The video version of this podcast can be found here:

·      https://youtu.be/IzuigE4BNVM

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 October 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.

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 October 2025 can be found here:

·      https://www.nice.org.uk/guidance/published?from=2025-10-01&to=2025-10-31&ndt=Guidance&ndt=Quality+standard

The updated Quality standard on head injury [QS74] can be found here:

·      https://www.nice.org.uk/guidance/qs74

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 October 2025, focusing on what is relevant in Primary Care only.

And this time there hasn’t been an awful lot that is relevant to Primary care, only an update to the quality standard on head injury.  

Right, let’s jump into it.

The updated quality standard on head injury covers the assessment, management and rehabilitation after a head injury. While much of it applies to secondary care, there are important areas where we play an important role in general practice

This updated quality standard focuses on the NICE guideline on head injury and rehabilitation for chronic neurological disorders.

For GPs, the main message is on recognition and referral. When a patient presents after a head injury, the standard reinforces the importance of same-day assessment and appropriate referral for imaging. The thresholds for CT scans are unchanged, but we should ensure rapid referral if the criteria are met.

But what exactly are these referral criteria? Let’s have a look at them.

The criteria can be divided between emergency referrals and urgent referrals, depending on whether imaging should be done within 1 hour or within 8 hours.

Let’s look at the emergency referral criteria first. They may appear fairly obvious but it is still worthwhile going through them:

• For those aged 16 and over, we need to do a CT head scan within 1 hour if any of the following risk factors are present:
• a Glasgow Coma Scale (GCS) score of 12 or less on initial assessment
• a GCS score of less than 15 at 2 hours after injury
• a suspected skull fracture
• A post-traumatic seizure
• a focal neurological deficit
• more than one episode of vomiting and
• any worrying signs of a basal skull fracture such as haemotympanum, “panda” eyes, cerebrospinal fluid leakage from the ear or nose and bruising over the mastoid process, also known as Battle’s sign
• For children under 16, in addition to what has already been mentioned, we also need to do a CT scan of the head within 1 hour if any of the following apply:
• a suspicion of non-accidental injury
• GCS < 14 or < 15 for babies on initial assessment
• GCS < 15 at 2 h
• a tense fontanelle and
• for babies under 1 year also a head swelling or laceration > 5 cm
• Additionally, a CT should be done within 1 hour if children have more than one of the following risk factors:
• witnessed loss of consciousness >5 minutes
• abnormal drowsiness
• 3 or more episodes of vomiting
• dangerous mechanism of injury
• amnesia >5 minutes and
• any bleeding disorder

Now, let’s look at the urgent referral criteria, that is, when a CT head scan should be done within 8 hours:

• For adults we will do a CT head scan within 8 hours of the head injury, or within one hour if they present more than 8 hours after the injury, if they have had loss of consciousness or amnesia and they also have any of the following factors:
• age 65 or over
• any bleeding or clotting disorder (including anticoagulants) and
• a dangerous mechanism of injury, for example, a pedestrian/cyclist being hit by car, a fall from >1 m or >5 stairs, or more than 30 minutes’ retrograde amnesia before the injury
• Additionally, even if there is no other indication, we should consider a CT head scan within 8 hours of injury (or within 1 hour if presenting >8 hours after injury) for anyone on anticoagulant treatment. This includes warfarin, DOACs, heparin, and antiplatelet treatment excluding aspirin monotherapy

In practice this means that if a patient comes with head trauma, we will need to identify if any of these thresholds are met and refer them appropriately via A&E for imaging. Our role is not to decide whether a CT is indicated or not, but to pick up risk factors, and expedite referral.

Now, going back to the quality statements, the rest of them simply emphasise the role of rehabilitation. In this respect in Primary Care, we should ensure that referral to community neuro-rehabilitation or therapy services happens in a timely fashion and that rehabilitation plans, and shared care arrangements are in place.

In summary: the update doesn’t change the imaging thresholds but for us, it emphasises follow-up, rehabilitation, and long-term management after a head injury.

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.