Diagnosing Sepsis in Primary Care: Navigating Clinical Uncertainty Across Vulnerable Patient Groups

Sepsis is a medical emergency characterised by life-threatening organ dysfunction arising from a dysregulated host response to infection. It represents one of the most significant patient safety challenges in the United Kingdom, responsible for tens of thousands of preventable deaths each year, with a growing burden of hospital admissions that has risen substantially over the past two decades. The majority of cases originate in the community, placing general practitioners (GPs) at the critical frontline of early recognition. Despite this, the evidence base for sepsis diagnosis in primary care is sparse, and widely used clinical tools, including the quick Sequential Organ Failure Assessment (qSOFA) score and the National Early Warning Score 2 (NEWS2), were developed and validated predominantly in hospital settings, limiting their direct applicability in general practice. This narrative review examines the diagnostic challenges faced by UK GPs in recognising sepsis, with a particular focus on vulnerable patient groups, including elderly and frail patients, children, and individuals with multimorbidity, who frequently present with atypical features that do not satisfy conventional diagnostic criteria. Published literature from 2015 to 2025 was reviewed alongside current UK guidelines, including the updated National Institute for Health and Care Excellence (NICE) guidelines on suspected sepsis (NG253, NG254, NG255) and UK Sepsis Trust resources. Evidence suggests that the majority of GPs rely primarily on clinical intuition rather than validated screening tools, with gut feeling cited as the principal diagnostic method by up to 98% of practitioners, while formal tools such as qSOFA are used by fewer than 10%. Awareness of the UK Sepsis Trust criteria remains particularly low. Barriers to timely diagnosis include short consultation times, the low baseline prevalence of sepsis within the undifferentiated GP caseload, the increasing use of remote and telephone consultations, and limited access to point-of-care testing. The updated NICE guidance reasserts the primacy of clinical judgement alongside structured risk stratification, yet implementation in primary care settings remains inconsistent. This review concludes that sepsis recognition in UK general practice is a high-stakes diagnostic challenge compounded by atypical presentations in vulnerable patients and systemic barriers to timely assessment. Greater investment in GP-specific training, improved awareness of current guidelines, and the development of primary care-validated diagnostic frameworks are essential to reducing preventable sepsis-related mortality originating in the community.