In 2021, Guidelines Live returned as an in-person event—what were the best bits from the most popular clinical streams?
The entrance to Guidelines Live 2021, which took place at ExCeL London on 30 November and 1 December
Keynote–Guidelines: useful, usable, and used
Presented by Dr Paul Chrisp
The event opened with the keynote address from Dr Paul Chrisp, Director of the NICE Centre for Guidelines, who outlined NICE’s 5-year strategy to make its guidance more useful and accessible. He revealed that, as part of its new approach, NICE will group guidelines into connected ‘topic suites’ to make them easier to access. These topic suites will focus on recovery from the COVID-19 pandemic and addressing the backlog of care, as well as health inequalities and the prevention agenda. A diabetes guideline in March 2022 will be the first to be published in the new format.
Further details on the Keynote speech are available here.
Cardiovascular– Chaired by Helen Williams
In the first of two cardiovascular (CV) streams, Consultant Pharmacist Helen Williams presented on primary care networks (PCNs) and cardiovascular disease (CVD) prevention, outlining the scale of the challenge to address the ABCs—atrial fibrillation, blood pressure, and cholesterol. The Quality and Outcomes Framework and PCN Directed Enhanced Services/Investment and Impact Fund provide levers to improve the detection and management of these high-risk conditions, and she also highlighted the UCL Partners Proactive Care Frameworks, which support general practice to identify patients at greatest risk and optimise care.
Dr Raj Thakker focused on hypertension, calling for improved detection and management. Hypertension is everyone’s responsibility, he said, with innovation, strong leadership, culture change, and imagination required to develop local solutions to address gaps in care.
"98% of delegates would recommend Guidelines Live to a colleague"
Gastroenterology– Chaired by Dr Charlie Andrews
The well-attended gastroenterology stream covered the management of flares of inflammatory bowel disease (IBD) and how to investigate abnormal liver function tests (LFTs).
Key messages on IBD were that patients with mild-to-moderate symptoms or who are systemically well may be suitable for community treatment; steroid-sparing therapies should be considered in those with ulcerative colitis; and patients should be reviewed regularly to identify those not responding to treatment, and their treatment escalated accordingly.
Abnormal LFTs can occur for many reasons, and patient history must be correlated with biochemical findings to guide further assessment. Around 20–30% of the population have non‑alcoholic fatty liver disease (NAFLD); of these, 10–15% will develop liver fibrosis, which may lead to cirrhosis and an increased risk of hepatocellular carcinoma. The Fibrosis-4 Index or an NAFLD Fibrosis Score should be used to risk assess patients with NAFLD, or an enhanced liver fibrosis blood test if this is available locally.
Health Promotion– Chaired by Dr Toni Hazell
Dr Vasumathy Sivarajasingam covered the vital topic of practice wellbeing, outlining the actions she has taken at Hillview Surgery, Perivale, and providing practical ideas based on five key tenets—connect, take notice, keep learning, be active, and give. The audience shared their own experiences, and left with plenty of ideas to improve wellbeing in their workplaces.
"86% of delegates said they either completely or mostly met their objectives"
Asthma– Chaired by Dr Kevin Gruffydd-Jones: Chronic obstructive pulmonary disease
Opening the stream, Dr Gruffydd‑Jones outlined the common causes of acute cough and major causes of chronic cough (lasting more than 8 weeks). Clinical assessment should aim to identify features that warrant urgent referral, and patients who can be initially managed with a trial of therapy.
Dr Ashish Chaudhry and Dr Harsha Master discussed long COVID, the symptoms of which are due to multisystem malfunction and are dominated by fatigue and breathlessness. Autonomic dysfunction is characterised by postural hypotension, vasovagal symptoms, and postural orthostatic tachycardia syndrome. They emphasised that other causes should be excluded, and that once the diagnosis has been established, patients should be referred to local post‑COVID-19 rehabilitation teams.