NICE Guidelines
A curated summary of NICE guidelines updated in 2025–2026, with practical implications for UK primary care. Last updated April 2026.
1. Clinical Practice Guidelines (NG): Updated 2025–2026
Covers the management of type 2 diabetes in adults, including education, dietary advice, blood glucose management, medication pathways, and management of complications. Around 4.6 million people are diagnosed with diabetes in the UK, with about 90% having type 2.
What changed:
- February 2026: Major update, described by NICE as the 'biggest shake-up in type 2 diabetes care in a decade'. The key change is a shift from automatically starting everyone on metformin alone to personalised treatment plans that aim to prevent cardiovascular and renal complications, not just control blood sugar.
- SGLT-2 inhibitors move from second-choice to first-choice treatment: SGLT-2 inhibitors (canagliflozin, dapagliflozin, empagliflozin, ertugliflozin) should now be offered alongside metformin as initial treatment for most adults with type 2 diabetes. Medicines should be introduced stepwise: start metformin first to check tolerability, then add the SGLT-2 inhibitor as soon as tolerability is confirmed. For patients who cannot tolerate metformin, start with an SGLT-2 inhibitor alone.
- Expanded access to GLP-1 receptor agonists and tirzepatide: Around 810,000 more people could benefit. GLP-1 receptor agonists (semaglutide, dulaglutide, liraglutide) and tirzepatide are now recommended for specific groups as part of initial treatment. Key groups: adults with established atherosclerotic CVD (triple therapy including subcutaneous semaglutide up to 1 mg weekly); adults with early-onset type 2 diabetes (diagnosed before age 40); adults living with obesity; adults with CKD (tailored to eGFR); adults with heart failure; adults with frailty or multiple health conditions.
- Additional changes: HbA1c target recommendations now refer to an 'initial medication regimen' rather than a 'single drug'. Endorsement of biosimilar insulin products. Expanded access to intermittently scanned CGM for adults on insulin with recurrent hypoglycaemia. Management of periodontitis incorporated into annual diabetes reviews. Links added to the NHS Type 2 Diabetes Path to Remission Programme.
- Cost impact: Generic dapagliflozin now available, with an estimated cumulative NHS savings of £560 million across 2025/26 and 2026/27. NICE analysis suggests the earlier introduction of SGLT-2 inhibitors could prevent approximately 17,000 deaths over 3 years by reducing heart attacks, strokes and kidney complications.
- Equity note: NICE analysis of nearly 590,000 anonymised records found SGLT-2 inhibitors are currently under-prescribed to women, older people, and Black or Black British individuals.
Last reviewed: 18 February 2026
Read feature article →Covers the identification and management of primary hypertension in adults aged 18 and over, including those with type 2 diabetes. Aims to reduce cardiovascular risk through accurate diagnosis and effective treatment.
What changed:
- New recommendation added: Clinicians should now offer healthy living advice to patients with raised blood pressure who have not yet been formally diagnosed with hypertension. This formalises a proactive, pre-diagnostic conversation within routine practice.
- NICE has noted it is actively monitoring emerging evidence on antihypertensive drug response across different ethnic groups, and will update the guideline if that evidence warrants it.
- No changes to treatment or monitoring recommendations at this stage.
Last reviewed: 26 February 2026
Covers identifying children, young people and adults with symptoms that could be caused by cancer, appropriate investigations in primary care, and selection of people to refer for specialist opinion.
What changed:
- January 2026: Removed an incorrect recommendation on blood tests for myeloma.
- May 2025: Amended recommendations 1.2.1 and 1.2.7: now recommends a suspected cancer pathway referral (rather than urgent direct access endoscopy) for people with symptoms indicating a 3% or more probability of oesophageal or stomach cancer.
- April 2025: Amended blood test recommendations for myeloma in response to NHS England National Cancer Programme reviews on earlier diagnosis. A further update covering colorectal, lung and other cancers is expected March 2026.
Last reviewed: 12 January 2026
Covers prevention and management of overweight, obesity and central adiposity in children, young people and adults. Consolidates and replaces seven previous NICE obesity guidelines (NG7, CG189, PH53, PH47, PH46, PH42, CG43).
What changed:
- January 2026: Amended recommendations to clarify that height-to-weight ratios should only be used to classify the degree of central adiposity in children and young people aged 5 years and over.
- February 2025: changed 'weight-loss' to 'weight-management' medicines; March 2025: added NHS BMI/waist-to-height ratio calculator links; April 2025: changed 'UKVRN registered nutritionist' to 'registered nutritionist'.
- January 2025 (new guideline): Major consolidation with new evidence-reviewed recommendations on prevention in schools/nurseries, general principles of care, identification/assessment/referral, behavioural interventions, dietary advice, advice for ethnic minority backgrounds, multidisciplinary teams for children, and raising awareness of interventions. Emphasis on respectful, non-judgemental, person-centred care.
Last reviewed: 8 January 2026
Covers recognising, assessing and early management of suspected sepsis in non-pregnant adults aged 16 and over. One of three new age/population-specific guidelines replacing the original NG51 (2016).
What changed:
- November 2025 (new guideline): Split from NG51 into three standalone guidelines. Key new recommendations include: initial IV fluid bolus of 250 ml over 10–15 minutes (previously 500 ml); guidance on peripheral vasopressor use; updated approach to finding and controlling the source of infection. Uses NEWS2 within clinical context for risk evaluation.
Last reviewed: 5 November 2025
Covers recognising, assessing and early management of suspected sepsis in children and young people under 16. New standalone paediatric guideline replacing relevant sections of NG51.
What changed:
- November 2025 (new guideline): Split from NG51 into a dedicated paediatric sepsis guideline covering recognition, early assessment, initial treatment, and escalation of care specific to children and young people. NICE plans to review the use of the national paediatric early warning score (PEWS) for future inclusion.
Last reviewed: 5 November 2025
Covers recognising, assessing and early management of suspected sepsis in people who are pregnant or have recently been pregnant. New standalone guideline replacing relevant sections of NG51.
What changed:
- November 2025 (new guideline): Split from NG51 into a dedicated guideline for pregnancy and the postpartum period. Covers recognition, early assessment, initial treatment and education. NICE plans to review the use of the modified early obstetric warning score (MEOWS) for future inclusion.
Last reviewed: 5 November 2025
Covers diagnosing and managing chronic heart failure in people aged 18 and over, aiming to improve diagnosis and treatment to increase the length and quality of life.
What changed:
- September 2025: Reviewed evidence on treating and monitoring heart failure with reduced ejection fraction (HFrEF), mildly reduced ejection fraction (HFmrEF) and preserved ejection fraction (HFpEF). Key practice changes include: new recommendations for HFmrEF and HFpEF (previously no specific guidance); amended HFrEF recommendations on pharmacological treatment.
- October 2025: amended rationale for rec 1.7.10 to clarify ECG before beta-blocker prescribing.
- December 2025: amended rationale for rec 1.7.2 to clarify advice on ARNI prescribing by primary care.
Last reviewed: 3 September 2025
Covers diagnosing, assessing and treating community-acquired and hospital-acquired pneumonia, including bacterial pneumonia secondary to COVID-19, in babies over 1 month, children, young people and adults.
What changed:
- September 2025 (new guideline): Amalgamates and replaces NICE antimicrobial prescribing guidelines on community-acquired pneumonia (NG138) and hospital-acquired pneumonia (NG139), both from 2019. Important practice changes: antibiotic course length reduced from 5 to 3 days for babies/children aged 3 months to 11 years with non-severe community-acquired pneumonia without complications; new recommendations on corticosteroids for adults in hospital with high-severity community-acquired pneumonia.
- Minor change November 2025: updated sepsis links to new NG253/254/255.
Last reviewed: 2 September 2025
Suspected acute respiratory infection in over 16s: assessment at first presentation and initial management
Covers assessment of people aged 16 and over with symptoms and signs of acute respiratory infection at first remote or in-person NHS contact, and initial management of infections.
What changed:
- September 2025: Removed the section on clinical diagnosis of community-acquired pneumonia in primary care (this content is now covered by the new NG250 pneumonia guideline).
Last reviewed: 2 September 2025
Covers assessing risk of falling and interventions to prevent falls in all people aged 65 and over, and people aged 50–64 who are at higher risk.
What changed:
- April 2025 (new guideline): Updates and replaces CG161 (2013). Key changes: scope expanded to include people aged 50–64 with conditions increasing fall risk (e.g. arthritis, dementia, diabetes, Parkinson's, stroke, learning disability). Recommends against using falls risk prediction tools (evidence shows insufficient accuracy when used alone). Emphasises opportunistic questioning about falls at routine appointments. New recommendations on comprehensive falls assessment, home hazard assessment using validated tools, and evidence-based exercise programmes. Applies across community, hospital, and care home settings.
Last reviewed: 29 April 2025
Covers diagnosing and managing epilepsies across all age groups, including investigation, anti-seizure medication choices, and ongoing management.
What changed:
- January 2025 (safety update): Amended recommendations on valproate and topiramate in line with MHRA safety guidance. Key changes: valproate must not be started for the first time in anyone (male or female) under 55 unless two specialists independently confirm no other effective/tolerated treatment exists; boys and men advised to use effective contraception throughout valproate treatment and for 3 months after stopping; topiramate must not be used in women/girls of childbearing potential unless Pregnancy Prevention Programme conditions are met.
- Minor change November 2025: added links to relevant technology appraisals in childhood-onset epilepsies section (no change in clinical content).
Last reviewed: 30 January 2025 (minor update 25 November 2025, no change in clinical content)
Covers identifying, assessing and managing gambling-related harms in children, young people and adults.
What changed:
- January 2025 (new guideline): First NICE guideline on gambling-related harms. Recommendations for healthcare professionals on recognising signs, screening at-risk populations, and referring for specialist support. Includes guidance on opportunistic identification in primary care settings.
Last reviewed: 28 January 2025
Covers nutrition and weight management in pregnancy, and nutrition in children up to 5 years of age.
What changed:
- January 2025 (new guideline): Consolidates and updates NICE's previous public health guidelines on maternal and child nutrition. Should be read alongside NG246 (obesity). Covers folic acid and vitamin D supplementation, breastfeeding support, and introduction of complementary foods.
Last reviewed: 15 January 2025
2. HealthTech Guidance (HTG): Updated 2025–2026
Guidance on implantable pulmonary artery pressure (PAP) sensors for remote haemodynamic monitoring in chronic heart failure. Two technologies assessed: CardioMEMS HF System and the Cordella Pulmonary Artery Sensor System.
What changed:
- February 2026 (new guidance): CardioMEMS HF System can be used as an option for remote monitoring of NYHA class 3 chronic heart failure in adults at risk of hospitalisation. Evidence from economic modelling shows CardioMEMS is likely to be cost effective. More research is needed on the Cordella system before it can be funded by the NHS.
Last reviewed: February 2026
Early value assessment of multicomponent digital platforms supporting COPD self-management in adults. App- or web-based platforms including symptom tracking, educational content, personalised action plans, medication reminders, and communication features with healthcare providers.
What changed:
- September 2025 update: Six technologies can be used in the NHS during a 3-year evidence generation period: Clinitouch, COPDhub, COPDPredict, Luscii, myCOPD, and one other. Two technologies were removed from recommendations because they are no longer available in the UK. COPD readmission rates remain high (23.9% within 30 days of discharge), highlighting the importance of effective self-management.
Last reviewed: September 2025
Early value assessment of digital self-management programmes for adults with mild to moderate symptoms of hip or knee osteoarthritis. App- or web-based platforms delivering personalised exercise programmes, education, pain management strategies, and symptom tracking. Musculoskeletal conditions account for 30% of GP consultations.
What changed:
- January 2026 (new guidance, early value assessment): Eight digital technologies recommended for use in the NHS during a 3-year evidence generation period. Clinical trial evidence is limited but suggests these technologies improve physical function and reduce pain and stiffness. They may also slow disease progression.
Last reviewed: January 2026
Early value assessment of unguided digital self-help programmes for people aged 16+ with eating disorders, specifically binge eating disorder, bulimia nervosa, and other specified eating disorders (OSFED). Three technologies assessed: Overcoming Bulimia Online, Digital CBTe, and Worth Warrior.
What changed:
- January 2026 (new guidance, early value assessment): Overcoming Bulimia Online recommended for use in the NHS during a 2-year evidence generation period, alongside usual waiting list care. It should only be offered after an initial assessment in primary care or by specialist eating disorder services. Evidence showed fewer binge-eating episodes and reduced symptom severity compared with those on waiting lists. Digital CBTe and Worth Warrior require more evidence.
Last reviewed: January 2026
Early value assessment of digital platforms enabling adults with cardiovascular disease (CVD) to complete cardiac rehabilitation at home. CVD affects over 7.6 million people in the UK. In 2023, only 41% of eligible people with acute coronary syndrome and 13% of those with heart failure participated in cardiac rehabilitation.
What changed:
- December 2025 (new guidance, early value assessment): Seven digital technologies conditionally recommended for NHS use during a 3-year evidence generation period: Activate Your Heart, D REACH-HF, Digital Heart Manual, Gro Health HeartBuddy, KiActiv, myHeart, and Pumping Marvellous Cardiac Rehab Platform. Five additional platforms require more research and should only be used in research settings.
Last reviewed: December 2025
Early value assessment of AI-powered chatbots or digital triage tools that gather service user information before NHS Talking Therapies for anxiety and depression assessments. In 2022–23, over 1.76 million people were referred to NHS Talking Therapies in England.
What changed:
- July 2025 (new guidance, early value assessment): Two technologies recommended: Limbic Access (an AI chatbot currently used by about 40% of NHS Talking Therapies services) and Wysa Digital Referral Assistant. A third technology, Censeo Digital, was removed after the MHRA issued a Field Safety Notice in January 2025 and the company confirmed it had left the UK market.
Last reviewed: July 2025
Early value assessment of digital therapies for chronic tic disorders and Tourette syndrome. When both motor and vocal tics are present for more than one year, the condition is classified as Tourette syndrome.
What changed:
- May 2025 (new guidance, early value assessment): ORBIT recommended for use alongside standard care in the NHS during a 3-year evidence generation period for children and young people aged 9–17 with chronic tic disorders and Tourette syndrome. Clinical evidence suggests ORBIT may reduce tic severity and improve everyday functioning. Neupulse could not be recommended in the final guidance because it does not yet have appropriate regulatory approval (CE/UKCA marking expected in 2026).
Last reviewed: May 2025
AI technologies for assessing and triaging skin lesions referred to the urgent suspected skin cancer pathway
Early value assessment of DERM (Deep Ensemble for Recognition of Malignancy), an AI technology designed to be used within secondary care teledermatology services to identify and triage non-cancer lesions out of the urgent suspected skin cancer pathway.
What changed:
- May 2025 (new guidance, early value assessment): DERM approved for use within NHS teledermatology services during a 3-year evidence generation period. Important caveats: evidence is mostly from people with white skin; a healthcare professional review is required for people with black or brown skin; regular monitoring of DERM's accuracy is mandatory; a national governance framework is needed for local oversight.
Last reviewed: May 2025
Late-stage assessment of slide sheets used to move or reposition patients on or from a bed or another surface. Around 2.3 million slide sheets are purchased per year, with spending exceeding £6.38 million in 2024.
What changed:
- April 2025 (new guidance, late-stage assessment): The clinical evidence on different slide sheet features is limited and of poor quality. Key findings: washable slide sheets may save money compared with disposable or single-patient-use sheets, but only if an effective laundry system is in place. Slide sheets that remain under the person (in situ) may save money and have benefits for both the carer and patient when used for longer periods in the community.
Last reviewed: April 2025
3. Quality Standards (QS): 2023–2025
Quality standard setting priority quality improvement areas for recognition, assessment and early management of sepsis in non-pregnant adults.
What changed:
- November 2025 (new quality standard): Aligned with the new NG253 sepsis guideline.
Last reviewed: November 2025
Quality standard on assessment and management of head injury across all care settings.
What changed:
- October 2025: Updated quality standard aligned with current clinical guideline recommendations.
Last reviewed: October 2025
Quality standard on diagnosis and management of chronic heart failure in adults.
What changed:
- September 2025: Updated to reflect the major NG106 overhaul, including updated quality statements on pharmacological treatment.
Last reviewed: September 2025
Quality standard on diagnosis and management of pneumonia.
What changed:
- September 2025: Updated to align with NG250, reflecting changes to antibiotic duration and new corticosteroid recommendations.
Last reviewed: September 2025
Quality standard on prevention and management of overweight and obesity.
What changed:
- August 2025 (new quality standard): Aligned with NG246. Sets priority areas for person-centred approaches, access to behavioural interventions, and pharmacological treatment pathways.
Last reviewed: August 2025
Quality standard on CVD risk assessment and lipid management.
What changed:
- July 2025: Updated quality standard on CVD risk assessment and management.
Last reviewed: July 2025
Quality standard on falls assessment and prevention.
What changed:
- April 2025: Updated to reflect NG249. Includes quality statements on identifying people at risk, multifactorial assessment, and falls prevention exercise programmes.
Last reviewed: April 2025
Quality standard on epilepsy care including timely diagnosis, appropriate anti-seizure medication choices, and specialist review.
What changed:
- December 2023 (published): Aligned with NG217. Note: published before the January 2025 valproate/topiramate safety update to the parent guideline.
Last reviewed: December 2023
Quality standard on assessment and initial management of suspected acute respiratory infection in adults.
What changed:
- October 2023 (published): Aligned with NG237. Includes statements on antibiotic prescribing and point-of-care CRP testing.
Last reviewed: October 2023
4. Technology Appraisals (TA): Updated 2025–2026
Covers the use of targeted-release budesonide (Kinpeygo) as an add-on to optimised standard care for adults with primary IgA nephropathy at risk of disease progression. IgA nephropathy is the most common form of glomerulonephritis worldwide.
What changed:
- February 2026: This appraisal updates and replaces TA937 (December 2023). The key change is an expansion of eligibility to a broader patient population. Previously recommended only for adults with a UPCR of 170 mg/mmol or more; the updated recommendation now extends to adults with a UPCR of 90 mg/mmol or more, or a urine protein excretion of 1.0 g/day or more. Evidence from the NefIgArd phase 3 trial showed a clinically relevant reduction in eGFR decline compared with placebo over two years. A commercial arrangement is in place. This is a secondary care prescribing decision.
Last reviewed: 12 February 2026
Covers the use of obinutuzumab (Gazyvaro) in combination with mycophenolate mofetil for treating active lupus nephritis in adults. Lupus nephritis is the most severe organ-threatening manifestation of systemic lupus erythematosus (SLE), occurring in up to 60% of people with SLE. The condition disproportionately affects women and people from Asian and Black African or Caribbean backgrounds.
What changed:
- February 2026 (new appraisal): Obinutuzumab recommended as an option to treat active class 3 or 4 (with or without class 5) lupus nephritis in adults, in combination with mycophenolate mofetil. The recommendation is based on evidence from the phase 3 REGENCY trial, which showed that 46% of patients receiving obinutuzumab achieved complete renal response compared with 33% on standard treatment alone. NHS England has made obinutuzumab available through the Innovative Medicines Fund. This could benefit approximately 12,000 people in England with lupus nephritis. This is a secondary care prescribing decision.
Last reviewed: 12 February 2026