The video version of this podcast can be found here:

·      https://youtu.be/Y3POCL-rh_Y

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 May 2025 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. 

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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 May 2025 can be found here:

·      https://www.nice.org.uk/guidance/published?from=2025-05-01&to=2025-05-31&ndt=Guidance&ndt=Quality+standard

The update on Suspected cancer: recognition and referral [NG12] can be found here:

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

·      https://www.nice.org.uk/guidance/ng12/chapter/Recommendations-organised-by-site-of-cancer#upper-gastrointestinal-tract-cancers

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 be looking at the NICE updates published in May 2025, focusing on what is relevant to Primary Care only.

We’ve got another short episode today, as there is only one clinical area to discuss: new advice on the cancer recognition guideline.

Right, let’s jump into it.

And this update refers to the early detection of upper gastrointestinal cancers. It only touches on the recommendations for oesophageal and stomach cancers, and it will not really change our practice very much, given that it affects the referral process only. The difference is that before, when someone developed red flag symptoms, we were advised refer them for an urgent direct access upper GI endoscopy (to be performed within 2 weeks), whereas now, the advice is to refer them using a suspected cancer pathway referral.

Is there a real difference? Well, in fact, there is. Let’s have a look at it:

The main difference between lies in who triages the referral, the urgency and coordination of care.

For example, in an urgent Direct Access Upper GI Endoscopy (done within 2 weeks)

• The GP directly refers the patient to the endoscopy service, who triages the referral without specialist review.
• Also, although urgent direct access endoscopy is expected within 2 weeks, it's not formally tracked like a cancer pathway.
• And finally, there is no coordinated follow-up if something is found. The GP will receive the report and must then arrange further care.

On the other hand, a Suspected Cancer Pathway Referral means that

• The hospital’s cancer referral team triages the referral and coordinates and tracks the process. This often means that the patient is seen or tested within 2 weeks, but the formal definition of a Suspected Cancer Pathway Referral is that the patient has the diagnosis of cancer either confirmed or ruled out within 28 days of the original referral.
• The advantage of this model is that if a cancer is found, follow-up is already embedded in the system.

So that is really the only change. Since today’s episode is so short, let’s take the opportunity to review re recommendation on upper GI cancers.

For Oesophageal and stomach cancers, we will refer them on a suspected cancer pathway if they:

• have dysphagia or
• are aged 55 and over, with weight loss, and they have any of the following:
• upper abdominal pain
• reflux or
• dyspepsia

We will consider non-urgent, direct access upper gastrointestinal endoscopy in people with haematemesis and in people aged 55 or over with:

• treatment‑resistant dyspepsia or
• upper abdominal pain with low haemoglobin levels or
• raised platelet count with any of the following:
• nausea
• vomiting
• weight loss
• reflux
• dyspepsia and
• upper abdominal pain or
• nausea or vomiting with any of the following:
• weight loss
• reflux
• dyspepsia and
• upper abdominal pain.

In terms of pancreatic cancer, we will refer if they are aged 40 and over and have jaundice. And we will also consider an urgent, direct access CT scan (to be done within 2 weeks), or an urgent ultrasound scan if CT is not available, in people aged 60 and over with weight loss and any of the following:

• diarrhoea
• back or abdominal pain
• nausea or vomiting
• constipation or
• new‑onset diabetes.

And finally, in terms of Gall bladder cancer or liver cancer

We will consider an urgent, direct access ultrasound scan (to be done within 2 weeks) in people with an upper abdominal mass consistent with either an enlarged gall bladder or an enlarged liver.

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.