Reasoning GP
Management protocols
The "what to do next" for a condition you've already diagnosed. One visual pathway per disease, taking you through everything achievable in primary care — non-drug measures, the stepwise drug ladder, monitoring, follow-up and safety-netting — up to the point of referral. Re-enter the ladder at any follow-up where the patient isn't responding.
No protocol matches that search yet.
Cardiovascular & Renal
17 live
Postural Tachycardia Syndrome (PoTS)Stand test +30 bpm · fluids, salt, compression · specialist drugs→
Venous Leg UlcerABPI ≤14 days · compression · refer for veins→
HypertensionA→C→D ladder · targets · resistant-HTN loop · NG136→
Atrial FibrillationStroke prevention + rate/rhythm · NG196→
Antiplatelets & AnticoagulantsDAPT durations · DOAC choice/dose · bleeding · peri-procedural · NG196/158→
Heart Failure (HFrEF)Four pillars + diuretics · NG106→
Chronic Kidney DiseaseSlow progression + cardio-renal protection · NG203→
HypercholesterolaemiaStatin ladder + >40% non-HDL goal · NG238→
Stable AnginaAnti-anginals + secondary prevention→
Peripheral Arterial DiseaseSupervised exercise + risk reduction→
Familial HypercholesterolaemiaCascade testing + ≥50% LDL reduction · CG71→
Stroke & TIASecondary prevention · life after stroke · DVLA→
MI Secondary PreventionFive-drug bundle + cardiac rehab · NG185→
Deep Vein ThrombosisDOAC choice + duration + PE net · NG158→
Varicose VeinsConservative measures + referral thresholds · CG168→
Acute Kidney InjurySick-day rules · stop nephrotoxins · find cause · ng148→
Pulmonary EmbolismWells · CTPA · DOAC · NG158→
Endocrine & Metabolic
18 live
Primary HyperparathyroidismCalcium + PTH · urine calcium (FHH) · 4 surgical features · NG132→
Non-diabetic Hyperglycaemia (Prediabetes)HbA1c 42–47 · NHS DPP · annual HbA1c · CVD risk · PH38→
T2DM in RamadanIDF-DAR risk tiers · retime to iftar · break-fast rules→
MalnutritionMUST · refeeding · thiamine first · food before ONS→
Type 2 DiabetesGlucose ladder + early organ protection · NG28→ Gestational DiabetesOGTT thresholds · fasting-7 rule · the missed postnatal test→
Insulin in Type 2 DiabetesBasal start/titrate · add prandial · pre-mix · hypos · prescribe by brand→ Sick Day RulesSADMAN holds · unwell on insulin: ketones and dose adjustment · steroid dosing · restart rules→ DKAJBDS triad · 999 always · K⁺ <3.5: senior review + extra K⁺ · prevention→
HypothyroidismLevothyroxine titration + subclinical · NG145→ Thyroid in PregnancyTrimester ranges · dose goes UP · PTU not carbimazole→
HyperthyroidismSymptom control + safe shared care · NG145→
GoutFlare + treat-to-target ULT · NG219→
OsteoporosisFRAX · bisphosphonates · monitoring→
Type 1 DiabetesInsulin self-management + annual screening · NG17→
Addison's DiseaseHydrocortisone · sick-day rules · adrenal crisis→
Metabolic SyndromeWeight · QRISK3 · treat each component to target→
ObesityTiered weight management · GLP-1 · bariatric · NG246→
Respiratory
6 live
Long COVID (Post-COVID-19 Syndrome)Exclude red flags · CXR by 12 weeks · pacing · post-COVID service→
AsthmaAIR → MART pathway · NG245 (2024)→ Chest Infections (LRTI / CAP)Severity is the diagnosis · CRB-65 · stewardship · resolution CXR→
COPDInhaler ladder + rehab + LTOT · NG115→
BronchiectasisAirway clearance + culture-guided abx · BTS→
Obstructive Sleep ApnoeaEpworth · CPAP · weight · DVLA · ng202→
Mental Health
18 live
Learning Disability & AutismAnnual health check 14+ · overshadowing · STOMP · LeDeR→
Personality DisordersCrisis plan · no drugs for core features · DBT/MBT→
Bipolar disorder and lithiumMania → urgent referral · no antidepressant alone · lithium levels 3-monthly then 6-monthly · toxicity · CG185→
Self-harm and Suicide RiskNo risk scores · same-day routes · safety plan · 48-hour aftercare · NG225→
Gender DysphoriaRefer via national service · no gatekeeping · bridging · anatomy-based screening→
DepressionRisk-first · stepped care · SSRI ladder · NG222→ ADHDTeacher scale before referral · adults get lisdexamfetamine→ AutismNever wait and see · refer on suspicion · audiology alongside→ Opioid DependenceNaloxone · confirm before prescribing · OST · missed-dose rule→ Psychosis & SchizophreniaTime-critical EIP · exclude organic · the mortality gap→ Eating DisordersSCOFF · MEED physical risk · refeeding · refer without delay→
Generalised AnxietyStepped care · SSRI ladder · CG113→
InsomniaCBT-I first · short-term hypnotics→
Benzodiazepines & Z-drugsShort-course only · diazepam-equivalent taper · deprescribing · TA77→
PTSDTrauma-focused therapy · SSRI · NG116→
OCDCBT/ERP + higher-dose SSRI · CG31→
Postnatal DisordersSepsis · VTE · PPH · psychosis · EPDS · 6-week check→
Postnatal DepressionScreen · therapy ± sertraline · psychosis red flag · CG192→
Neurology
18 live
Multiple SclerosisRefer suspected MS · relapse vs infection · symptoms · DMTs→
Head Injury and ConcussionNG232 ED criteria · anticoagulants · graduated return · no sport before 21 days→
MigraineAcute + prophylaxis + MOH avoidance · CG150→ Vasovagal SyncopeExclude cardiac first · ECG + standing BP before referral→ EpilepsyGP does not diagnose or start AEDs · DVLA · SUDEP · valproate PPP→
Tension-Type HeadacheICHD-3 diagnosis · MOH · days-per-month cap · amitriptyline→
Restless Legs SyndromeIron · triggers · dopaminergic caution→
DementiaCognitive enhancers · BPSD · support→
Bell's PalsyEarly prednisolone + eye protection→
Parkinson's DiseaseShared care · on-time meds · non-motor · NG71→
Essential TremorPropranolol / primidone · vs Parkinson's→
Neuropathic PainCG173 ladder · 4 first-line · switch not stack→
Chronic Primary PainNG193 · exercise + ACT · do-not-start list · 10% taper→
Opioids (Non-Cancer Pain)Trial · 90mg/day OME cap (ideally ≤50) · named opioids · taper & stop · Opioids Aware→
Trigeminal NeuralgiaCarbamazepine · MRI red flags · CG173→
Post-Herpetic NeuralgiaCG173 ladder · topical · prevent→
Carpal Tunnel SyndromeSplint · injection · decompression→
ME/CFSPacing · avoid GET · NG206→
Gastroenterology
16 live
HerniaStrangulation risk · watchful waiting · mesh repair · HerniaSurge→
Irritable Bowel SyndromeDiet (FODMAP) · antispasmodics · neuromodulators→ Fatty Liver (MASLD)FIB-4 gatekeeper · CV risk dominates · statins are safe→
Ulcerative Colitis5-ASA maintenance · flare management→
Crohn's DiseaseShared-care maintenance · flare pathway→
Diverticular DiseaseFibre · symptom control · safety net→
Constipation (Adult)Laxative ladder · review→
Aphthous UlcerSymptomatic relief + 3-week cancer rule→
HaemorrhoidsFibre + topical + procedures→
Anal FissureStool softening + GTN/diltiazem→
GORD / Acid RefluxLifestyle · PPI step-down · H. pylori · ng12→
PPI Prescribing & DeprescribingCheap first-line · gastroprotection · step-down/stop · rebound · CG184→
GastroenteritisOral rehydration · avoid antibiotics · exclusion 48h→
Gilbert's SyndromeBenign unconjugated hyperbilirubinaemia · reassure→
Cholecystitis & GallstonesAdmit acute · USS · lap cholecystectomy · CG188→
Coeliac DiseaseTest on gluten · biopsy · gluten-free diet · NG20→
Musculoskeletal & Rheumatology
16 live
FibromyalgiaPositive diagnosis · exercise, CBT/ACT · no opioids or gabapentinoids→
SciaticaNG59 · no gabapentinoids · cauda equina script→
Rheumatoid ArthritisRefer early · DMARD shared care→
Giant Cell ArteritisSight-threatening · steroid NOW→
OsteoarthritisExercise-first · topical/oral analgesia · NG226→
Leg CrampsStretching · review drugs · quinine caution→
TMDsSelf-care + analgesia + dental splint→
Polymyalgia RheumaticaSteroid taper + bone protection + GCA net · BSR→
Raynaud's PhenomenonPrimary vs secondary · warmth + nifedipine→ Ankylosing SpondylitisExercise + NSAID → biologic · NG65→
Plantar FasciitisFirst-step heel pain · stretching · footwear→
Greater Trochanteric Pain SyndromeLateral hip pain · load management · physio→
Osgood-Schlatter DiseaseAdolescent knee · activity modification · self-limiting→
Achilles TendinopathyLoad mgmt · exclude rupture · no steroid→
Tennis ElbowActivity mod · exercise · self-limiting→
Morton's NeuromaFootwear · injection · surgery→
Women's Health
18 live
Recurrent Miscarriage3+ losses · APS, thyroid, scan, karyotype · progesterone if bleeding→
EndometriosisSuspect · TVUS · normal scan doesn't exclude · CHC or progestogen · refer · NG73→
DysmenorrhoeaPrimary vs secondary · normal USS excludes nothing→
Heavy Menstrual BleedingNG88 · LNG-IUS first · check the ferritin→
PCOSWeight · cycle control · hirsutism · fertility→ Recurrent Thrush (RVVC)Culture + speciation · the mimics · induction then suppression→
Menopause and HRTDiagnose · POI · choose regimen · endometrial protection · bleeding · NG23/BMS→
InfertilityBoth partners in parallel · 36+ don't wait · funding criteria→
Nausea/Vomiting in PregnancyAntiemetic ladder + hyperemesis · RCOG→
ContraceptionUKMEC screen · LARC-led · emergency contraception · CoSRH→
Hypertension in PregnancyLabetalol · aspirin prophylaxis · pre-eclampsia · NG133→
Bacterial VaginosisMetronidazole · not an STI · BASHH→
Vulvar DisordersExamine · treat cause · don’t miss VIN→
Pelvic Inflammatory DiseaseTreat empirically · protect fertility · BASHH→
Benign Breast DisordersNG12 thresholds · mastalgia · lumps · discharge · gynaecomastia→
Mastitis & Breast AbscessKeep feeding · antibiotics · drain abscess→ Breast CancerThe symptom refers, not your impression · NG12 exactly→
Premenstrual SyndromeSymptom diary · SSRI · hormonal→
Urology & Men's Health
14 live
Male LUTSAlpha-blocker · 5-ARI · anticholinergic→
Female Urinary IncontinencePFMT · bladder training · drugs→ Pelvic Organ ProlapseExamine the bulge · treat by symptoms · pessary before surgery→
Erectile DysfunctionCV risk · PDE5 inhibitors · referral→
Premature EjaculationBehavioural · topical · SSRI→
VaricoceleReassure + red-flag imaging + fertility · BAUS→
BalanitisHygiene + cause-directed treatment→ Penile DisordersNon-healing lesion is cancer · four emergencies · BXO not thrush→
UTI in WomenEmpirical antibiotics + recurrent prevention · NG109→ Recurrent UTINever blame haematuria on infection · oestrogen first · antibiotics last→
UTI in MenComplicated by default · prostate-aware · NG112→
Benign Prostate EnlargementConservative → alpha-blocker/5-ARI · CG97→
ProstatitisProlonged abx (acute) · multimodal (chronic)→
Undescended TestisOrchidopexy · vs retractile→
Children
14 live
Febrile seizures>5 min = 999 · first seizure → hospital · exclude meningitis · antipyretics don't prevent→
Childhood rashes and school exclusionNon-blanching = 999 · UKHSA exclusion periods · notifiable · MMRV 2026 · pregnant contacts→
CroupGrade severity · dexamethasone 0.15 mg/kg for all · stridor at rest → hospital→
Bronchiolitis999 signs · refer on feeding · no salbutamol or steroids · RSV prevention · NG9→
Nocturnal EnuresisAlarm · desmopressin · CG111→ Precocious PubertyRefer all · every boy urgently · plot the growth chart→
UTI in ChildrenUnder 3 months → refer · clean catch · NG224 imaging→
Constipation (Child)Disimpaction · maintenance · CG99→
Cow's Milk Protein AllergyElimination · formula ladder · reintroduction→
Reflux in InfantsPositioning · feeds · stepwise · NG1→
Pre-school WheezeViral wheeze is not asthma · NG9 thresholds · spacer technique→
Asthma in ChildrenStepwise ICS · spacer · action plan · acute attack · NG245→
Nappy RashBarrier + nappy care · antifungal for candida→
Surgical Problems in ChildrenBilious vomiting 999 · intussusception · torsion · hernia · pyloric stenosis→
Allergy & Immunology
4 liveInfections
11 live
Animal and Human BitesClean · co-amoxiclav 3/5 days · tetanus · rabies · BBV · NG184→
Tuberculosis (TB)CXR + 3 sputums · urgent TB service · notify · latent TB IGRA · BCG→
Influenza and COVID-19 AntiviralsOseltamivir ≤48h at-risk · Paxlovid highest-risk · interactions→
Hepatitis B and CTest at-risk groups · HBsAg · HCV RNA · refer all positives · DAA cure · vaccinate contacts→
CellulitisEron class · flucloxacillin · treat the portal→
ThreadwormWhole-household treatment + hygiene→
Lyme DiseaseTreat EM clinically · doxycycline · NG95→
Hepatitis ANotifiable · supportive · PEP + vaccine · UKHSA→
Malaria ProphylaxisABCD · region-specific · fever after travel = urgent→
Whooping CoughNotify · macrolide · protect infants→
Glandular FeverSupportive · avoid amoxicillin + contact sport→
Dermatology
23 live
Burns and ScaldsCool 20 min · %TBSA · refer ≥2% child / ≥3% adult · NAI→
Hidradenitis SuppurativaHurley stage · 12-week tetracycline · refer early→
Skin cancers — melanoma, SCC and BCC7-point checklist ≥3 → suspected cancer pathway · SCC consider · BCC routine · NG12→
Actinic KeratosisIs it SCC? · field treatment · warn about the reaction→
HirsutismRate of onset · 6-month rule · not hypertrichosis→
Acne VulgarisTopical → oral → isotretinoin referral · NG198→
Atopic EczemaEmollients + TCS + infection · CG57→
PsoriasisTopical ladder by site + PsA/CVD screen · CG153→
RosaceaFeature-led: triggers · topicals · oral→
HyperhidrosisAntiperspirants · iontophoresis · referral→
Bullous PemphigoidRefer to confirm + steroid shared care · BAD→
Anogenital WartsHPV 6/11 · GUM + STI screen · topical/cryo · vaccine→
Male Pattern Hair LossReassure · minoxidil / finasteride→
Female Pattern Hair LossScreen · minoxidil · exclude virilisation→
ChilblainsKeep warm · skin care · nifedipine if severe→
ScabiesPermethrin ×2 · treat ALL contacts→
Seborrhoeic DermatitisAntifungal + anti-inflammatory · maintenance→
Shingles (Herpes Zoster)Antiviral ≤72h · watch the eye · vaccine→
ImpetigoLocalised topical · widespread oral · NG153→
Fungal Skin InfectionTopical · oral for scalp/nail · avoid steroid alone→ Nail DisordersOne pigmented nail is melanoma · confirm fungus before tablets→
Pityriasis RoseaSelf-limiting · reassure · exclude syphilis→
Pityriasis VersicolorAntifungal · pigment recovers slowly→
ENT & Vestibular
6 live
BPPVHINTS first · Epley step by step · no sedatives→
Otitis Media & ExternaAOM vs OE · mastoiditis red flag→ Otitis Media with EffusionGlue ear · no drugs work · 3-month observation · decision table→
Vestibular NeuronitisShort-term relief + rehab + stroke exclusion→
Ménière's DiseaseAcute relief + betahistine/salt + ENT→
SinusitisMostly viral · INCS >10d · antibiotics rarely · NG79→
Ophthalmology
9 live
Infective ConjunctivitisRule out the painful red eye · self-care · chloramphenicol · no school exclusion→
Dry Eye DiseaseLubricants ladder + lid hygiene→ Subconjunctival HaemorrhageBenign — but measure the acuity · never stop anticoagulation→
GlaucomaAcute angle-closure emergency · chronic shared care · NG81→
Allergic ConjunctivitisItch · avoidance + antihistamine/MCS→
BlepharitisLid hygiene + warm compress · antibiotic/doxycycline→
Macular Degeneration (AMD)Urgent wet AMD referral · dry support · NG82→
Chalazion (Meibomian Cyst)Warm compress · refer persistent→
UveitisSame-day referral · painful red eye · systemic links→
Lifestyle & Prevention
6 live
SafeguardingSuspect → refer today · DASH/MARAC · FGM duty · Prevent · NRM→
Frailty and medication revieweFI → CFS · CGA · STOPP/START v3 · anticholinergic burden · deprescribe · ReSPECT→
Smoking CessationVery Brief Advice · varenicline / cytisinicline / combo NRT / vape · NG209→
Alcohol — Problem DrinkingAUDIT · brief intervention · safe detox→
UK Screening ProgrammesCervical · breast · bowel FIT · AAA · diabetic eye · NHS Health Check→
Driving and Diseases (DVLA)Stop-driving advice · notify DVLA · Group 1 vs 2 · GMC duty→
Sexual Health
7 live
SyphilisPainless ulcer · palms-and-soles rash · serology + HIV · GUM referral · benzathine penicillin · BASHH 2024→
Genital HerpesAciclovir · episodic/suppressive · BASHH→
HIVTest widely · ART · U=U · BHIVA→
ChlamydiaNAAT · doxycycline · partner notification→
GonorrhoeaCeftriaxone IM · culture · test of cure→
TrichomoniasisMetronidazole · treat partner · BASHH→
Urethritis (Male)NGU doxycycline · gonococcal ceftriaxone→
Haematology
5 live
Haemochromatosis (HFE)Ferritin → saturation → C282Y · ferritin >1000 liver · venesection · family→
Haematological CancersNG12 · very urgent FBC · CRAB · neutropenic sepsis→
Iron-Deficiency AnaemiaFerritin · find the cause (NG12) · iron→
Sickle Cell DiseaseProphylaxis · fast crisis analgesia · shared care→
Neutropenic SepsisEmergency — admit NOW · IV abx ≤1h→
Palliative & End of Life Care
14 live
MSCCSteroid on suspicion · MRI within 24h · NG234→
Cauda Equina SyndromeRefer at first suspicion · immediate MRI→
SVC ObstructionSit up · steroid · admit · NG12 immediate→
Catastrophic HaemorrhageAnticipatory planning · crisis meds · the family→
Palliative Pain & OpioidsWHO ladder · strong-opioid choice · conversion charts · breakthrough · adjuvants→ Malignant HypercalcaemiaMimics dying · rehydrate first · ONE bisphosphonate→
Nausea & VomitingCause-based antiemetic choice · receptor sites · syringe driver→
Constipation (Palliative)Opioid-induced · stimulant + softener · methylnaltrexone→
Breathlessness (Palliative)Non-drug measures · low-dose opioid · benzodiazepine→
Respiratory SecretionsDeath rattle · antimuscarinics · reposition · reassure family→
Delirium & Terminal AgitationFind reversible causes · haloperidol · midazolam · levomepromazine→
Anxiety & DepressionPsychological support · SSRI/mirtazapine · benzodiazepine for crisis→
Care of the DyingRecognising dying · anticipatory meds · syringe driver · the 4 PRN drugs→
Corticosteroids (Palliative)Dexamethasone indications · dosing · morning dose · taper · gastroprotection→
How to use. These pathways assume the diagnosis is already made. They are static visual references — print any one to a clean handout for the consultation room. Educational use only; always verify against current NICE and your local formulary.