📖 Clinical Guideline Library

Source: NICEView full guideline on NICE ↗ See full guideline on the NICE website. ClinicaliQ Editorial Note: Sourced and indexed from NICE. Always refer…

Source: NICEView full guideline on NICE ↗ See full guideline on the NICE website. ClinicaliQ Editorial Note: Sourced and indexed from NICE. Always refer…

Test for MSI-H/dMMR before treatment: All patients with advanced or recurrent endometrial cancer should undergo microsatellite instability or mismatch repair deficiency testing prior to…

Evaluation terminated: Brensocatib for non-CF bronchiectasis is no longer under NICE appraisal—do not initiate new treatment pathways for this indication pending alternative guidance from…

Consider ex-situ machine perfusion as an alternative to static cold storage for deceased donor livers, particularly for higher-risk grafts (extended criteria donors, prolonged cold…

This NICE evaluation was terminated, meaning lisocabtagene maraleucel is not currently recommended for routine NHS use in relapsed or refractory follicular lymphoma—do not commission…

Evaluation terminated – Rilzabrutinib for immune thrombocytopenia (ITP) is no longer under NICE appraisal; refer to current NICE guidance or your local ITP treatment…

Donidalorsen is recommended as a preventive treatment option for recurrent hereditary angioedema (HAE) attacks in patients aged 12 years and over – consider it…

First-line treatment option: Acalabrutinib combined with bendamustine and rituximab is recommended as a first-line treatment for untreated mantle cell lymphoma, offering an alternative to…

Use acalabrutinib with venetoclax ± obinutuzumab as first-line treatment for untreated CLL – this combination is recommended by NICE and offers improved outcomes compared…

Refer boys with DMD to orthopaedic services early to prevent contractures and maintain mobility—early intervention with stretching, splinting, and positioning can delay loss of…

Finerenone is recommended as an option for chronic heart failure with preserved or mildly reduced ejection fraction (HFpEF/HFmrEF) and can be initiated in primary…

Patient selection: Consider aficamten for symptomatic obstructive hypertrophic cardiomyopathy patients who remain symptomatic despite optimised standard therapy (beta-blockers, non-dihydropyridine calcium channel blockers, or disopyramide),…

Use the FRAX tool or DXA scan results to stratify fracture risk in adults aged 50+ with risk factors (prior fracture, corticosteroid use, family…

Netarsudil evaluation by NICE was terminated, indicating it is not recommended for routine use in NHS treatment pathways for open-angle glaucoma or ocular hypertension—continue…

Evaluation terminated – NICE discontinued appraisal of lutetium-177 vipivotide tetraxetan; this agent is not recommended for routine NHS use and should not be prescribed…

Deuruxolitinib is recommended as a treatment option for severe alopecia areata in adults—consider initiation in patients with extensive hair loss where conventional therapies have…

Pembrolizumab combined with chemoradiotherapy is recommended for untreated locally advanced cervical cancer, improving survival outcomes compared to chemoradiotherapy alone—consider this combination as first-line treatment…

Cemiplimab is recommended as a treatment option for patients with recurrent or metastatic cervical cancer only after progression on or following platinum-based chemotherapy—ensure prior…

First-line topical option: Glycopyrronium bromide cream is recommended as a first-line treatment for severe primary axillary hyperhidrosis in adults, offering an effective alternative to…

Teplizumab is recommended for people aged 8 years and over with stage 2 type 1 diabetes to delay progression to stage 3; discuss with…

Preoperative assessment: Systematically identify and optimise modifiable risk factors (cardiovascular, respiratory, renal function, anaemia, diabetes control) before elective surgery to reduce perioperative complications and…

Pirtobrutinib is recommended as a treatment option for relapsed or refractory chronic lymphocytic leukaemia (CLL) specifically in patients who have progressed on a prior…

Atogepant is recommended as a preventive treatment option for episodic migraine in adults; consider initiating in patients with ≥4 migraine days per month who…

Mirvetuximab soravtansine is recommended for platinum-resistant epithelial ovarian, fallopian tube, or primary peritoneal cancer in patients with folate receptor-alpha (FRα) positivity—confirm FRα status via…

Daratumumab in combination with bortezomib, lenalidomide and dexamethasone is recommended as a treatment option for newly diagnosed multiple myeloma patients who are ineligible for…

Seladelpar is recommended as an option for adults with primary biliary cholangitis (PBC) who have had an inadequate response to ursodeoxycholic acid (UDCA) and…

Serplulimab combined with carboplatin and etoposide is recommended as first-line treatment for untreated extensive-stage small-cell lung cancer (ES-SCLC) and should be considered for eligible…

Imlunestrant evaluation was terminated – NICE did not complete appraisal of imlunestrant for oestrogen receptor-positive HER2-negative advanced breast cancer; clinicians should refer to current…

Mepolizumab is recommended for patients with uncontrolled COPD and blood eosinophils ≥100 cells/μL; check eosinophil levels before initiating treatment as this is a mandatory…

First-line treatment option: Cemiplimab combined with platinum-based chemotherapy is recommended by NICE for patients with untreated advanced non-small-cell lung cancer (NSCLC), offering an evidence-based…

Tisotumab vedotin is recommended for cervical cancer patients with recurrent or metastatic disease that has progressed despite prior systemic treatment—consider this as a treatment…

Consider nusinersen or risdiplam early in SMA diagnosis – both are recommended treatment options for eligible patients and should be initiated promptly after confirmation,…

Nogapendekin alfa inbakicept combined with BCG is no longer recommended for BCG-unresponsive non-muscle-invasive bladder cancer with carcinoma in situ in the UK, as NICE…

Consider lisocabtagene maraleucel for patients with relapsed/refractory large B-cell lymphoma who have failed ≥2 prior systemic treatments and are ineligible for or have declined…

Durvalumab combined with chemotherapy should be offered as neoadjuvant treatment followed by surgery, then adjuvant durvalumab monotherapy for eligible patients with resectable gastric or…

Sotatercept is recommended as a treatment option for pulmonary arterial hypertension (PAH) in patients who meet NICE criteria; verify patient eligibility and existing PAH…

Use amivantamab with carboplatin and pemetrexed as first-line treatment for patients with advanced NSCLC harbouring EGFR exon 20 insertion mutations, following NICE appraisal recommendations…

Givinostat is recommended as an option for treating Duchenne muscular dystrophy in people aged 6 years and over – consider initiating this histone deacetylase…

Observe for biphasic reactions: Keep patients under clinical observation for at least 4-6 hours post-treatment, as up to 20% may experience a second wave…

Osimertinib is recommended by NICE for EGFR mutation-positive unresectable locally advanced NSCLC only after prior platinum-based chemoradiotherapy has been completed, making it a sequential…

Rozanolixizumab is recommended as an option for treating antibody-positive generalised myasthenia gravis (gMG) in adults—consider as an add-on therapy for patients with inadequate response…

Establish multidisciplinary team review at diagnosis and at key developmental stages (infancy, pre-school, school age, adolescence) to monitor for complications including spinal stenosis, foramen…

AI-assisted echocardiography can support faster preliminary analysis and reporting of echo images in heart failure patients, potentially reducing reporting delays and improving clinical workflow…

Oxybutynin is effective for neurogenic detrusor overactivity in patients aged 6+ years with spinal cord injury or spina bifida—consider as first-line antimuscarinic therapy for…

Zanidatamab is recommended by NICE as an option for HER2-positive advanced biliary tract cancer only after 1 or more prior lines of systemic treatment,…

Semaglutide is recommended for adults with established cardiovascular disease and overweight/obesity to reduce major adverse cardiovascular events – consider prescribing as part of a…

Test for BRAF V600E mutation in patients with advanced NSCLC before considering encorafenib plus binimetinib, as this combination is only recommended for mutation-positive disease…

Appraisal terminated: Inebilizumab appraisal was terminated by NICE; refer to current NICE guidance and your local formulary for up-to-date treatment recommendations for IgG4-related disease…

Use digital asthma self-management tools (apps, web platforms, wearables) as adjuncts to standard care to help patients monitor symptoms, track triggers, and improve medication…

Belantamab mafodotin combined with bortezomib and dexamethasone is recommended for previously treated multiple myeloma patients; consider this regimen when standard retreatment options have been…

Indicated for IDH-mutant gliomas post-surgery: Vorasidenib is recommended for astrocytoma or oligodendroglioma with confirmed IDH1 or IDH2 mutations in patients aged 12+ following surgical…

Sodium zirconium cyclosilicate is recommended as a treatment option for hyperkalaemia in adults and can be used for both acute management and chronic maintenance…

Ripretinib is recommended as an option for adults with advanced gastrointestinal stromal tumours who have received 3 or more prior kinase inhibitors – use…

Pembrolizumab is recommended as neoadjuvant treatment prior to surgery for resectable locally advanced head and neck squamous cell carcinoma, followed by adjuvant pembrolizumab to…

Consider transvenous embolisation in patients with spontaneous intracranial hypotension confirmed to have a cerebrospinal fluid–venous fistula, as it offers a targeted intervention when conservative…

This NICE publication is marked as a terminated appraisal, so it functions as a status notice rather than an active treatment recommendation for routine…

Digital spirometry algorithms can improve diagnostic accuracy for asthma and COPD in primary care and community diagnostic centres, potentially reducing unnecessary referrals to secondary…

Fezolinetant is recommended as an option for moderate to severe vasomotor symptoms (hot flushes and night sweats) in menopausal women when hormone replacement therapy…

Initial assessment in primary care: Offer semen analysis to men and check ovulation status (via progesterone blood test on day 21 of cycle) in…

GOLD 2025 updates COPD diagnosis criteria: spirometry FEV1/FVC

GINA 2024 reinforces no SABA-only treatment for any asthma severity: all patients should receive ICS-containing controller therapy or ICS-formoterol MART as first-line to reduce…

This EMA guideline addresses EMA Reflection Paper on Extrapolation of Efficacy in Oncology in Oncology. Use it to review current recommendation wording, eligibility criteria,…

This EHA guideline addresses 2023 EHA Guidelines on the Management of Myeloma in Haematology. Use it to review current recommendation wording, eligibility criteria, and…

This ESPGHAN guideline addresses 2022 ESPGHAN Guidelines on Coeliac Disease Diagnosis in Gastroenterology. Use it to review current recommendation wording, eligibility criteria, and implementation…

This EMA guideline addresses EMA Guideline on Clinical Investigation of Medicinal Products for Heart Failure in Cardiology / Cardiovascular. Use it to review current…

This EAN guideline addresses 2022 EAN/EFNS Guidelines on Dementia Diagnosis and Management in Neurology. Use it to review current recommendation wording, eligibility criteria, and…

This ERA guideline addresses 2022 ERA Guidelines on the Management of Chronic Kidney Disease in Nephrology. Use it to review current recommendation wording, eligibility…

This ESCMID guideline addresses 2022 ESCMID Guidelines on Candidaemia and Invasive Candidiasis in Infectious Disease. Use it to review current recommendation wording, eligibility criteria,…

This EAN guideline addresses 2023 EAN Guidelines on the Management of Multiple Sclerosis in Neurology. Use it to review current recommendation wording, eligibility criteria,…

This EAN guideline addresses 2022 EAN Guidelines on Epilepsy Management in Adults in Neurology. Use it to review current recommendation wording, eligibility criteria, and…

This EULAR guideline addresses 2023 EULAR Recommendations for Systemic Lupus Erythematosus in Rheumatology. Use it to review current recommendation wording, eligibility criteria, and implementation…

This ESCMID guideline addresses 2021 ESCMID Guidelines for the Management of Community-acquired Pneumonia in Respiratory / COPD / Asthma. Use it to review current…

Covers screening recommendations for average-risk and high-risk individuals • Provides guidance on diagnostic staging and pretreatment evaluation • Addresses surgical and neoadjuvant/adjuvant treatment approaches…

This EULAR guideline addresses 2022 EULAR Recommendations for the Management of Rheumatoid Arthritis in Rheumatology. Use it to review current recommendation wording, eligibility criteria,…

This EULAR guideline addresses 2023 EULAR Recommendations for the Management of Gout in Rheumatology. Use it to review current recommendation wording, eligibility criteria, and…

Focuses on multidisciplinary management of early breast cancer including surgery, radiation, and systemic therapy • Covers genetic testing recommendations (BRCA, PD-L1, HER2) and how…

Covers diagnostic workup and molecular profiling for metastatic non-small cell lung cancer (NSCLC) • Provides treatment algorithms based on biomarker status (EGFR, ALK, ROS1,…

This EASL guideline addresses 2023 EASL Clinical Practice Guidelines on Cirrhosis in Gastroenterology. Use it to review current recommendation wording, eligibility criteria, and implementation…

This EASL guideline addresses 2023 EASL-EASD-EASO Clinical Practice Guidelines for MASLD in Gastroenterology. Use it to review current recommendation wording, eligibility criteria, and implementation…

This EASD guideline addresses 2022 EASD/ESC Guidelines on Diabetes and Cardiovascular Disease in Diabetes / Metabolic. Use it to review current recommendation wording, eligibility…

This EASL guideline addresses 2022 EASL Clinical Practice Guidelines on Hepatitis C in Gastroenterology. Use it to review current recommendation wording, eligibility criteria, and…

This ERS guideline addresses 2022 ERS/ESC Guidelines on Pulmonary Hypertension in Respiratory / COPD / Asthma. Use it to review current recommendation wording, eligibility…

This ERS guideline addresses 2023 ERS Guidelines on Sleep-disordered Breathing in Respiratory / COPD / Asthma. Use it to review current recommendation wording, eligibility…

Joint consensus update prioritising SGLT2 inhibitors and GLP-1 receptor agonists based on cardiovascular and renal comorbidities. Introduces individualised glucose targets and deprescribing guidance.

Covers diagnosis and assessment of COPD exacerbations including severity grading • Provides recommendations for pharmacologic management (bronchodilators, steroids, antibiotics) • Addresses indications for non-invasive…

Covers diagnostic criteria for idiopathic pulmonary fibrosis (IPF) including HRCT patterns • Provides recommendations for antifibrotic therapy and patient selection • Addresses management of…

Covers risk stratification for sudden cardiac death and indications for ICD implantation • Provides management recommendations for ventricular tachycardia and ventricular fibrillation • Addresses…

Covers indications for cardiac pacing and cardiac resynchronization therapy (CRT) • Provides guidance on device selection, implantation techniques, and optimization • Addresses follow-up protocols,…

Covers AF classification, stroke risk assessment (CHA2DS2-VASc), and bleeding risk (HAS-BLED) • Provides recommendations for rate vs rhythm control strategies • Addresses anticoagulation choices…

Covers diagnostic criteria for infective endocarditis (Duke criteria) and appropriate imaging modalities • Provides antimicrobial treatment recommendations based on causative organisms and valve involvement…

Covers rapid diagnosis and risk stratification for acute coronary syndromes (ACS) including STEMI and NSTEMI • Provides evidence-based recommendations for reperfusion strategies (PCI vs…

Diagnose hidradenitis suppurativa clinically based on recurrent painful nodules, abscesses, sinus tracts, and scars localised to intertriginous areas (axillae, groin, inframammary folds), then assess…

Refer suspected BCC or SCC to specialist dermatology using 2-week wait pathway if diagnosis is clear; use urgent referral for lesions >4 mm depth,…

Prescribe topical benzoyl peroxide monotherapy for mild facial acne; for mild-to-moderate acne, combine benzoyl peroxide with a topical retinoid or topical antibiotic Prescribe oral…

Diagnose atopic eczema clinically based on itching, typical morphology and distribution, onset before age 2 years, and history of dry skin or atopic disease;…

Assess psoriasis severity using BSA, PASI, or clinical judgement; classify as mild (

Offer urine pregnancy test to all women presenting with abdominal pain or vaginal bleeding; proceed to transvaginal ultrasound if positive, using this as first-line…

Offer supervised pelvic floor muscle training programmes lasting at least 6 weeks as first-line treatment for stress urinary incontinence and mixed incontinence Prescribe antimuscarinics…

Diagnose PCOS using Rotterdam criteria (≥2 of: irregular periods, clinical/biochemical hyperandrogenism, or polycystic ovaries on ultrasound) after excluding other diagnoses, then assess cardiovascular risk…

Offer initial fertility assessment after one year of regular unprotected intercourse, or after six months if the woman is aged 36 years or over.…

Suspect endometriosis in women presenting with chronic pelvic pain, dysmenorrhoea, or deep dyspareunia; refer to gynaecology if symptoms persist after adequate trial of NSAIDs…

Diagnose menopause clinically in women aged ≥45 years presenting with vasomotor or genitourinary symptoms without routine FSH testing; reserve FSH testing only for those…

Refer men with testicular lump or swelling urgently to urology within 2 weeks without delaying for primary care ultrasound; perform scrotal ultrasound as first-line…

Take a sexual history exploring onset, severity, partner concerns and quality of life impact; simultaneously assess cardiovascular risk and screen for diabetes, hypertension, hyperlipidaemia,…

Measure serum testosterone between 08:00–11:00 on two separate occasions (repeat if initial result 9–12 nmol/L); confirm deficiency only when total testosterone

Obtain focused history and perform urinalysis (dipstick) to exclude urinary tract infection before further investigation in all men presenting with lower urinary tract symptoms.…

Offer PSA testing with risk calculators (such as ERSPC) to men aged 50–69 years on request, and to men aged 40–49 years with African…

Offer opt-out HIV testing in emergency departments, sexual health clinics, and antenatal services to maximise identification of undiagnosed HIV cases without requiring explicit patient…

Diagnose long COVID when symptoms persist for more than 4 weeks after acute COVID-19 infection and alternative diagnoses have been excluded; undertake baseline assessment…

Offer TB testing to all contacts of patients with active pulmonary or laryngeal TB within two weeks of case notification using IGRA (preferred) or…

For non-severe cellulitis in adults, prescribe oral flucloxacillin 500 mg four times daily; use cephalexin 500 mg four times daily if penicillin-allergic • For…

Use CRB65 score in primary care to stratify CAP severity (1 point each for confusion, respiratory rate ≥30, systolic BP

Do not treat asymptomatic bacteriuria in non-pregnant women or men with antibiotics • For uncomplicated cystitis in women, prescribe nitrofurantoin 100 mg twice daily…

Use qSOFA tool (altered mental state, systolic BP ≤100 mmHg, respiratory rate ≥22) or NEWS2 score to identify suspected sepsis in adults and escalate…

Confirm acute pancreatitis diagnosis using serum lipase (or amylase if unavailable) with characteristic clinical features; perform baseline assessment including FBC, U&Es, LFTs, glucose, calcium,…

Use Glasgow-Blatchford score at initial assessment to stratify risk and determine whether patients can be managed as outpatients or require admission Insert two large-bore…

Perform upper endoscopy to screen all cirrhosis patients for oesophageal varices; if present, offer variceal band ligation and initiate non-selective beta-blockers (propranolol or carvedilol)…

Assess all newly diagnosed chronic hepatitis B patients with HBsAg, anti-HBc, HBeAg, anti-HBe, quantitative HBV DNA, ALT, and liver function tests before treatment decisions…

Test for coeliac disease using tissue transglutaminase (tTG) IgA antibodies as first-line serology, with concurrent total IgA measurement; if IgA deficient, use IgG-based tests…

Offer structured dietary and lifestyle advice as first-line treatment, including consideration of a low FODMAP diet if standard measures are insufficient, before prescribing antispasmodics,…

Offer all patients with osteoarthritis structured information about self-management, weight management, and both land-based and aquatic exercise programmes as first-line treatment before considering pharmacological…

Diagnose SLE using combination of clinical features plus positive ANA with anti-dsDNA or anti-Smith antibodies, and refer to rheumatology if SLE suspected Screen all…

Refer adults to rheumatology if they present with chronic back pain (≥3 months) plus any of: inflammatory back pain features, elevated inflammatory markers, HLA-B27…

Refer to rheumatology for diagnostic assessment if psoriatic arthritis is suspected in patients with psoriasis and joint symptoms, regardless of psoriasis severity Start NSAIDs…

Diagnose acute gout clinically (sudden joint pain, erythema, swelling) and confirm with serum urate level plus polarising microscopy of synovial fluid showing needle-shaped monosodium…

Use DEXA scan to measure BMD in women aged ≥65 years, men aged ≥70 years, and younger adults with osteoporosis risk factors • Use…

Diagnose OCD and BDD through systematic assessment of intrusive thoughts, images or impulses combined with repetitive behaviours or mental acts that cause significant distress…

Conduct comprehensive psychosocial assessment within 48 hours of all self-harm presentations (including low-lethality harm) to inform risk stratification and care planning, followed by follow-up…

Use SCOFF questionnaire or validated screening tool in primary care to assess for weight loss, food restriction, compensatory behaviours and body image concerns when…

Offer trauma-focused cognitive behavioural therapy (TF-CBT) or eye movement desensitisation and reprocessing (EMDR) as first-line psychological treatment, delivered by trained practitioners for 8–12 sessions…

Refer suspected ADHD cases (presenting with inattention, hyperactivity, impulsivity, or functional impairment) to specialist services (paediatrician, psychiatrist, or specialist ADHD nurse) for diagnosis using…

Refer urgently to specialist psychiatry if bipolar disorder is suspected; diagnosis must be made by specialists using ICD-10 or DSM-5 criteria For acute mania…

Offer oral antipsychotics as first-line treatment for first-episode psychosis at the lowest effective dose, with long-acting injectables reserved for patients with adherence concerns or…

Obtain detailed witness account documenting prodrome, colour during episode, duration of unconsciousness, injury pattern, and postictal confusion to distinguish between syncope and seizure Perform…

Refer suspected MND urgently to a specialist neurology centre for diagnosis confirmation by an MND-experienced neurologist using clinical examination, EMG/NCS, imaging, and genetic testing…

Initiate mobilisation within 24 hours of stroke admission and perform swallowing assessment before allowing oral intake to prevent aspiration complications Deliver structured, task-specific, repetitive…

Take a focused history documenting headache onset, frequency, duration, severity, associated symptoms, and functional impact to distinguish primary headaches from secondary causes requiring investigation…

Initiate disease-modifying therapy (DMT) in all adults with relapsing-remitting MS immediately upon diagnosis using first-line agents (interferon beta, glatiramer acetate, or teriflunomide), escalating to…

Start levodopa at low dose with titration based on response in patients with early motor symptoms, or use dopamine agonists (ropinirole/pramipexole) as first-line in…

Refer urgently (two-week wait) any adult with unexplained persistent hoarseness, dysphagia, otalgia, oral ulceration lasting more than 3 weeks, or suspicious neck lump for…

Perform colposcopy with ≥4 biopsies from different quadrants for all abnormal cervical cytology results to establish histological diagnosis Stage all suspected invasive cervical cancer…

Refer urgently via suspected cancer pathway any patient with persistent lymphadenopathy (lymph nodes >1 cm short axis) or splenomegaly without clear infective cause lasting…

Proteasome inhibitors (bortezomib, carfilzomib) combined with immunomodulatory drugs (lenalidomide) and dexamethasone have become standard first-line therapy for transplant-eligible myeloma patients. Daratumumab (anti-CD38 monoclonal antibody)…

Blue light cystoscopy with hexaminolevinate improves detection of recurrent bladder tumours compared to white light cystoscopy alone, particularly for carcinoma in situ. Intravesical BCG…

Multimodal treatment with neoadjuvant chemotherapy followed by surgical resection improves survival for locally advanced oesophago-gastric junction and gastric adenocarcinomas. HER2 testing is mandatory for…

CT scan with pancreatic protocol (arterial and portal venous phase) is required for all suspected pancreatic cancer, with CA19-9 as supplementary tumour marker rather…

Excise primary melanomas with 2 cm margins if Breslow thickness ≤2 mm, or 1–2 cm margins if >2 mm, tailored to tumour characteristics and…

Perform CA125 blood test and pelvic ultrasound (including ovarian assessment) as first-line investigations in primary care when ovarian cancer is suspected based on persistent…

Offer PSA testing to men aged 50–69 years after informed discussion of benefits and harms; consider testing men aged 40–49 with family history or…

Refer adults with rectal bleeding plus abdominal pain, change in bowel habit, weight loss, iron-deficiency anaemia, or age >60 with unexplained symptoms for urgent…

Prescribe tirzepatide to adults with BMI ≥35 kg/m² or BMI 30–34.9 kg/m² with weight-related comorbidities, initiating treatment in specialist weight management services or trained…

Initiate semaglutide only in specialist obesity services or via shared care with clear primary-secondary care protocols for adults with BMI ≥30 kg/m² or BMI…

Perform a 2-hour 75 g OGTT between 24–28 weeks in women with GDM risk factors; diagnose GDM if fasting glucose ≥5.6 mmol/L or 2-hour…

Perform annual foot risk assessment using structured approach in all people with diabetes; stratify those with sensory neuropathy, reduced ankle mobility, or previous ulceration…

Use FIB-4 or NAFLD Fibrosis Score in primary care to stratify fibrosis risk in adults with metabolic risk factors (type 2 diabetes, obesity, metabolic…

Use BMI thresholds to identify obesity (≥30 kg/m² in adults; ≥27.5 kg/m² in Asian populations) and offer structured first-line weight loss interventions combining 600…

Initiate dupilumab in adults and adolescents aged 12+ with moderate-to-severe atopic dermatitis only when topical corticosteroids have failed or are inadvisable, using induction dose…

Initiate mepolizumab 100 mg subcutaneously once monthly only in adults with severe eosinophilic asthma inadequately controlled on high-dose inhaled corticosteroids plus long-acting beta-2 agonists,…

Suspect bronchiectasis in patients presenting with chronic productive cough or recurrent respiratory infections and refer for High-Resolution CT chest imaging; investigate all newly diagnosed…

Use STOP-BANG questionnaire in primary care to screen for OSAHS and refer to sleep services if clinical suspicion is high based on excessive daytime…

Suspect IPF in adults aged >50 presenting with unexplained progressive dyspnoea, cough, or fatigue with significant smoking history or occupational exposure, and refer urgently…

Initiate empagliflozin 10 mg once daily as add-on therapy to standard HFrEF treatment (ACE inhibitors, beta-blockers, and aldosterone antagonists) in adults with reduced ejection…

Offer TAVI as first-line intervention for symptomatic aortic stenosis in patients at high or prohibitive surgical risk, or with severe comorbidities precluding surgery, following…

Use FAST recognition (Face, Arms, Speech, Time) in primary care to identify suspected stroke and arrange immediate hospital admission as a medical emergency Assess…

Use ABPI measurement as first-line investigation in primary care; refer to secondary care if ABPI ≤0.9 • Prescribe aspirin 75 mg daily for all…

Perform CVD risk assessment using Framingham equation or QRISK3 in all adults aged 40–74 years; initiate atorvastatin 20 mg daily if 10-year risk ≥10%…

Use two-level Wells score or revised Geneva score combined with D-dimer testing in low-risk suspected PE; proceed directly to CT pulmonary angiography in high-risk…

Initiate all stable angina patients on beta-blocker or rate-limiting calcium channel blocker (diltiazem/verapamil) plus aspirin and high-intensity statin; add ACE inhibitor if left ventricular…

Use NT-BNP or BNP testing in primary care to rule out heart failure; refer urgently to secondary care if elevated with compatible symptoms, and…

Dupilumab is recommended for maintenance treatment of uncontrolled COPD only in patients with blood eosinophil count ≥400 cells/μL, as this biomarker predicts treatment response…

Abandon severity-based classification and instead assess each patient's individual need, preference, and symptom severity to personalise treatment selection • Offer explicit choice between psychological…

Initiate treatment with education and self-help resources (bibliotherapy); escalate to individual CBT or applied relaxation only if insufficient response • Prescribe sertraline as first-line…

Use cognitive testing (MMSE or MoCA) combined with appropriate imaging to confirm dementia diagnosis • Prescribe acetylcholinesterase inhibitors (donepezil, rivastigmine, or galantamine) for mild-moderate…

Refer patients with suspected first seizure to an epilepsy specialist within 2 weeks of presentation For focal onset seizures, initiate lamotrigine or levetiracetam as…

Perform triple assessment (clinical examination, imaging, and biopsy) for all suspicious breast lesions to confirm diagnosis before treatment planning Offer breast-conserving surgery with axillary…

Arrange urgent chest CT within 2 weeks for patients with suspected lung cancer via 2-week wait referral pathway Perform EGFR mutation testing for all…

Start methotrexate within 3 months of persistent synovitis diagnosis, combined with short-term bridging corticosteroids • Adopt treat-to-target strategy aiming for remission or low disease…

Treat mild-moderate ulcerative colitis with oral mesalazine and rectal 5-ASA as first-line therapy, and use prednisolone for induction of remission in moderate-severe disease Maintain…

Use prednisolone or budesonide as first-line induction therapy for active Crohn's disease, or consider exclusive enteral nutrition as an alternative induction strategy • Prescribe…

Document the clinical indication, dose, route, and planned review/stop date on every antibiotic prescription at the point of initiation Review all intravenous antibiotic therapy…

Diagnose hypertension using clinic BP ≥140/90 mmHg confirmed with ambulatory or home blood pressure monitoring, then initiate treatment if stage 1 hypertension with age…

Initiate dual antiplatelet therapy with aspirin plus ticagrelor or prasugrel for all NSTEMI patients unless contraindicated, continuing for 12 months post-ACS unless bleeding risk…

Use CHA2DS2-VASc score to stratify stroke risk and offer anticoagulation to men scoring ≥2 and women scoring ≥3 (consider treatment at scores of ≥1…

Initiate metformin as first-line therapy in type 2 diabetes unless eGFR

Offer multiple daily injection (MDI) basal-bolus insulin regimen as first-line treatment for all adults with type 1 diabetes, with continuous subcutaneous insulin infusion (CSII)…

Confirm COPD diagnosis with spirometry showing post-bronchodilator FEV1/FVC ratio

Diagnose asthma only with objective evidence of reversible airflow obstruction or bronchial hyperresponsiveness, not on clinical symptoms alone Initiate Step 2 treatment by adding…

Insert a catheter-based left ventricular microaxial flow pump in patients with acute cardiogenic shock refractory to medical therapy and inotropic support, as a bridge…

Percutaneous insertion of catheter-based left ventricular microaxial flow pumps may be considered for patients with acute cardiogenic shock refractory to medical therapy and intra-aortic…

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Use AI-assisted polyp detection systems during colonoscopy to improve adenoma detection rates, particularly in colonoscopists with baseline detection rates below 25% • Implement real-time…

Offer off-pump minimal access mitral valve repair with artificial chordae insertion to patients with mitral regurgitation who are suitable candidates and meet criteria for…

Offer ruxolitinib cream as a treatment option for non-segmental vitiligo in patients aged 12 years and over who have involvement of

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SQ-Bet SLIT is recommended for moderate to severe allergic rhinitis or conjunctivitis caused by tree pollen in patients aged ≥5 years, offering a non-pharmacological…

Use AI technologies as an adjunct to clinical assessment when triaging skin lesions in the urgent suspected cancer pathway, but do not use as…

Consider 12 SQ-HDM SLIT as a treatment option for patients with allergic rhinitis and/or allergic asthma caused by house dust mite sensitisation who have…

Consider digital technologies (apps, wearables, online programmes) as adjuncts to standard care for non-specific low back pain, particularly for patient engagement and self-management adherence…

Virtual reality exposure therapy (VRET) can be considered as an alternative to traditional in-vivo exposure for agoraphobia when patients refuse or are unable to…

Continuous fetal monitoring is recommended for women at high risk of intrapartum complications – use cardiotocography (CTG) for those with pre-existing maternal conditions, previous…

Use KardiaMobile 6L as a practical tool to monitor QT interval prolongation in adults on antipsychotic medications, enabling earlier detection of cardiac risk without…

Offer guided self-help digital CBT as a first-line intervention for children and young people presenting with mild to moderate anxiety or low mood symptoms,…

Perform cardiotocography (CTG) on admission in labour for all women, then use intermittent auscultation with handheld Doppler at 15-minute intervals during active labour in…

Initiate disease-modifying therapy early: Start DMTs as soon as MS diagnosis is confirmed in relapsing-remitting MS, regardless of disability level, to reduce relapse rates…

First-line treatment for mild-moderate acne: Prescribe topical retinoid (adapalene or tretinoin) as monotherapy, or combine with benzoyl peroxide or topical antibiotic to prevent bacterial…

Consider bempedoic acid with ezetimibe as a treatment option for patients with primary hypercholesterolaemia or mixed dyslipidaemia who are unable to tolerate statins or…

Conduct a comprehensive postnatal assessment within 24 hours of birth, including maternal physical examination, vital signs, and psychological wellbeing screening to identify complications early…

Intrapartum antibiotic prophylaxis is indicated for Group B Streptococcus (GBS)-positive mothers, those with unknown GBS status in preterm labour <37 weeks, or those with…

Use quantitative hCG and transvaginal ultrasound together – diagnose ectopic pregnancy by combining serial hCG measurements (48-hour rise <53% is concerning) with transvaginal scan…

First-line pharmacological treatment: Offer levonorgestrel-releasing intrauterine system (LNG-IUS) as first-line, or tranexamic acid/NSAIDs if LNG-IUS unsuitable; combined oral contraceptives are second-line options for those…

Assess fracture risk using FRAX or similar tool – Calculate 10-year probability of major osteoporotic fracture and hip fracture in all adults aged 50+…

Avoid routine imaging for non-specific low back pain: Do not order X-rays, CT, or MRI for uncomplicated low back pain without red flags, as…

Assess all patients with MASLD using FIB-4 index or transient elastography to stratify fibrosis risk—those with advanced fibrosis require specialist hepatology referral and more…

Diagnose menopause clinically in women aged 45+ with vasomotor symptoms (hot flushes, night sweats) or mood changes without requiring FSH testing; use FSH only…

Use NICE 2-week wait referral criteria for suspected cancer – refer patients with relevant red flag symptoms (e.g., unexplained weight loss, persistent cough, dysphagia,…

Offer initial fertility assessment and advice to all couples who have not conceived after 12 months of regular unprotected intercourse (or 6 months if…

Use serum beta-hCG measurement and transvaginal ultrasound as first-line investigations for suspected ectopic pregnancy or miscarriage; serial hCG levels help distinguish viable intrauterine pregnancy…

Offer antipsychotic medication as first-line treatment for first-episode psychosis, combined with psychosocial interventions (CBT and family therapy), as monotherapy with either oral or long-acting…

Refer women with persistent pelvic pain, abdominal bloating, early satiety, or increased abdominal size to gynaecology using the urgent suspected cancer pathway—do not rely…

Refer suspected lung cancer urgently – use the 2-week wait referral pathway for patients with symptoms suggestive of lung cancer (persistent cough, haemoptysis, chest…

Refer women with suspicious breast symptoms to breast specialist services urgently (within 2 weeks) if they meet NICE referral criteria, including persistent breast pain…

Recognise persistent symptoms requiring investigation: Report any persistent pelvic or abdominal pain, bloating, difficulty eating, or urinary/bowel changes lasting >2 weeks to your GP—these…

Refer patients with suspected advanced breast cancer urgently to specialist breast units for staging imaging (CT chest/abdomen/pelvis, bone scan) and multidisciplinary team assessment before…