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OXFORD MEDICAL PUBLICATIONS
Oxford Handbook of
General Practice
ALGRAWANY
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Published and forthcoming Oxford Handbooks
Oxford Handbook for the Foundation
Programme 5e
Oxford Handbook of Acute
Medicine4e
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– Mini Edition 10e
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and Diabetes 3e
Oxford Handbook of ENT and Head
and Neck Surgery 3e
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& Hepatology 2e
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Gynaecology 3e
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Health 2e
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Surgery 3e
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Maxillofacial Surgery 2e
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and Trauma
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Therapy 2e
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OXFORD HANDBOOK OF
General
Practice
FIFTH EDITION
Chantal Simon
General Practitioner; Programme Lead Physician’s
Associate Studies, Bournemouth University;
Former Medical Director for Professional
Development, RCGP, UK
Hazel Everitt
Professor of Primary Care Research,
University of Southampton, UK
Françoise van Dorp
General Practitioner, Wiltshire, UK
Nazia Hussain
General Practitioner, Gwent, UK
Emma Nash
GP Partner; GP Lead for Mental Health, Fareham &
Gosport and South Eastern Hampshire CCG, UK
Danielle Peet
General Practitioner, Manchester, UK
1
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1
Great Clarendon Street, Oxford, OX2 6DP,
United Kingdom
Oxford University Press is a department of the University of Oxford.
It furthers the University’s objective of excellence in research, scholarship,
and education by publishing worldwide. Oxford is a registered trade mark of
Oxford University Press in the UK and in certain other countries
© Oxford University Press 2020
The moral rights of the authors have been asserted
First Edition published in 2002
Second Edition published in 2005
Third Edition published in 2010
Fourth Edition published in 2014
Fifth Edition published in 2020
Impression:1
All rights reserved. No part of this publication may be reproduced, stored in
a retrieval system, or transmitted, in any form or by any means, without the
prior permission in writing of Oxford University Press, or as expressly permitted
by law, by licence or under terms agreed with the appropriate reprographics
rights organization. Enquiries concerning reproduction outside the scope of the
above should be sent to the Rights Department, Oxford University Press, at the
address above
You must not circulate this work in any other form
and you must impose this same condition on any acquirer
Published in the United States of America by Oxford University Press
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British Library Cataloguing in Publication Data
Data available
Library of Congress Control Number:2019942347
ISBN 978– 0– 19– 880818– 3
Printed in Italy by L.E.G.O. S.p.A.
Oxford University Press makes no representation, express or implied, that the
drug dosages in this book are correct. Readers must therefore always check
the product information and clinical procedures with the most up- to- date
published product information and data sheets provided by the manufacturers
and the most recent codes of conduct and safety regulations. The authors and
the publishers do not accept responsibility or legal liability for any errors in the
text or for the misuse or misapplication of material in this work. Except where
otherwise stated, drug dosages and recommendations are for the non- pregnant
adult who is not breast- feeding
Links to third party websites are provided by Oxford in good faith and
for information only. Oxford disclaims any responsibility for the materials
contained in any third party website referenced in this work.
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Contents
Preface vii
Acknowledgements viii
Abbreviations used in the text x
Standard abbreviations xi
1 What is general practice? 1
2 Practice management 29
3 Consulting with patients 59
4 Social aspects of primary care 81
5 Medicines and prescribing 111
6 Minor surgery 131
7 Healthy living 143
8 Chronic disease and elderly care 171
9 Cardiology and vascular disease 203
10 Respiratory medicine 263
11 Endocrinology 311
12 Gastrointestinal medicine 343
13 Renal medicine and urology 407
14 Musculoskeletal problems 445
15 Neurology 507
16 Dermatology 559
17 Infectious disease 617
18 Haematology and immunology 635
19 Breast disease 663
20 Gynaecology 677
21 Sexual health and contraception 709
22 Pregnancy 761
23 Child health 825
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CONTENTS
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24 Ear, nose, and throat 907
25 Ophthalmology 931
26 Mental health 963
27 Cancer care 997
28 Palliative care 1011
29 Emergencies 1033
Index 1111
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Preface
For this new, fth edition of the Oxford Handbook of General Practice
(OHGP), we welcome three new guest editors:
Dr Nazia Hussain is a GP in Cardi and a former Deputy Editor of the
RCGP’s educational journal for GPs in training, InnovAiT. She has revised the
respiratory chapter for this edition of the OHGP.
Dr Emma Nash is a GP in Portchester. She is her CCG Mental Health Lead,
a GP Training Programme Director, and one of the Clinical Leads working
for the On- line Learning Environment team at the RCGP. She has revised
the mental health chapter of this new edition of the OHGP.
Dr Danielle Peet is a GP in Manchester and was also a former Deputy
Editor of InnovAiT. She has revised and separated out the chapters on
cancer care and palliative care for this new edition of the OHGP.
Since the last edition of the OHGP, new areas of work are evolving for
GPs. The concept of ‘personalized’ medicine driven by a deeper understanding of the genetic code underpinning our personal characteristics is a
good example. The way that we work has also changed with a workforce
crisis and many GPs now working outside traditional practice structures ‘at
scale’. Our teams have changed too, with practitioners undertaking new,
extended- scope roles performing many of the tasks traditionally done by
GPs; GPs are learning to manage much larger multidisciplinary teams, cope
with increased complexity in their own consultations, and perform wider
supervisory roles. Alongside these changes there has been a technology
revolution, meaning that GPs now consult and communicate in a range of
new ways.
To address all these factors, we have completely rewritten the non- clinical
sections of the OHGP. We have simplied the structure to make information easier to nd, and reduced the amount of detail on contracts as these
are changing apace. We have also included new sections on new modes of
consultation and communication. The clinical topics have all been updated
and, in addition, we have included new sections on genetics and genomics,
liver disease, multimorbidity, sepsis, risk scoring for GP emergencies, and
communication across settings.
As always, we welcome feedback from our readers. We would also like to
thank the many of you who have contacted us to point out errors, omissions, and ways to improve the OHGP in the past. It is thanks to you and
the feedback that you provide that the OHGP continues to develop to meet
your day- to- day needs.
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viii
Acknowledgements
This book would not have come into being without input from a large
number of individuals.
First, we would like to thank our extremely helpful editorial team at Oxford
University Press. In particular, we would like to thank Kate Smith, who has
been a real pleasure to work with.
Next, we would like to thank our long- suering families. Writing and editing
a book like the OHGP is very time- consuming, and we all have other ‘day
jobs’. Without the support of our families, a project like the OHGP would
not be possible. In alphabetical order, we would like to give special thanks to
our close family:Ben Jewell, David Gough, Ian Wright, Jonathan Nash, Dr
and Mrs M AHussain, and Peter Wynn— and children:Adam, Alicia, Ben,
Charlie, Chloe, Emily, Emma, Ethan, Hannah, Helena, Kate, Oskar, Samuel,
and Sophie.
The OHGP has always had a ‘hands- on’ feel. That is because it is written by
practising GPs who learn new things every day from their patients and colleagues. We would like to thank all those that we work with for their help
and support. In particular, we would like to thank:
• The CPD, EKU/ EKC, CIRC, and OLE teams at the RCGP
• The Department of Primary Care at the University of Southampton
• The Lansdowne Campus Library, GP Centre, and Health and Social
Sciences Faculty of the University of Bournemouth
• The GPs, practice manager, sta, and patients of the Banks and
Bearwood Medical Practice in Bournemouth
• The sta and patients of Westlands Medical Centre in Portchester
Finally, we would like to give special thanks to all the other many individuals
who contributed, either directly or indirectly, to this edition of the OHGP.
We do not always know who you are, as much of the OHGP is peer reviewed anonymously, but your expert input has been extremely valuable. In
particular, we would like to thank:
• The Primary Care Dermatology Society for their hard work in helping
us to substantially revise the Dermatology chapter of this book
(Chapter16). In particular:Dr Tim Cunlie, Dr Helen Frow, Dr George
Moncrie, Dr Julian Peace, Dr Angelika Razzaque, Dr Chin Whybrew,
Dr Iain Henderson and Dr Michelle Ralph
• Mr Richard Newsom (Independent Consultant Ophthalmologist) for his
expert review of Chapter25 (Ophthalmology)
• Dr Anne Connolly (GP and Women’s Health Lead for the RCGP) for
her expert review of Chapter20 (Gynaecology) and Chapter21 (Sexual
health and contraception)
• Felicity Ashworth (Consultant Obstetrician) for her feedback on the
obstetrics sections of this handbook (Chapters22 and 29)
• Dr Carmel Wills (GP, Salisbury, Wiltshire) for her comprehensive
feedback on the Emergencies chapter of this book (Chapter29)
ACKNOWLEDGEMENTS
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• Dr Umidjon Madaliyev for his help reviewing parts of this handbook
from a GP in training’s perspective
• Previous authors and editors of the OHGP Dr Brian Stevenson,
Dr Jon Birtwistle, Dr Knut Schroeder, Dr Matt Burkes, and Professor Tony
Kendrick. Our junior reviewing team Dr Hossam Abdel-Hamid,
Dr Hannah Billett, Dr Rosie Dudson, Dr Joshua Getty, Dr Abi Moore,
Dr Smitha Thurairatnam, Dr Ravi Tomar, and Dr Adam Zacks.
If there are any omissions from this list, we apologize. Please tell us, and we
will add your name to the list at the rst opportunity.
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