The video version of this podcast can be found here:

·      https://youtu.be/-kla7F8yibM

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

NICE stands for "National Institute for Health and Care Excellence" and is an independent organization within the UK healthcare system that produces evidence-based guidelines and recommendations to help healthcare professionals deliver the best possible care to patients, particularly within the NHS (National Health Service) by assessing new health technologies and treatments and determining their cost-effectiveness; essentially guiding best practices for patient care across the country.

My name is Fernando Florido and I am a General Practitioner in the United Kingdom. In this episode I go through new and updated recommendations published in March 2026 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 summary and my interpretation of the guidelines and you must use your clinical judgement.  

Disclaimer:

The Video Content on this channel is for educational purposes and not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read or seen on this YouTube channel. The statements made throughout this video are not to be used or relied on to diagnose, treat, cure or prevent health conditions.

In addition, transmission of this Content is not intended to create, and receipt by you does not constitute, a physician-patient relationship with Dr Fernando Florido, his employees, agents, independent contractors, or anyone acting on behalf of Dr Fernando Florido.

Intro / outro music: Track: Halfway Through — Broke In Summer [Audio Library Release] 

• Music provided by Audio Library Plus 
• Watch: https://youtu.be/aBGk6aJM3IU 
• Free Download / Stream: https://alplus.io/halfway-through 

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

Primary Care guidelines podcast:

·      Redcircle: https://redcircle.com/shows/primary-care-guidelines

·      Spotify: https://open.spotify.com/show/5BmqS0Ol16oQ7Kr1WYzupK

·      Apple podcasts: https://podcasts.apple.com/gb/podcast/primary-care-guidelines/id1608821148

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 Full NICE News bulletin for February 2026 can be found here:

·      https://www.nice.org.uk/guidance/published?from=2026-03-01&to=2026-03-31&ndt=Guidance&ndt=Quality+standard

The new guideline on Kidney cancer: diagnosis and management [NG256] can be found here:

·      https://www.nice.org.uk/guidance/ng256

The guideline on suspected cancer: recognition and referral can be found here:

·      https://www.nice.org.uk/guidance/ng12/

Transcript

If you are listening to this podcast on YouTube, for a better experience, switch to the video version. The link is in the top right corner of the video and in the episode description.

Hello and welcome! I’m Fernando, a GP in the UK. In today’s episode, we’ll look at the NICE updates published in March 2026, focusing on what is relevant in Primary Care only.

This month, none of the updated guidelines were relevant to primary care. Only one new guideline had some relevance: kidney cancer: diagnosis and management.

We will cover this briefly, focusing mainly on diagnosis and referring to the relevant section of the NICE guideline on suspected cancer, recognition and referral.

Right, let’s jump into it.

Before we go into kidney cancer itself, let’s briefly set the scene by looking at the NICE suspected cancer guideline. It is designed to help us recognise when symptoms may represent cancer and when to refer patients urgently.

In urological cancers, we need to be aware that many cancers, including kidney and bladder cancer, may present with relatively non-specific symptoms.

However, one symptom stands out as particularly important: that is, haematuria.

Visible haematuria is the single most important red flag symptom for urological cancers.

NICE recommends that we should make an urgent suspected cancer referral for bladder or renal cancer in adults aged 45 and over with unexplained visible haematuria, either without a urinary tract infection, or if it persists or recurs after treatment of a urinary tract infection.

So, this is an important point. Visible haematuria, especially when unexplained, should always be taken seriously.

At the same time, we should remember that haematuria can also be associated with prostate cancer. NICE advises that we should consider a PSA test and a digital rectal examination in patients with visible haematuria as well as those with lower urinary tract symptoms or erectile dysfunction.

However, prostate cancer assessment follows a separate pathway, so today we will just focus on renal cancer.

Now, what about non-visible haematuria?

This is less specific, but still important in certain groups.

NICE recommends that we should consider an urgent suspected cancer referral in people aged 60 and over with unexplained non visible haematuria if this is associated with symptoms such as dysuria, or abnormal blood results such as a raised white cell count.

So the threshold is higher, but it is still clinically relevant.

However we should note that this relates to suspected bladder cancer rather than kidney cancer, as the urgent criteria for renal cancer are based on visible haematuria.

And while we are here, NICE also advises that we should consider a non urgent referral for bladder cancer, I repeat, a non urgent referral for bladder cancer in people aged 60 and over with recurrent or persistent unexplained urinary tract infection.

Additionally, the suspected cancer guideline also emphasises safety netting.

If a patient does not meet the referral criteria but symptoms persist or evolve, we should reassess and reconsider referral, always using our clinical judgement alongside the guideline.

Now, with that context in mind, let’s move on to the new kidney cancer guideline itself.

Diagnosing kidney cancer in Primary Care can be challenging. In fact, patients with kidney cancer may present late or with non-specific symptoms which may overlap with other conditions.

So in practice, the diagnosis pathway for kidney cancer in Primary Care relies heavily on the features that trigger referral under the guideline on suspected cancer.

This means that visible haematuria remains central.

In addition, we also need to be aware that kidney cancer may present with more general symptoms, like flank or abdominal pain, weight loss, or fatigue.

However, these are non-specific, and on their own may not meet referral thresholds.

So again, clinical judgement and safety netting are really important.

Another important point is the role of incidental findings.

Some kidney cancers are detected incidentally on imaging performed for other reasons, although, in these cases, the pathway is usually driven by secondary care.

In Primary Care, our role is mainly in recognising the features and making the referral and after that, most of the diagnostic pathway takes place in secondary care. There, once kidney cancer is suspected, the main test used is a CT scan of the abdomen and pelvis, or, if necessary, an MRI scan. On occasions, a contrast-enhanced ultrasound scan can be considered.

So to summarise this section.

Kidney cancer diagnosis in Primary Care is largely based on recognising features that trigger referral under the suspected cancer guideline.

Visible haematuria remains the most important red flag symptom.

Non-visible haematuria can also be relevant for bladder cancer in higher risk groups.

And because symptoms can be vague, safety netting and clinical judgement are essential.

So that is it, a review of the NICE updates relevant to primary care.

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

Thank you for listening and goodbye.