This episode makes reference to guidelines produced by the "National Institute for Health and Care Excellence" in the UK, also referred to as "NICE". Please note that the content on this channel reflects my professional interpretation/summary of the guidance and that I am in no way affiliated with, employed by or funded/sponsored by NICE.

My name is Fernando Florido and I am a General Practitioner in the United Kingdom. In this episode I will go through new and updated guidelines published in September 2023 by the National Institute for Health and Care Excellence (NICE), focusing on those that are relevant to Primary Care only. 

I am not giving medical advice; this video is intended for health care professionals; it is only my interpretation of the guidelines and you must use your clinical judgement.  

There is a YouTube version of this and other videos that you can access here: 

• The Practical GP YouTube Channel:  

https://youtube.com/@practicalgp?si=ecJGF5QCuMLQ6hrk

The link to the PDF version of this video can be downloaded here: 

·      https://1drv.ms/b/s!AiVFJ_Uoigq0mEl3L2KH_8bOGFrM?e=NqGNSZ 

The Full NICE News bulleting for September 2023 can be found here:

·      https://www.nice.org.uk/guidance/published?from=2023-09-01&to=2023-09-30&ndt=Guidance&ndt=Quality+standard

The links to the update guidance covered can be found here:

Chronic obstructive pulmonary disease in adults: quality standard

·      https://www.nice.org.uk/guidance/qs10

Semaglutide for managing overweight and obesity: Technology appraisal

·      https://www.nice.org.uk/guidance/ta875

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Transcript

Hello and welcome, I am Fernando, a GP in the UK. Today, we are looking at the NICE updates published in September 2023, focusing on what is relevant in Primary Care only. 

So, let’s jump into it.

The first clinical area is an update on COPD because some of the quality standards have changed.

And the first one says that we have to refer patients with COPD to a pulmonary rehabilitation programme if they have a score of 3 or above on the Medical Research Council (MRC) dyspnoea scale. And this is because pulmonary rehabilitation improves exercise capacity, quality of life, and levels of anxiety and depression.

And let’s remember what a score of 3 or above means on the MRC dyspnoea scale:

Grade 3 is defined as 'walks slower than contemporaries on level ground because of breathlessness, or has to stop for breath when walking at own pace'.

Grade 4 is defined as 'stops for breath after walking about 100 metres or after a few minutes on level ground' and

Grade 5 is defined as 'too breathless to leave the house, or breathless when dressing or undressing'.

NICE also specifies that pulmonary rehabilitation will be at least 6 weeks in duration and include a minimum of twice‑weekly supervised sessions of structured training.

The second Quality standard change refers to patients being discharged from hospital after an acute COPD exacerbation. We will be able to expect these patients to receive a care bundle before discharge which means that before they leave hospital they will have:

·      a good understanding of their medication and inhaler use,

·      a self-management plan,

·      a smoking cessation intervention,

·      a referral to pulmonary rehabilitation if appropriate, and

·      a follow-up within 72 hours from discharge

The second clinical area refers to the use of Semaglutide for managing overweight and obesity. The update in September 2023, is not a clinical one and it refers to the company’s commercial arrangement that makes semaglutide available to the NHS with a discount.

But let’s quickly review the recommendations for semaglutide for managing overweight and obesity.

Semaglutide is recommended with a low-calorie diet in adults, only if:

·      it is used for a maximum of 2 years, with specialist input, and

·      they have at least 1 weight-related comorbidity and:

o  a BMI of 35.0 or more, or

o  a BMI between 30.0 and 35 and meets other referral criteria (for example failure of conventional treatment or when we are considering surgery).

·      We will use lower BMI thresholds (usually reduced by 2.5) for people from non-White family backgrounds. This is because they have an equivalent risk from obesity at a lower BMI than people from a White ethnic family background

And we will consider stopping semaglutide if less than 5% of the initial weight has been lost after 6 months of treatment.

We have come to the end of this episode. Remember that this is not medical advice and it is only my summary and my interpretation of the guidelines. You must always use your clinical judgement.

Thank you for listening and goodbye.