The video version of this podcast can be found here:

·      https://youtu.be/qZPisPCp4eQ

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 September 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 September 2025 can be found here:

·      https://www.nice.org.uk/guidance/published?from=2025-09-01&to=2025-09-30&ndt=Guidance&ndt=Quality+standard

The updated Clinical guideline CG57 on Atopic eczema in under 12s: diagnosis and management can be found here:

·      https://www.nice.org.uk/guidance/cg57

The updated NICE guideline on Chronic heart failure in adults: diagnosis and management NG106 can be found here:

·      https://www.nice.org.uk/guidance/ng106

The updated Quality standard on Chronic heart failure in adults QS9 can be found here:

·      https://www.nice.org.uk/guidance/qs9

The new NICE guideline on Pneumonia: diagnosis and management NG250 can be found here:

·      https://www.nice.org.uk/guidance/ng250

The updated Quality standard on Pneumonia: diagnosis and management QS110 can be found here:

·      https://www.nice.org.uk/guidance/qs110

The updated NICE guideline on Suspected acute respiratory infection in over 16s: assessment at first presentation and initial management NG237 can be found here:

·      https://www.nice.org.uk/guidance/ng237

The updated Clinical guideline on Bipolar disorder: assessment and management CG185 can be found here:

·      https://www.nice.org.uk/guidance/cg185

The updated technology appraisal guidance on Tirzepatide for treating type 2 diabetes TA924 can be found here:

·      https://www.nice.org.uk/guidance/ta924

The updated Technology appraisal guidance on Tirzepatide for managing overweight and obesity TA1026 can be found here:

·      https://www.nice.org.uk/guidance/ta1026

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

In recent months, there hasn’t been much in the way of updates that directly affect us in General Practice. But September is very different — there’s a lot we need to pay attention to. These updates cover eczema, respiratory infections, pneumonia, bipolar disorder, tirzepatide, and, importantly, a new updated guideline on chronic heart failure.

Right, let’s jump into it.

The updated NICE guideline on atopic eczema in children under 12 has revised the section on complementary therapies, washing, and clothing. The new wording makes it clear that children with atopic eczema may bathe or shower once daily. Bathing can help remove crusts and skin debris and improve comfort, but it should always be followed by emollient application to prevent the skin from drying out.

The update also clarifies that water softeners and silk garments do not improve eczema severity and therefore should not be recommended.

So, in summary: daily bathing is acceptable and can be beneficial if followed by emollient use, and water softeners or silk clothing should not be recommended because they provide no proven benefit.

The next section is on Chronic Heart failure. The updated NICE guideline has introduced substantial changes, particularly to how we treat and monitor different categories of heart failure. This is such an important area that I’ll only cover the highlights today, as I will cover it in more detail in a future episode.

The main focus of the update was the drug management of the three subtypes of heart failure, that is, heart failure with reduced ejection fraction, mildly reduced ejection fraction, and preserved ejection fraction.

For heart failure with reduced ejection fraction, that is, an ejection fraction 40% or less, the recommendations now reflect strong evidence for SGLT-2 inhibitors, which consistently reduce hospitalisations for heart failure and improve survival regardless of diabetes status. These drugs are now embedded alongside established treatments such as ACE inhibitors, beta-blockers, and mineralocorticoid receptor antagonists.

For heart failure with mildly reduced ejection fraction — that is, an ejection fraction between 41% and 49% — NICE issues new recommendations for the first time. This group used to be a bit of a grey area. The update highlights evidence that people with mildly reduced EF may benefit from SGLT-2 inhibitors in much the same way as those with reduced EF, and the guidance now advises considering them here too.

For heart failure with preserved ejection fraction, meaning an ejection fraction of 50% or more, NICE also makes new recommendations. In the past, management was mostly limited to controlling symptoms and comorbidities. Now, on the back of trial evidence, SGLT-2 inhibitors are also recommended here because they reduce hospitalisations for heart failure, even if mortality benefit is less certain.

In practice, this means SGLT-2 inhibitors will be used much more widely — not only in people with reduced EF, but also in those with mildly reduced or preserved EF.

An updated NICE Quality Standard on chronic heart failure has also been published, bringing it into line with these changes.

Next, there is a brand-new NICE guideline on pneumonia, which consolidates and replaces previous guidance, including antimicrobial prescribing guidelines.

The biggest change for us in primary care relates to children: the recommended course of antibiotics for non-severe community-acquired pneumonia without complications or underlying disease has been reduced from 5 days to 3 days. This is because evidence shows that shorter courses are just as effective at resolving symptoms, while reducing the risk of side effects and, most importantly, lowering the risk of antibiotic resistance.

Additionally, although more relevant to secondary care, there are new recommendations on corticosteroids in patients with high-severity community-acquired pneumonia when admitted to hospital. This reflects growing evidence that systemic steroids can improve outcomes in severe cases alongside standard antibiotic and supportive care. However, corticosteroids are not recommended for routine use in mild or moderate pneumonia, so it is something that we will not be doing routinely in Primary Care.

There is also an updated Quality Standard on pneumonia, aligned with the new guideline and reflecting the changes I’ve just mentioned.

Next, we have the updated NICE guideline on suspected acute respiratory infection which covers assessment at first presentation and initial management.

The main change here is that the section on the clinical diagnosis of community-acquired pneumonia in primary care has been removed, because that information is now fully covered by the new pneumonia guideline. In practical terms, pneumonia-specific recommendations move to the pneumonia guideline, while the guideline on respiratory infections continues to provide guidance on the assessment and initial management of these infections more broadly.

This guideline should also be read alongside NICE’s existing antimicrobial prescribing guidelines for acute cough, COPD exacerbations, sinusitis, and sore throat.

The latest update is on the clinical guideline on bipolar disorder, which focuses on recommendations around valproate use, following new safety advice from the MHRA.

The key change is that boys and men taking valproate must now be advised to use effective contraception throughout their treatment and for three months after stopping the drug. This means using condoms in addition to contraception used by a female sexual partner. Additionally, men who are planning a family within the next year should also discuss potential fertility risks and alternative treatment options.

Previously, recommendations were already strict around valproate use in females of childbearing potential. Valproate must not be initiated in anyone under 55 unless two specialists agree there are no other suitable alternatives or that the reproductive risks do not apply. For them, it can only be prescribed if other treatments are unsuitable and the Pregnancy Prevention Programme is in place.

The new update now extends this caution explicitly to male patients, confirming that valproate carries reproductive risks for both sexes.

Finally, there are updates to the NICE technology appraisals on tirzepatide — marketed as Mounjaro — covering both type 2 diabetes and the management of overweight and obesity.

The recommendations themselves remain unchanged. What has changed is that a commercial access agreement has now been added, together with updated pricing. This is intended to reduce the budget impact for the NHS and make implementation of the guidance more sustainable.

As a reminder, let’s remember that for type 2 diabetes, tirzepatide continues to be recommended when triple therapy with metformin and two other oral drugs is ineffective, not tolerated, or contraindicated, and when a GLP-1 receptor agonist would otherwise be considered. For obesity, it remains recommended in adults who meet the BMI and comorbidity thresholds specified in the original appraisal and following a gradual NHS roll out process.

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.