Between 20% and 40% of young children suffer a feverish illness each year and many of these will present to their general practitioner. Although the majority of these children have benign, self-limiting illness, infection remains the leading cause of death in children under the age of 5 years. Appropriate assessment, management and referral of the febrile child are important skills to acquire for doctors working in primary care. This article outlines the signs and symptoms of serious infective illness in children under 5 years of age and describes current National Institute for Health and Clinical Excellence (NICE) guidelines for feverish illness in children and the use of the ‘traffic-light’ risk score in the context of face-to-face and remote assessment.

Recreational SCUBA (self-contained underwater breathing apparatus) is defined as diving to a depth of 40 metres without decompression stops. This has become increasingly popular over the last two decades, with around 100 000 individuals in the UK participating in diving (British Thoracic Society, 2003; Edmonds, Lowry, Pennefather & Walker, 2005). This article considers what GPs need to know about contraindications to diving, professional liability associated with documenting fitness to dive and the role of diving medicine specialists.

Rhinitis is characterized by nasal discharge, congestion, blockage and sneezing. These symptoms can have a variety of aetiologies, including allergic, non-allergic or infective causes. This article focuses on the diagnosis and management of patients with non-allergic non-infective rhinitis, but clearly, there are overlaps with the
management of rhinitis due to other causes. Non-allergic rhinitis is very common; it is estimated to affect almost one in four adults, particularly elderly patients.

Systemic diseases, anaemia and skin conditions may initially present to the GP with oral signs. It is important that GPs have a good understanding of these oral manifestations, prompting appropriate examination and investigation, early diagnosis and effective treatment. This article describes a pragmatic approach to oral examination in the general practice setting and discusses
all the common, and some rarer, presentations of systemic disease in adults.

It is becoming increasingly common for GPs to manage
patients who have been prescribed a relatively new class
of medications, the ‘novel oral anticoagulants’ (NOACs).
This article aims to give a general overview of NOACs,
current indications for use and possible implications for
future use

Saudi Arabia is a rapidly developing, oil-rich country. In less than a century it has been transformed from a desolate desert landscape into an affluent kingdom of modern cities, skyscrapers and international airports. Originally inhabited by nomadic Bedu, King Abdul-Aziz Al Saud led a movement in 1932 to unite this vast area of distinct tribal regions into one nation. It is now the largest country in the Middle East with a population of 28 000 000 people (Ministry of Health (MoH), 2012). The development of the Saudi Arabian healthcare system and the challenges it faces are considered within this article.

The polypill concept is a single daily tablet that contains a combination of medications routinely used in the primary prevention of cardiovascular disease (CVD). Since the term polypill was first coined in 2003 by Wald and Law, the idea has received intermittent fame and unrealised potential. Publication of favourable trial results in 2012 led to a resurgence of media interest in the UK, with news headlines claiming that the polypill could save thousands of lives (Gallagher, 2012). Although the polypill itself is still a concept formulated purely for research trials, adults in the UK without cardiovascular risk factors may purchase the component medications online. Therefore, GPs should have knowledge of the polypill, not just for its possible future public health use but because their patients may already be taking it.

Hirsutism is thought to affect 1 in 10 premenopausal women. The most common cause remains polycystic ovarian syndrome, however, other rare but serious diagnoses must be excluded. Regardless of the cause, hirsutism can have a significant effect on self-esteem and quality of life for those affected and GPs need to know how this condition can be managed.

Referral letters are the key mode of communication between GPs and hospital specialists for routine and acute management of conditions. While verbal communication skills are strongly emphasized in undergraduate training, written communication is relatively neglected. Medical students and postgraduate doctors are rarely formally taught to write referral letters; it is a skill learnt on the job through opportunistic and informal tuition and by reading referral letters written by others. Consequently, the style, content and quality of referral letters differ greatly among doctors. This article discusses professional expectations, outlines components of effective referral writing and provides a referral letter template.

As the population ages, increasing numbers of patients regularly attend their GP with chronic conditions, such as diabetes, ischaemic heart disease, hypertension and chronic obstructive pulmonary disease (COPD). Similarly, depression is becoming more common. By 2020, the World Health Organization estimates that depression will be one of the leading causes of disability worldwide, second only to ischaemic heart disease. As one of the frontline care providers for patients with chronic medical illnesses, GPs are in an ideal position to diagnose and manage depression in this patient group. This article reviews the aetiology of depression in chronic illness, the challenges involved in diagnosis and recommended management strategies.

Rhinitis is an inflammatory condition of the nasal mucosa which causes nasal discharge, itching, sneezing, nasal stuffiness, congestion and blockage. Rhinitis can be due to a variety of causes and is classified as allergic, non- allergic and infective. This article focuses on the diagnosis and management of rhinitis with an allergic aetiology.