Stay current — weekly, without the noise
A live feed of what's changing in UK general practice — pulled automatically from the official MHRA Drug Safety Update, UKHSA and NICE feeds, plus editorial picks explained in two sentences each and linked to the source.
NICE guideline changes for primary care are shown first, grouped by month. Use the filter to switch to All, MHRA or UKHSA updates (a source’s filter appears once it has items) — every update is kept here for 12 months.
The latest practice-changing update for each of the 20 topics GPs see most, dated and linked to the source, with what to do differently and the site page that holds the detail. Checked October 2026.
Hypertension — advice for raised BP below the diagnostic line
NICE added 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.
- Offer healthy-living advice (diet, salt, alcohol, activity, smoking) when clinic BP is raised but hypertension is not confirmed — and keep checking it.
- Still confirm a clinic reading of 140/90 or more with ambulatory or home monitoring before diagnosing.
- Step 1 for under-55s not of Black African or African–Caribbean family origin is still an ACE inhibitor or ARB.
Atrial fibrillation — no NICE change — check your best-value DOAC
NG196 has not changed in the last 12 months. NHS England’s national DOAC commissioning recommendations now put generic apixaban first as best value, and most ICBs have followed.
- Keep using CHA₂DS₂-VASc to decide on anticoagulation, and ORBIT to assess bleeding risk and fix modifiable factors — not to withhold anticoagulation.
- Offer a DOAC first line; follow your ICB’s best-value choice for new starts.
- Switch existing patients only as part of a full anticoagulation review.
Heart failure — all four pillars, started early
The September 2025 update recommends starting all four main medicine classes in HFrEF without first optimising the dose of each one, and adds options for mildly reduced and preserved ejection fraction.
- HFrEF: offer an ACE inhibitor, a beta-blocker, an MRA and an SGLT2 inhibitor — introduce them early, then titrate.
- HFpEF: consider an MRA and an SGLT2 inhibitor (dapagliflozin or empagliflozin).
- NT-proBNP above 2,000 ng/L → specialist assessment and echo within 2 weeks.
Lipids & CVD prevention — treat-to-target in secondary prevention
NG238 brought in lipid targets for people with established CVD and replaced CG181.
- Primary prevention: offer atorvastatin 20 mg when 10-year QRISK3 is 10% or more, after discussion; aim for a reduction in non-HDL cholesterol of more than 40%.
- Secondary prevention: atorvastatin 80 mg and aim for LDL 2.0 mmol/L or less, or non-HDL 2.6 mmol/L or less; consider adding ezetimibe.
- Inclisiran and PCSK9 inhibitors only through NICE criteria and local pathways.
CKD — keep renoprotection when potassium is high
TA1148 (replacing TA599) makes sodium zirconium cyclosilicate an option for persistent hyperkalaemia, so that RAAS inhibitors need not be stopped.
- Persistent potassium 5.5 mmol/L or more in CKD stage 3b–5 or heart failure that would otherwise stop an optimised ACE inhibitor or ARB → consider sodium zirconium cyclosilicate, which may be started in primary care (UKKA July 2026); never instead of emergency treatment.
- Keep the four kidney-protecting medicines in view: ACE inhibitor/ARB, dapagliflozin (TA1075), atorvastatin 20 mg, and finerenone where indicated.
- Potassium 6.0–6.4 → same-day hospital assessment if acutely unwell or with AKI; if well, repeat within 1 day after discussing with the renal/medical team; 6.5 or more, or ECG changes → emergency care.
Type 2 diabetes — dual therapy from the start
Metformin on its own is no longer the default. When medication is needed, NICE now recommends modified-release metformin plus an SGLT2 inhibitor first line for most people, with extra options for established cardiovascular disease and early-onset diabetes.
- Offer MR metformin and an SGLT2 inhibitor first line unless contraindicated — introduce them stepwise and check DKA risk and sick-day rules before starting the SGLT2 inhibitor.
- Established atherosclerotic CVD: add subcutaneous semaglutide (up to 1 mg weekly).
- Run a register search — many people on metformin alone may now qualify for an SGLT2 inhibitor.
Type 1 diabetes — Levemir (insulin detemir) is being discontinued
Novo Nordisk is discontinuing Levemir Penfill and FlexPen in the UK, with supply expected to end in December 2026 and a risk of earlier stock-outs. ABCD/PCDOS switching guidance was revised in May 2026.
- Do not start Levemir in new patients.
- Find everyone on detemir now and agree each switch with the diabetes team, following ABCD/PCDOS guidance — not by changing the repeat prescription alone.
- Warn patients that doses may need adjusting after a switch and to monitor glucose closely.
Obesity — tirzepatide in primary care, in phases
NICE TA1026 recommends tirzepatide for weight management. NHS England’s funding variation started a phased primary-care rollout from 23 June 2025, beginning with the highest-need cohort.
- Prescribe tirzepatide only within your local commissioned pathway with wraparound care — NICE eligibility does not mean immediate local access.
- First cohort: BMI 40 or more with at least 4 of type 2 diabetes, hypertension, cardiovascular disease, obstructive sleep apnoea and dyslipidaemia (BMI thresholds are usually 2.5 lower for higher-risk ethnic groups).
- Explain that weight often returns when the medicine stops, and plan maintenance from the start.
Asthma — AIR and MART replace SABA-only plans
The joint NICE, BTS and SIGN guideline changed diagnosis and treatment: objective tests in a set order, and an inhaled corticosteroid in every regimen.
- Do not start or continue a SABA-only regimen — move to as-needed ICS/formoterol (AIR), then low-dose MART.
- Confirm the diagnosis objectively: blood eosinophils or FeNO first in adults; FeNO first at 12–16.
- Review within 2 working days after an asthma attack treated in primary care or hospital.
COPD — the first biologics for eosinophilic COPD
NICE recommended dupilumab (TA1142, March 2026) and then mepolizumab (TA1166, June 2026) as specialist add-on maintenance for uncontrolled COPD with raised blood eosinophils.
- Identify people on triple inhaled therapy who are still uncontrolled (1 or more severe, or 2 or more moderate, exacerbations in 12 months).
- Check the blood eosinophil count; 0.3 × 10⁹/L or more → refer to the respiratory team to consider a biologic.
- Get the basics right first: inhaler technique, smoking cessation and pulmonary rehabilitation.
Menopause & HRT — bleeding on HRT, and fezolinetant
NG23 now says when unscheduled bleeding on systemic HRT needs prompt assessment (April 2026), and TA1143 recommends fezolinetant when HRT is unsuitable (March 2026).
- Tell women starting systemic HRT that unscheduled bleeding is common in the first 6 months and within 3 months of a dose or preparation change.
- Bleeding beyond those windows, or heavy, prolonged or persistent bleeding → prompt assessment (BMS guidance).
- Fezolinetant only when HRT is unsuitable: check liver function before starting and monitor per the SPC/MHRA advice.
Contraception — UKMEC 2025
The College of Sexual and Reproductive Healthcare (formerly FSRH) published UKMEC 2025, with new conditions and several upgraded categories for conditions that raise VTE risk.
- Re-screen with UKMEC 2025 — new entries include CKD, multiple sclerosis, sickle cell trait and multiple VTE risk factors.
- Several UKMEC 2 conditions together can add up to an unacceptable risk — weigh them, do not just count them.
- Check that your PGDs and templates have moved to UKMEC 2025.
Heavy menstrual bleeding — ferritin testing back in
NICE removed the recommendation not to routinely test serum ferritin, because iron deficiency is common in heavy menstrual bleeding.
- FBC for every woman with heavy menstrual bleeding, alongside starting treatment.
- Consider ferritin, particularly where iron deficiency is suspected with a normal haemoglobin, or the result will change treatment.
- Treat iron deficiency fully and recheck the response.
Infertility — NG257 replaces CG156
The new fertility guideline sets when to investigate, who to refer early, and preconception care in primary care.
- Investigate both partners after 1 year of regular unprotected intercourse — semen analysis and the female tests at the same visit, not one after the other.
- Offer specialist referral at presentation if the person trying to conceive is 36 or over, or there is a known cause or predictive history.
- Folic acid 400 micrograms daily; 5 mg only for a recognised indication — BMI alone does not need 5 mg (NG247).
Depression & anxiety — antidepressants not routine first line in less severe depression
NICE clarified recommendation 1.5.3 in October 2025 and amended its antidepressant tables in December 2025 to stress regular reviews and the timing of the first review.
- Less severe depression: do not routinely offer an antidepressant first line unless it is the person’s informed preference — offer guided self-help, CBT, behavioural activation or group exercise.
- When an antidepressant is started, book the first review and keep reviewing regularly while it continues.
- Anxiety disorders: NHS Talking Therapies self-referral remains first line (CG113 unchanged).
UTI & antimicrobials — updated UTI diagnostic tools
UKHSA’s primary-care UTI diagnostic tools now have separate algorithms for women under 65, adults 65 and over, and suspected catheter-associated UTI. NICE NG109 prescribing is unchanged.
- Do not use urine dipsticks to diagnose UTI in people aged 65 and over or with a catheter — use symptoms and the age-specific algorithm.
- Non-pregnant women: nitrofurantoin for 3 days first line if eGFR allows (NG109).
- Fever or confusion without urinary symptoms → look for another source; assess every patient for sepsis.
Sepsis — NG51 replaced by three guidelines
NG253 (16 and over), NG254 (under 16s) and NG255 (pregnant or recently pregnant) replaced NG51.
- Judge sepsis on physiology and risk factors, not temperature — a raised respiratory rate is often the earliest warning sign.
- NEWS2 is for acute hospital, acute mental health and ambulance settings; in general practice use a structured set of observations and consider an early warning score as an adjunct.
- High risk → 999; anyone managed at home gets clear safety-netting on what to watch for and where to go.
Suspected cancer — NG12 updated April 2026
The update brought in age-specific CA125 thresholds for suspected ovarian cancer and revised the recommendations on unexplained weight loss and on postmenopausal bleeding not explained by HRT.
- Aged 40 and over with symptoms suggesting ovarian cancer: CA125, then urgent ultrasound by the age-specific threshold; aged 39 and under, do not use CA125 alone — consider urgent ultrasound.
- Aged 60 and over with unexplained weight loss of more than 5% in 6 months: urgent investigation or a suspected cancer or non-specific symptoms pathway referral.
- Postmenopausal bleeding at 55 and over not explained by HRT → suspected cancer pathway; bleeding on HRT follows NG23 and BMS guidance.
Osteoporosis — new risk assessment guideline
NG259 replaced CG146. It covers who to assess, which tools and methods to use, identifying vertebral fractures, when to start treatment and when to reassess.
- Use FRAX or QFracture and keep the same tool throughout one assessment; QFracture is the only option at age 30–39.
- Act on vertebral fractures reported incidentally on imaging — do not just file the report.
- Use the NOGG thresholds to decide on treatment; a fragility fracture in an older adult need not wait for DXA.
Low back pain & sciatica — psychological programmes withdrawn
In July 2026 NICE withdrew the NG59 recommendations on psychological therapy and on combined physical and psychological programmes.
- Build the plan on exercise, self-management and staying active; manual therapy only as part of a package that includes exercise.
- Do not refer for a psychological or combined programme for back pain — treat low mood or distress in its own right (for example NHS Talking Therapies).
- Chronic primary pain features → use NG193.
Verified, practice-relevant news that is not a NICE guideline change — MHRA safety updates, vaccine programme changes, the GP contract and MRCGP exams — plus outbreaks and public-health alerts that patients may bring to the surgery. Each item is dated and linked to its primary source.
Pulled automatically from the official MHRA Drug Safety Update, UKHSA and NICE feeds — this list refreshes itself, no manual editing.
Curated explainers, each dated to when the change actually happened and linked to the source. For the authoritative, continuously-dated stream see the NICE archive at the top of this page and the live feed.
ACE inhibitors — delayed-onset angioedema
Stop the ACE inhibitor immediately if angioedema (tongue, lip, face, larynx, or GI pain/cramps) is suspected — it can occur at any time, even after years of use. Consider a bradykinin-mediated cause when standard anaphylaxis treatment isn't working; higher risk in older adults, women, smokers and people of Black/African-Caribbean ethnicity.
Drug Safety Update ↗Nasal decongestant sprays — rebound congestion
Xylometazoline and oxymetazoline sprays/drops can cause rebound congestion and, with prolonged use, rhinitis medicamentosa and tachyphylaxis. Advise patients not to exceed the dose and not to use for more than 5 consecutive days.
MHRA Safety Roundup ↗Hypertension — NICE NG136
The November 2023 update added recommendations on measuring and managing postural hypotension, plus summary tables of blood pressure targets. Step 1 for under-55s not of Black African or African–Caribbean family origin is still an ACE inhibitor or ARB (switch to an ARB if an ACE inhibitor is not tolerated, for example because of cough). Diagnostic and treatment thresholds unchanged.
Read NICE ↗Measles — national incident
UKHSA is running a national standard incident response to rising measles cases. Keep a low threshold for testing and actively promote catch-up MMR (any age if unvaccinated).
UKHSA bulletin ↗Topiramate — Pregnancy Prevention Programme
Topiramate (epilepsy & migraine) is now contraindicated in pregnancy and in women of childbearing potential unless the conditions of a PPP are met — highly-effective contraception mandatory.
Drug Safety Update ↗SCA — current exam format
The Simulated Consultation Assessment (SCA) replaced the RCA in November 2023 and is the licensing exam for the 2026 sittings — 12 cases, weighted on data-gathering, clinical management and relating to others.
RCGP SCA ↗Weekly diff of NICE
We check the entire NICE topic list every Monday for revisions. Every case affected by a change is updated within 48 h.
UKHSA outbreak bulletins
Daily check for outbreak alerts: measles, mpox, group A strep, AMR notifications. Triaged into primary-care relevance.
MHRA Drug Safety Update
Monthly DSU summarised — what to deprescribe, what to monitor, who to write to.
NICE NG / TA / CG releases
New / amended NICE guidance flagged, mapped to relevant cases, with a 200-word "what changed and what to do" summary.
The places UK GPs follow for guideline changes and primary-care news — each kept current at source. NICE publishes a dated “What’s new” log every month.
NICE — What’s new
The official monthly log of new and revised NICE guidance topics, dated and listed change-by-change.
Open NICE What’s new ↗Pulse Today
UK general-practice news, clinical updates and policy — the GP profession’s main news outlet.
Open pulsetoday.co.uk ↗GPonline
Clinical news, education and the latest on contracts, QOF and primary-care policy.
Open gponline.com ↗Guidelines & Guidelines in Practice
Summaries of national guidance distilled for primary care, with “top tips” implementation articles.
Open guidelinesinpractice.co.uk ↗Prescribing Advice for GPs
Prescribing-change summaries and clinical news written for GPs.
Open prescriber.org.uk ↗British Journal of General Practice
The RCGP’s peer-reviewed journal — primary-care research, editorials and clinical reviews.
Open bjgp.org ↗Red Whale — Pearls & blog
GP-update provider; their blog flags practice-changing updates in digestible primary-care language.
Open red-whale.co.uk ↗MHRA Drug Safety Update
The monthly bulletin of drug-safety advice — what to deprescribe, monitor or warn patients about.
Open Drug Safety Update ↗The Reasoning GP weekly
One email, every Monday, 5-minute read. What changed in UK primary care and what to do about it.