabetes? What is the role of the gut–brain axis? What signs should clinicians be looking out for in spotting depression?

In this epsiode, which has been recorded for Chronic Conditions Month 2021, Dr Peter Bagshaw (Clinical Lead in Dementia and Mental Health, South Gloucestershire CCG) and Dr Yassir Javaid (Cardiovascular and Diabetes Clinical Lead, Nene CCG) discuss the management of palpitations in primary care. How can we identify those patients with palpitations who have a significant cardiac abnormality or are at risk of an adverse outcome? What are the main causes of palpitations – including those that might have a psychological basis? What are the roles of history-taking and investigations? Finally, what red flags do we need to look out for?

Steroids are prescribed for a range of health conditions. In this podcast, which has been recorded for Chronic Conditions Month 2021, Dr Steve Holmes (Clinical Respiratory Lead for NHS Somserset) and Dr Kevin Fernando (GP Partner at North Berwick Health Centre and Education Director for GPnotebook Education) discuss the factors that primary care clinicians need to be aware of when prescribing these drugs. What are the most common side effects with steroid use? What do clinicians need to do to minimise the risk of adrenal crisis when withdrawing steroids? What should sick-day guidance look like for people on long-term steroid treatment? How vigilant do clinicians need to be for steroid-induced diabetes?

In her first podcast for GPnotebook, Dr Kate Chesterman discusses new evidence on the management of children with non-blanching rashes with Dr Edward Snelson. Dr Snelson is a Consultant Emergency Paediatrician at Sheffield Children’s Hospital and is the author of the blog GPpaedstips. Should we be treating every non-blanching rash as meningococcal disease, and if not, why not? What important differentials do we want to consider in children with a fever and a non-blanching rash? Can GPs safely decide which children require emergency treatment?

In this episode, Kevin discusses the case of Lyndsey: a 44-year-old lady who presents to us in primary care with recurrent dizzy episodes over the last month. Lyndsey feels like her head is spinning. She feels nauseated with these episodes, but there is no history of vomiting. Lyndsey can walk unaided but feels very unsteady on her feet during these episodes. The dizziness can last for hours before resolving. There is no clear precipitant to these episodes, and there is no history of headache. Lyndsey denies any hearing loss or tinnitus. What should we do next?

In this episode, Kevin discusses thrombocytosis in the context of suspected cancer. How should an unexplained high platelet count be interpreted and managed in primary care? Which cancers are most commonly associated with thrombocytosis? Aside from underlying malignancy, what are the other possible causes? What further investigations and referrals should we consider, and when? Show notes including key references and take-home points are available at: https://www.gpnotebookpodcast.com.

In this episode, Kevin looks at common questions around non-visible haematuria (NVH) – the condition formerly known as microscopic haematuria. Should we be screening for NVH? What follow-up investigations should we do for people with asymptomatic NVH? Should we change our approach for patients taking aspirin, warfarin or direct-acting oral anticoagulants (DOACs)? Finally, who should we refer and how urgently?

In this episode, Kevin examines some common questions regarding vitamin B12 deficiency. In whom should we suspect it? What investigations should be carried out in primary care? How is it associated with folate deficiency? Once a deficiency in vitamin B12 is detected, how should it be managed? Finally, what approach should be taken during the current COVID-19 pandemic, when intramuscular administration of hydroxocobalamin may be challenging? Visit https://gpnotebookpodcast.com for show notes, including key references and take-home points from the episode.

In the first episode in a new season of the podcast, Kevin discusses helpful guidance on the corrected QT interval in the context of primary care prescribing. Why should we be concerned about prolongation of the QT interval? Which medications can affect QT interval? What other risk factors for QT prolongation should be considered? And for which patients should we recommend electrocardiogram monitoring?

Kevin is joined by Drs Patrick Holmes, Amrit Lamba and Amar Puttanna to discuss the key take-home points from last week’s American Diabetes Association Virtual Scientific Sessions congress.

Kevin discusses the findings of NHS research on COVID-19 in people with diabetes with study author Professor Partha Kar, National Specialty Advisor – Diabetes with NHS England.

Kevin discusses what to do with each of the commonly used classes of diabetes drugs during intercurrent illness – a topic of particular relevance during the COVID-19 pandemic. Are these medications safe to continue? If so, is dose titration required? Which of these drugs be temporarily be stopped?

Kevin discusses some helpful and important clinical guidance on the prevention of adrenal crisis during the pandemic. Notably, this includes not only those patients with primary adrenal insufficiency but also all of those patients on long-term steroid treatment.

Kevin summarises recommendations from the Faculty of Sexual and Reproductive Healthcare to help support women with contraceptive requirements as primary care cuts back on non-essential face-to-face contact to reduce viral transmission.

Kevin covers recently updated guidance from the British Society for Haematology on managing vitamin B12 supplementation in primary care within the context of the pandemic.

Kevin covers helpful BSR guidance including a risk stratification and scoring grid for those with rheumatological conditions who are receiving immunosuppressive therapies, and considers which patients should be advised to practice shielding.

Kevin discusses evidence-based practical advice to potentially reduce transmission of coronavirus, in the form of nasal irrigation and gargling with saline solution.

Kevin considers the challenges related to managing osteoporosis in the context of conflicting clinical guidelines, including who to assess for fracture risk, who to treat (and with what agent) and how long to treat individuals for.

Dr Kevin Fernando explains why the thinking around gout needs to change, along with common questions in relation to its management in primary care. What lifestyle advice should be given? When should urate-lowering therapy be offered, and what options are available? For those with a history of gout, how can future episodes be avoided?

Dr Kevin Fernando provides a practical overview of the utility of sodium–glucose cotransporter 2 inhibitors, focusing on dosing, cardiovascular and renal safety and the management of adverse events, including dehydration and genital infections.

Have your notebooks at the ready as Dr Kevin Fernando rounds off 2019 with tips on topical oestrogen, mirtazapine prescribing, symptoms associated with withdrawal of varenicline, valvular atrial fibrillation and gout, among others.

Dr Kevin Fernando considers the optimal use of these tests: can we reduce unecessary testing, unecessary referrals and primary care workload?

Dr Kevin Fernando summarises the key points for primary care from the NICE guideline update.

Dr Kevin Fernando discusses detection and management of the condition in primary care, including how presentation in children differs from that in adults.

Dr Kevin Fernando takes us through brief case scenarios to illustrate diagnostic tips and pitfalls in primary care.

Kevin discusses interpretation and management of mildly abnormal liver blood tests in primary care. What are the possible causes? And what should the next step be?