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responses will yield a handy list of patients to follow up more closely as those winter bugs begin to circulate .
A similar exercise looking at exacerbation frequency , prednisolone prescriptions or hospital admissions for your COPD patients is also worthwhile .
Support type 1 diabetes patients to access continuous glucose monitoring
5There is strong evidence that continuous glucose monitoring ( CGM ) improves both quality of life and glycaemic control for patients with type 1 diabetes . 4 In August a new monitor , Dexcom One , was made available on NHS prescription . This differs from previous flash monitors , where the user had to scan the sensor with their smartphone ; instead , it delivers real-time readings continuously . There is uncertainty about whether these devices are funded , but national guidance 5 is clear that CGM or flash glucose monitoring should be available on the NHS to anyone with type 1 diabetes .
Optimise blood pressure and lipid management
6Through necessity , general practice has largely prioritised Covid vaccination over chronic disease management for the past two years . As we restart our monitoring programmes , we are consequently picking up signs of suboptimal control of cardiovascular risk factors like elevated HbA1c , increased weight and raised blood pressure ( BP ) and lipids . Cardiovascular disease remains the leading global cause of death , with hypertension the number one risk factor . Nurses in primary care have a key role in identifying raised BP readings and taking a holistic approach to management . To address raised lipids , it is worth a refresh on the current targets and processes for lipid-lowering therapy . NICE advises that statin treatment should achieve a greater than 40 % reduction in the non-high-density lipoprotein ( non-HDL ) cholesterol level from baseline . 6
Box 1 Seasonal flu and Covid booster campaign summary
Eligible Patients
• Care home residents and staff ( older adults ’ care settings )
• Frontline health and social care workers
• Adults aged 50 years and over
• People aged five to 49 years in a clinical risk group
• People aged five to 49 years who are household contacts of people with immunosuppression
• People aged 16 to 49 years who are carers
Covid vaccines : adults aged 18 years and above
• Moderna mRNA ( Spikevax ) Bivalent
• Moderna mRNA ( Spikevax ) Original
• Pfizer-BioNTech mRNA ( Comirnaty ) bivalent Original / Omicron *
• Pfizer-BioNTech mRNA ( Comirnaty ) Original *
• Novavax Matrix-M can be used in exceptional circumstances for adults if no other product is available
* Ages 12 and above
Covid vaccines : children aged five to 17 years
• Pfizer-BioNTech mRNA ( Comirnaty ) 30mcg for ages 12-17 ; 10mcg for ages five to 11
Source : JCVI statement on the Covid-19 booster vaccination programme for autumn 2022 : update 3 September 2022 . bit . ly / 3RjdaXh
If this is not achieved after three months , discuss with the patient their treatment adherence , timing of dose , diet and lifestyle . If baseline cholesterol is unknown , as is often the case with secondary prevention , follow the Joint British Societies recommendation 7 to treat to a non-HDL target of below 2.5mmol / L ( low-density lipoprotein cholesterol below 1.8mmol / L ).
Be especially vigilant when reviewing dementia patients
7Every patient interaction is an opportunity to review and reflect on a patient ’ s care . Discussions about future wishes and preferences often occur in practice nurse-led chronic disease reviews , and our practice welcomes input and prompts from all team members regarding our dementia patients . Often nurses have known these patients for years and recognise subtle changes or signs of strain on the family and carers . Things can change quickly and keeping advanced care plans and ReSPECT forms up to date can help avoid traumatising inappropriate hospital admissions ( see page 26 ).
Update your knowledge of local long Covid pathways
8It is highly likely you have encountered patients suffering the after-effects of Covid infection . For some , this is an unpleasant inconvenience lasting four to six weeks but for others it has created lifechanging morbidity . Different localities have different pathways and referral criteria for long Covid services so it is worth familiarising yourself with yours . In Doncaster , we have to complete a range of blood tests , an ECG , a chest X-ray and a questionnaire . If there is a query about long Covid at a chronic disease review , it may be worth expanding the blood request to include all of the necessary items so as to streamline the patient ’ s journey . The NHS website Your Covid Recovery features useful resources , including patient information leaflets . 8
Promote weight-management services
9Frail and elderly patients are not the only ones who can be vulnerable . A morbidly obese 50-year-old person with diabetes , for example , is also highly vulnerable . Not only are they at increased risk of stroke and cardiovascular disease , they are also far more likely to experience severe Covid if they become infected .
We shouldn ’ t underestimate the potential for a sensitively delivered brief intervention regarding obesity . The BWeL Study 9 showed brief interventions are effective for weight loss but that clinicians rarely use them . 10 The study website includes some useful resources . If you don ’ t have a local obesity referral pathway , another option is to signpost eligible obese patients to the NHS Digital Weight Management service . 11 It offers a 12-week online behavioural and lifestyle-based programme , which may help motivated patients get the ball rolling .
Don ’ t neglect your own self-care goes without saying that your health and welfare is of paramount importance . Take your
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breaks , leave on time , limit exposure to social media ( consider a time limit for social media apps ), talk about things that are causing stress , within your team and with the wider practice , and don ’ t be afraid to suggest changes to your working patterns . We will all face immense pressure this winter and we need to look out for each other so we can do our best for our patients .