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Primary Care GuidelinesAuthor: Juan Fernando Florido Santana
A podcast intended for healthcare professionals wanting to keep up to date relevant information about clinical practice guidelines Language: en-us Genres: Education, Health & Fitness, Medicine Contact email: Get it Feed URL: Get it iTunes ID: Get it |
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Podcast - NICE News - June 2026
Saturday, 18 July, 2026
The video version of this podcast can be found here: · https://youtu.be/i9b7QqtmcAsThis 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 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 June 2026 can be found here: · https://www.nice.org.uk/guidance/published?from=2026-06-01&to=2026-06-30The new Technology appraisal guidance [TA694] Bempedoic acid with ezetimibe for treating primary hypercholesterolaemia or mixed dyslipidaemia can be found here:· https://www.nice.org.uk/guidance/ta694The updated NICE guideline on Ectopic pregnancy and miscarriage: diagnosis and initial management [NG126] can be found here:· https://www.nice.org.uk/guidance/ng126 The updated NICE guideline on Postnatal care [NG194] can be found here:· https://www.nice.org.uk/guidance/ng194 The new updated NICE guideline on Multiple sclerosis in adults: management [NG220] can be found here:· https://www.nice.org.uk/guidance/ng220 TranscriptIf you are listening to this podcast on YouTube, for a better experience, switch to the video version. The link is 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 June 2026, focusing on what is relevant in Primary Care only. This month, the main update is the guidance on bempedoic acid with ezetimibe, although we will also briefly touch on ectopic pregnancy and miscarriage, postnatal care, and multiple sclerosis.Right, let’s jump into it.And let’s start with the new guidance on bempedoic acid with ezetimibe for treating primary hypercholesterolaemia or mixed dyslipidaemia.But first, what is bempedoic acid?Bempedoic acid is a relatively new oral, non-statin lipid-lowering drug used to reduce LDL cholesterol.It works in the liver by inhibiting cholesterol production earlier in the pathway than statins.Because it is activated mainly in the liver rather than skeletal muscle, it can be useful when statins are not tolerated, particularly because of muscle symptoms.The result is reduced cholesterol synthesis in the liver and increased clearance of LDL cholesterol from the blood.Bempedoic acid is usually given with ezetimibe because the two drugs work in complementary ways.Bempedoic acid reduces cholesterol production in the liver, while ezetimibe reduces cholesterol absorption from the intestine.Together, they lower LDL cholesterol more than either drug alone, and they provide an all-oral option for people who cannot tolerate statins.Now let’s look at the NICE guidance.In the NICE guideline, bempedoic acid with ezetimibe is an option for adults with primary hypercholesterolaemia or mixed dyslipidaemia only when statins are contraindicated or not tolerated, and ezetimibe alone has not controlled LDL cholesterol well enough.The evidence shows LDL cholesterol reduction, with cardiovascular outcome evidence.In practical terms, this is not a replacement for statins as first-line lipid-lowering treatment.NICE describes the usual pathway as statins first, with ezetimibe added if LDL cholesterol is not lowered enough.NICE also notes that there was no direct comparison with PCSK9 inhibitors such as alirocumab or evolocumab, and indirect comparison suggested bempedoic acid may be less effective than these options.However, a useful practical point is that bempedoic acid is an oral treatment, whereas alirocumab and evolocumab are given by subcutaneous injection.Despite those uncertainties, NICE concluded that bempedoic acid with ezetimibe is a cost-effective option for people with primary hypercholesterolaemia or mixed dyslipidaemia, where statins are contraindicated or not tolerated, and ezetimibe alone does not control LDL cholesterol well enough.Let’s now move to the updated guideline on ectopic pregnancy and miscarriage.The main change affects secondary care, but it is useful for us to know that anti-D immunoglobulin prophylaxis is no longer offered for ectopic pregnancy, miscarriage, or threatened miscarriage up to and including eleven weeks and six days’ gestation.However, from twelve weeks and zero days to twelve weeks and six days, anti-D remains relevant for RhD-negative pregnant people.And while we are here, we should remember that in any woman of reproductive age with non-specific symptoms, we should consider pregnancy and think about offering a pregnancy test.We should also refer to early pregnancy assessment services if there is bleeding or pain, and the pregnancy is of 6 weeks or more, or the pregnancy is of uncertain gestation. The urgency will depend on the clinical situation.If the pregnancy is under 6 weeks, there is bleeding but no pain, and there are no risk factors such as previous ectopic pregnancy, NICE recommends expectant management.We should advise them to return if bleeding continues or pain develops, to repeat a urine pregnancy test after 7 to 10 days, and to return if it is positive.A negative test will mean the pregnancy has miscarried.Let’s now touch on the updated guideline on postnatal care.For GP practice, the June 2026 update itself probably changes very little.NICE has added a recommendation to offer vitamin K prophylaxis for babies, linking to the intrapartum care guideline.For primary care, the main practical message is unchanged: the 6-to-8-week postnatal check remains an opportunity to assess maternal physical and mental health, contraception, pelvic floor and perineal problems, bleeding, safeguarding, feeding, and the baby’s wellbeing and development.And finally, the updated guideline on multiple sclerosis.The main change is diagnostic: the guideline now refers to specialist criteria known as the McDonald criteria, and NICE has removed the old statement that MS should not be diagnosed solely on MRI findings.But this does not affect us in primary care.For us, the practical message is that we should think of MS when there are focal neurological symptoms evolving over more than 24 hours, lasting days or weeks, often improving afterwards, and not explained by other common diagnoses.However, we should not routinely suspect MS from fatigue, dizziness, or vague sensory symptoms alone.We should then refer suspected MS cases to neurology, and secondary care will make the diagnosis following specific criteria.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.
