Independent content logo

Guidance continually needs to be updated to ensure that it remains credible, relevant, and aligned with the latest evidence. NICE routinely assesses its guidelines every 5 years to check that they are up to date, and guidelines are also assessed and updated in response to relevant events, (for example, changes in legislation, publication of new evidence, changes in the licensing status of medicines, development of related guidance, or drug safety updates).1

Healthcare professionals (HCPs) need to stay on top of new and updated guidance to ensure that the care they provide is based on the best evidence available. Given that NICE alone has over 270 guidelines (not to mention the number of additional guidelines developed by independent professional bodies) it can be challenging to fit this in alongside all of the other requirements of a clinical role. 

One of the main aims of Guidelines in Practice is to support HCPs with keeping abreast of and implementing the latest clinical guidance. Our Key learning points article series has been designed to distil the key information HCPs in primary care need to know about new and updated guidance. In this issue we have included two articles of this type on very different topics: uncontrolled and severe asthma, and physical activity in osteoporosis. 

Dr Mark L Levy provides five key learning points on diagnosing and managing difficult-to-treat and severe asthma, and identifying patients who should be referred to a specialist asthma service. Certain aspects of management apply to all patients with asthma, but those with uncontrolled, difficult-to-treat, and severe asthma will require additional care. Modifiable risk factors present in a high proportion of patients with difficult-to-treat asthma; identifying a patient’s modifiable risk factors presents the clinician with an opportunity to optimise care, improve asthma control, and increase the chance of better outcomes. Patients whose asthma remains difficult-to-treat, and patients who have possible severe asthma, should be referred to specialist asthma services—Dr Levy emphasises that: ‘tragic outcomes occur when the diagnosis of severe or difficult-to-treat asthma is not recognised and there is failure to refer to specialists.’ 

Sarah Leyland, Virginia Wakefield, and Dr Zoe Paskins identify six take-home messages for primary care clinicians from the Royal Osteoporosis Society (ROS) publication Strong, steady and straight—an expert consensus statement on physical activity and exercise for osteoporosis. Many patients with osteoporosis fear that movement could cause injury, but they should be encouraged to exercise to promote bone strength. Healthcare professionals should reassure patients that the benefits of exercise outweigh the risks, and support them to exercise in line with their individual needs; patients who are otherwise fit should prioritise ‘strong’, frail or falling patients should start with ‘steady’, while patients who have back pain or other vertebral fracture symptoms should focus on ‘straight’ exercises. 

Vertebral trabecular bone

Key learning points: physical activity in osteoporosis

Sarah Leyland, Virginia Wakefield, and Dr Zoe Paskins

Guidelines Live is another way in which we aim to support you with updating your knowledge on guidance. This 2-day conference brings together specialists and generalists to share guidance and inform changes to clinical practice; Guidelines Live event organiser, Valerie Benfield, answers questions about this year’s event.

In the Top tips article on anxiety disorders, Dr Ed Beveridge offers ten top tips on the diagnosis, management, and treatment of adults with anxiety disorders in primary care, in line with recommendations from relevant guidelines. Anxiety disorders are a common form of mental illness but they respond well to treatment and can be managed in primary care. Anxiety is a symptom rather than an illness in its own right, so patients presenting with anxiety should have a thorough mental and physical health assessment to screen for depression, psychosis, post-traumatic stress disorder, dementia, and substance abuse. The mainstays of treatment are self-help, bibliotherapy, and cognitive behavioural therapy, but pharmacological treatments may be beneficial in some cases.

Muhummad Sidiqur Rahman discusses how and why prescribing rights have been extended over the years to include different professions, represented pictorially with a summary timeline. He also highlights the impact of the Clinical pharmacists in general practice programme, and summarises the aims of a competency framework for prescribers published by the Royal Pharmaceutical Society.


  1. NICE. Developing NICE guidelines: the manual. Ensuring that published guidelines are current and accurate. Process and methods guideline 20. NICE, 2014 (updated 2018). Available at: