Atrial fibrillation is the most common sustained cardiac arrhythmia. One in 40 of the over 45s, 1 in 20 of the over 65s, 1 in 10 of the over 75s and 1 in 5 of the over 85s will have paroxysmal, persistent or permanent atrial fibrillation. Although many individuals will have idiopathic atrial fibrillation with otherwise healthy hearts and no comorbidities, its development is associated with a number of common risk factors. Every patient with a diagnosis of atrial fibrillation should have a physical examination to assess blood pressure and look for signs of valve disease and heart failure. It is routine to check thyroid function and NICE guidelines recommend echocardiographic assessment.

Scurvy is a disabling, potentially fatal, but entirely treatable, condition that can easily pass unrecognised. It has by no means been confined to the history books, even in affluent cultures, and vitamin C deficiency appears to be relatively common in the UK, particularly in those living on a low income. The occurrence of a macular purpuric eruption on the legs should always prompt consideration of the diagnosis of scurvy, especially in those at risk.

London has just played host to possibly the greatest ever Olympic and Paralympic Games. I enjoyed my small part as a medical volunteer at the Olympic football tournament. Numerous public figures have talked about the potential legacy promoting sport and exercise to the population. This could also be the greatest opportunity for GPs and sport and exercise medicine specialists in the UK to combine forces to deliver our strongest ever campaign to promote physical activity and improve the nation’s health.

In July 2012, NICE published guidance on the identification and management of type 2 diabetes in adults who are at high risk. This new NICE guidance dovetails with the NHS Health Check programme. The guidance advises using a validated risk assessment tool to identify patients at risk of diabetes. NICE recommends that high-risk patients should be offered a programme encouraging them to undertake a minimum of 150 minutes of moderate intensity physical activity a week, gradually lose weight to reach and maintain a BMI within the healthy range, increase consumption of whole grains, vegetables, and other foods that are high in dietary fibre, reduce the total amount of fat in their diet and eat less saturated fat.

Because it can be difficult to diagnose heart failure correctly, NICE has given specific advice in its guideline, issued in 2010. In 2012, any patient with suspected heart failure should have the diagnosis confirmed or refuted rapidly, with onward referral for echocardiography and specialist assessment. GP access to BNP/NTproBNP testing is vital to do this effectively. The GP is key to this process – acting as the patient’s advocate for timely diagnosis, making sure drug therapy is introduced and optimised, monitoring the patient’s condition, and identifying when the plan needs to be modified. With access to good diagnosis and good treatment the prognosis of this condition has improved remarkably in the past 20 years but without such modern therapy the syndrome can still be a death sentence.

18% of all deaths in adults aged 35 or over in England are still attributable to smoking. Almost all these premature deaths could be avoided if smokers stopped before their mid-thirties but only a quarter of people who have ever smoked regularly manage to quit by this age. GP advice is one of the most important triggers to a smoker making an attempt to quit. Evidence shows that offering help to all smokers is easier, quicker and likely to be more effective than just advising smokers to stop or asking whether they are interested in quitting.

Although generally considered a childhood ailment, 38% of patients with atopic eczema in the UK are adults. The condition often has a significant detrimental effect on the quality of life of affected individuals and their families. Despite national evidence-based guidelines in the UK, standards of care in the community setting can vary. Patients or carers should receive a full explanation of how to use topical treatments and a demonstration of how to apply dressings, if applicable. [With external links to the evidence base]

NICE has recently published guidelines on the care and follow-up of patients who have received emergency treatment for anaphylaxis. Once patients have been assessed in a specialist clinic, and provided with a tailored management plan, regular review will be necessary in primary care. Important aspects include ensuring that: adrenaline devices are in date; injection technique refresher sessions are available; background asthma is well controlled; any dietary restrictions have not led to an unhealthy diet (e.g. lack of adequate calcium source in patients avoiding dairy products).

Movement disorders are a common cause of neurological disability in older people. Idiopathic Parkinson’s disease (IPD), caused by degradation of dopaminergic neurones in the nigrostriatal pathways of the brain leading to a triad of tremor, rigidity and bradykinesia, is probably the most well known. This article focuses on the most common non-parkinson’s movement disorders seen in older people.

Chronic inflammatory rheumatological conditions are associated with an increased burden of cardiovascular disease (CVD). In both rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) most excess mortality is cardiovascular. The prevalence of subclinical disease indicates that the atherogenic processes start early in the course of inflammatory disease. Although less data are available regarding the extent of the problem in other inflammatory arthritides or connective tissue diseases, increased CVD risk is also associated with psoriatic arthritis, ankylosing spondylitis, antiphospholipid syndrome and systemic sclerosis. Management of CVD risk in these patient groups is hampered by the complexity of both the underlying disorder and its treatment, and by the lack of clear guidelines for either primary or secondary care teams.

Autism, like most psychiatric disorders, covers a spectrum of severity from severely disabling classic autism to milder forms of Asperger’s syndrome which border on normality. The term autism spectrum disorder (ASD) includes autism, atypical autism and Asperger’s syndrome. Some parents consult their GP worried that their child might have autism. Others may attend with a range of concerns that might point to the condition such as problems with hearing, vision, hypersensitivity to sensory stimuli, behaviour management, language impairment or repetitive behaviour. Autism conditions often co-exist with neurological disorders (particularly those including epilepsy), and more than 300 syndromes which include autism have been described.The new NICE guidelines, launched in September 2011, cover children, from birth up to 19 years, on the autism spectrum and build on the guidance published by SIGN in 2007. ASD was once believed to be relatively rare but is now thought to occur in about 1% of children. There is certainly increasing demand for diagnostic services for children and young people. Whether the apparent increasing prevalence signifies an epidemic or an epidemic of discovery is debatable.

Common mental health disorders affect as many as one in six people in the community. The 2007 ONS household survey of adult psychiatric morbidity in England found that 16.2% of 16-64 year olds were suffering from an anxiety or depressive disorder. Of those 4.4% were diagnosed with generalised anxiety disorder (GAD); 3.0% with post-traumatic stress disorder (PTSD); 2.3% with major depression; 1.4% with phobias; 1.1% obsessive compulsive disorder (OCD); and 1.1% with panic disorder. The conditions are not mutually exclusive and the most common problem was mixed anxiety and depression, found in 9% of patients. The diagnoses were established through diagnostic psychiatric interviews with subjects screening positive in the survey.These disorders are even more common in primary care. The New Zealand Magpie Study found that 20.7% of people presenting to primary care had suffered a common mental health disorder over a 12-month period, compared with 14.8% in the community.

The average age at hip fracture is 83 for women and 84 for men, with around 80% of cases in women. The reported 30% mortality and 20% new institutionalisation rates at 12 months reflect the high prevalence of comorbidity and to some extent suboptimal management at the time of the fracture. With timely intervention and better clinical management many fractures can be prevented and even when they do occur their human and economic costs can be greatly reduced.  Prevention and management span a full spectrum of typical need from primary prevention through acute an rehabilitative management to secondary prevention and long-term and palliative care. Changing what happens in acute hospitals is fundamental to this challenge, but the achievement of seamless clinical continuity across primary, secondary and social care is equally important.

Cystic fibrosis (CF) is the most common fatal inherited disease in Caucasian people. Recent data indicate that there are more than 9,000 patients with CF in the UK. This would equate to around one or two patients for an average GP practice. Recognising the symptoms and signs that may point to a diagnosis of CF is important so that appropriate referral and investigations can be organised. Symptoms suggestive of CF in the first two years of life include failure to thrive, steatorrhoea, recurrent chest infections, meconium ileus, rectal prolapse and prolonged neonatal jaundice. In older children, additional suggestive symptoms include ‘asthma'-like symptoms, clubbing and idiopathic bronchiectasis, nasal polyps and sinusitis, and heat exhaustion with hyponatraemia. Suggestive symptoms in patients who present in adulthood, who are more likely to have atypical CF, include azoospermia, bronchiectasis, chronic sinusitis, acute or chronic pancreatitis, allergic bronchopulmonary aspergillosis, focal biliary cirrhosis, abnormal glucose tolerance, portal hypertension and cholestasis/gallstones. [With external links to the evidence base]

Ovarian cancer is the fifth most common cancer in women. The incidence has increased over the past 20-25 years, particularly in the 65 and over age group. The outcome for women with ovarian cancer is generally poor, with an overall five-year survival rate of less than 35%. The survival rates for women with ovarian cancer in the UK are significantly lower than the European average. Despite recommendations, published by NICE in 2005, on referral of patients with suspected cancer, the majority of women diagnosed with ovarian cancer are not electively referred via the ovarian cancer two-week pathway. They are often referred to the wrong specialty or present as emergencies. NICE has now published a clinical guideline on the diagnosis and initial management of ovarian cancer.  [With external links to current evidence and summaries]

Seasonal allergic rhinitis (SAR) is a global health problem and affects 20% of the UK population. It is the main form of rhinitis in children whereas in adults it accounts for about a third of cases. SAR can have  a significant impact on patients' quality of life. It can lead to non-attendance and underperformance at school and work and results in substantial NHS costs. In children, it may affect GCSE results as the grass pollen season coincides with exams. SAR is a risk factor for the development of asthma and chronic rhinosinusitis which may be difficult to treat. As the major burden of allergic rhinitis is on primary care, GPs play a key role in the management of these patients.

The term men who have sex with men (MSM) encompasses a diverse group of men of all ages, ethnicities and cultural backgrounds. Their sexual behaviour is equally diverse: while some MSM have exclusively male partners, others have partners of both genders or identify themselves as heterosexual but have occasional casual sexual encounters with men. MSM may be involved in the commercial gay scene, may visit cruising environments in public places or may be in monogamous sexual relationships. There were an estimated 415,600 MSM aged 15-44 in the UK in 2007. The estimated prevalence of HIV in this group was 5.2%. Of 60,050 people aware of their HIV-positive diagnosis in the UK, 26,050 (43%) were MSM. A further 9,000 MSM in the UK are estimated to be infected with HIV but unaware of their diagnosis.

Generalised anxiety disorder (GAD) is a common condition, with a point prevalence of 4.4% among the adult population in England. It is characterised by a persistent, unfocused sense of threat, associated with symptoms of tension, autonomic hyperactivity and vigilance. Patients repeatedly overestimate the danger of physical or social harm, and at the same time underestimate their ability to cope. As a result, they worry excessively about a wide range of activities and life events, such as work, family issues, financial difficulties and health problems. GAD is a chronic relapsing condition, with a remission rate of only 38% after five years. It is associated with even greater impairment of occupational and social functioning than that associated with major depression, and has a significant impact on quality of life. However, around two-thirds of patients are not recognised in primary care and only a third of those identified by the 2007 household survey in England were receiving any form of treatment. Both in research and in clinical practice, there has been an excessive focus on depression to the detriment of the anxiety disorders. This is unfortunate in view of the high prevalence of GAD, its substantial impact on functioning and its association with chronic physical health problems. It is to be welcomed that this imbalance is now being addressed.

Currently the vast majority of people with familial hyper-cholesterolaemia (FH) in the UK remain undiagnosed, probably 85% of the predicted 120,000 cases.In FH families, patients sometimes feel guilty about passing on a defective gene, and there are often concerns about confidentiality surrounding genetic diagnoses. However, in general most people find that knowing the cause of the early heart disease in their family and, more importantly, that the risk can be very significantly reduced by adherence to statins, means that anxiety is easily dealt with and is very shortlived.  It is important that all members of the primary healthcare team have a good working knowledge of the simple Mendelian inheritance of FH, and can explain the elevated risk and how it can be reduced through medication and lifestyle changes.