The guidance changes from the last 12 months that matter in general practice, each in two or three sentences with a link to the source and to the protocol or pathway it affects. 22 NICE changes and 6 MHRA safety updates, as at 13 October 2026.
Read the newest entries first. Each one says what changed and links to the source, so you can read the recommendation itself before changing practice. Where the change has already been worked into a protocol or pathway on this site, that page is linked under the entry.
The Updates page has the same list with filters by source, plus vaccine programme changes, contract news and outbreak alerts.
29 July 2026 · NICE NG59
NICE withdrew the recommendations on psychological therapy (cognitive behavioural approach) and on combined physical and psychological programmes. Keep the plan built on exercise, self-management and staying active, with manual therapy only alongside exercise; treat low mood or distress in its own right.
NICE guidance page · On this site: Sciatica protocol · Back pain algorithm
29 July 2026 · NICE NG259
Replaces the 2012 guideline: who to assess for fragility fracture risk, which risk tools and methods to use, identifying vertebral fractures, when to start treatment and when to repeat the assessment. The risk factors from 2012 are kept.
NICE guidance page · On this site: Osteoporosis protocol
9 July 2026 · NICE TA1175
Recommended for adults when lifestyle advice, aluminium-based antiperspirants and oral antimuscarinics have not controlled underarm sweating, or are contraindicated or not tolerated.
NICE guidance page · On this site: Hyperhidrosis protocol
7 July 2026 · NICE NG88
NICE removed the recommendation not to routinely test serum ferritin, because iron deficiency is common in heavy menstrual bleeding. FBC for everyone; consider ferritin where iron deficiency is suspected or the result will change treatment.
NICE guidance page · On this site: Menorrhagia protocol
17 June 2026 · NICE TA1166
Second biologic option (after dupilumab, TA1142) as specialist add-on maintenance for adults with uncontrolled COPD on triple inhaled therapy and blood eosinophils of 0.3 × 10⁹/L or more. Response is reviewed at 12 months.
NICE guidance page · On this site: COPD protocol
17 June 2026 · NICE NG126
Do not offer anti-D immunoglobulin for ectopic pregnancy or miscarriage (including threatened miscarriage) up to and including 11+6 weeks. From 12+0 to 12+6 weeks, offer at least 250 IU to RhD-negative people having medical or surgical management.
NICE guidance page · On this site: Vaginal bleeding in pregnancy algorithm
27 May 2026 · NICE NG258
Covers documenting a suspected anaphylactic episode, timing of tryptase samples, the observation period, admission, discharge and referral to a specialist allergy service. In primary care: anyone treated for anaphylaxis goes to hospital for observation.
NICE guidance page · On this site: Anaphylaxis protocol · Anaphylaxis algorithm
30 April 2026 · NICE NG198
Recommendations 1.5.19 and 1.5.20 amended: two independent healthcare professionals no longer need to approve isotretinoin for people under 18, because this is no longer a regulatory requirement. MHRA risk-minimisation measures and the Pregnancy Prevention Programme still apply.
NICE guidance page · On this site: Acne protocol
29 April 2026 · NICE TA1148
An option for persistent hyperkalaemia (confirmed potassium 5.5 mmol/L or more) in CKD stage 3b–5 or heart failure when it would otherwise stop optimised RAAS-inhibitor treatment, and in emergency care alongside standard treatment. Not for people on dialysis.
NICE guidance page · On this site: CKD protocol · Hyperkalaemia algorithm
15 April 2026 · NICE NG12
Age-specific CA125 thresholds for women aged 40 and over with symptoms suggesting ovarian cancer; aged 39 and under, do not use CA125 alone — consider urgent ultrasound. Updated recommendations on unexplained weight loss (age 60 and over, more than 5% in 6 months) and on postmenopausal bleeding not explained by HRT.
NICE guidance page · On this site: Bloating algorithm (ovarian) · Weight loss algorithm
15 April 2026 · NICE NG23
Recommendation 1.8.4 amended and 1.8.5 added to align with NG12: unscheduled bleeding is common in the first 6 months of systemic HRT and within 3 months of a dose or preparation change; bleeding outside these windows, or heavy or persistent bleeding, needs prompt assessment (BMS guidance signposted).
NICE guidance page · On this site: Menopause and HRT protocol · Bleeding on HRT algorithm
31 March 2026 · NICE NG257
Investigate both partners after 1 year of regular unprotected intercourse; offer earlier specialist referral if the person trying to conceive is 36 or over or there is a known cause or predictive history. Folic acid 400 micrograms for most — BMI alone does not need 5 mg (NG247).
NICE guidance page · On this site: Infertility protocol · Infertility algorithm
31 March 2026 · NICE TA1143
Recommended as an option only when HRT is unsuitable — not as a general first-line alternative. Check liver function before starting and monitor per the SPC/MHRA advice on drug-induced liver injury.
NICE guidance page · On this site: Menopause and HRT protocol
26 March 2026 · NICE TA1142
First biologic recommended for COPD: specialist add-on maintenance for adults with uncontrolled COPD (1 or more severe, or 2 or more moderate, exacerbations in 12 months) on triple therapy, with blood eosinophils of 0.3 × 10⁹/L or more.
NICE guidance page · On this site: COPD protocol
19 March 2026 · NICE NG256
Covers Bosniak 2F cysts, oncocytomas and localised, advanced and heritable renal cell carcinoma — relevant when an incidental renal mass or complex cyst is reported on imaging.
NICE guidance page · On this site: Incidental renal mass algorithm
February 2026 · NICE NG28
If medication is needed, offer modified-release metformin plus an SGLT2 inhibitor first line for most people, unless contraindicated. Established atherosclerotic CVD: add subcutaneous semaglutide (up to 1 mg weekly). New recommendations for early-onset type 2 diabetes and individualised targets.
NICE guidance page · On this site: Type 2 diabetes protocol
February 2026 · NICE NG136
New recommendation 1.2.11: offer healthy-living advice to people with raised blood pressure who have not been diagnosed with hypertension. Diagnostic and treatment thresholds are unchanged.
NICE guidance page · On this site: Hypertension protocol
January 2026 · NICE NG246
Recommendations 1.10.5, 1.10.10 and 1.10.11 clarified: use waist-to-height ratio to classify central adiposity in children and young people only from age 5.
NICE guidance page · On this site: Obesity protocol
December 2025 · NICE NG222
Information on antidepressants in tables 1 and 2 amended to stress regular reviews in relation to length of treatment and to set out when the first review should happen.
NICE guidance page · On this site: Depression protocol
19 November 2025 · NICE NG253
Replace NG51. Recognise sepsis from physiology and risk factors, not temperature. NEWS2 is for acute hospital, acute mental health and ambulance settings; elsewhere use a structured set of observations, consider an early warning score as an adjunct, and safety-net anyone managed at home.
NICE guidance page · On this site: Fever in adults algorithm · Neutropenic sepsis protocol
5 November 2025 · NICE TA1106
Recommended as an option for preventing HIV-1 (pre-exposure prophylaxis) in adults and young people.
NICE guidance page · On this site: HIV protocol
October 2025 · NICE NG222
Recommendation 1.5.3 reworded: do not routinely offer antidepressant medication as first-line treatment for less severe depression, unless that is the person’s informed preference.
NICE guidance page · On this site: Depression protocol
27 July 2026 · MHRA
The MHRA review found that the evidence does not confirm that bladder anticholinergics cause dementia, but a small increased risk cannot be ruled out.
For practice: Keep the number of anticholinergic medicines low in older people, and use the lowest effective dose for the shortest time.
MHRA public assessment report · On this site: Female urinary incontinence protocol · Male LUTS protocol
21 July 2026 · MHRA
Domperidone is now contraindicated in confirmed or suspected phaeochromocytoma because of the risk of severe hypertension. It can also unmask a tumour that has not been diagnosed.
For practice: Stop domperidone and switch to an alternative if phaeochromocytoma is confirmed or suspected. If someone taking domperidone has an episode of severe hypertension, consider investigating for phaeochromocytoma. Use the lowest dose for the shortest time, usually no more than 1 week.
MHRA Drug Safety Update · On this site: Nausea and vomiting in adults algorithm
15 July 2026 · MHRA
Warnings were strengthened for all botulinum toxin type A products after an outbreak of iatrogenic botulism in 2025. Symptoms usually start 4 to 8 days after treatment but can take up to 4 weeks.
For practice: Ask about recent cosmetic or medical injections in anyone with drooping eyelids, slurred speech, or difficulty swallowing or breathing. Treat it as a medical emergency and follow the UKHSA guidance on iatrogenic botulism.
16 June 2026 · MHRA
Warnings were strengthened because about half of UK angioedema reports with a recorded onset began 30 or more days after starting the ACE inhibitor. It can occur after weeks or years of use.
For practice: Stop the ACE inhibitor immediately if angioedema is suspected. Bradykinin-mediated angioedema is unlikely to respond to standard anaphylaxis treatment, including adrenaline, so think of it when that treatment is not working.
MHRA Drug Safety Update · On this site: Angioedema protocol
11 May 2026 · MHRA
Warnings were strengthened for finasteride 1 mg for hair loss, including that sexual dysfunction may contribute to mood changes. A precautionary warning was added for dutasteride.
For practice: Tell patients taking finasteride to stop and seek advice if they have depression or suicidal thoughts. Ask patients on either medicine to report sexual side effects. The finasteride patient alert card stays in place.
MHRA · On this site: Male pattern hair loss protocol · Male LUTS protocol
8 January 2026 · MHRA
Product information, leaflets and packaging are being updated to warn more clearly about addiction, dependence, withdrawal and tolerance, and the MHRA has published new patient resources.
For practice: Agree how long treatment will last and how it will stop before starting, and taper gradually when stopping. Share the MHRA patient resources.
MHRA Drug Safety Update · On this site: Benzodiazepines and Z-drugs protocol · Neuropathic pain protocol
Each protocol shows its review date and the guidance it is anchored to. Five protocols and five pathways are free without an account, and a new account can open all of them for 7 days with no card.
The trial needs no card. When it ends the account moves to the Free plan by itself.Reasoning GP is independent and is not affiliated with or endorsed by NICE or the MHRA. The summaries are written for clinicians as a prompt to read the source; they are not a substitute for it. Last full check of the site’s guidance register: October 2026.