Where UK practice differs

Medicine

• Stable chest pain: the first test is CT coronary angiography, not an exercise ECG.
• Hypertension is not diagnosed from clinic readings alone. Ambulatory or home monitoring must confirm it.
• First blood pressure drug: an ACE inhibitor or ARB under 55 or with type 2 diabetes; a calcium-channel blocker at 55 or over, or for an adult of Black African or African-Caribbean origin without diabetes.
• Heart failure with reduced ejection fraction: since 2025, NICE starts the four pillars together (ACE inhibitor, beta-blocker, MRA and SGLT2 inhibitor), without waiting to reach full doses one at a time.
• AF: stroke risk uses CHA2DS2-VASc and bleeding risk uses ORBIT. Aspirin is never used for stroke prevention in AF.
• No routine antibiotic prophylaxis before dental work for people at risk of endocarditis.
• Asthma: a new adult diagnosis starts with as-needed low-dose ICS-formoterol. Salbutamol alone is not offered, and the diagnosis needs an objective test such as FeNO.
• Type 2 diabetes: since 2026, modified-release metformin plus an SGLT2 inhibitor first for most people.
• H. pylori is tested with a breath or stool test, never serology, 2 weeks off a PPI.
• Upper GI bleeding: no PPI before endoscopy, and tranexamic acid is not used.
• VTE: apixaban or rivaroxaban first, with no routine thrombophilia testing after a provoked clot and no routine cancer screening after an unprovoked one.
• Epilepsy: valproate is not started in anyone under 55 unless two specialists agree.
• Pneumonia: 5 days of antibiotics in adults, and only 3 days of amoxicillin for non-severe pneumonia in children aged 3 months to 11 years.

Acute and surgical care

• Anaphylaxis: IM adrenaline is the treatment. Antihistamines and steroids are no longer part of the first-line sequence.
• Paracetamol overdose: a single treatment line from 100 mg/L at 4 hours, and acetylcysteine at once for a staggered overdose.
• Head injury on anticoagulants or antiplatelets (other than aspirin alone): consider a CT within 8 hours, even with no other signs.
• Major trauma goes to a major trauma centre, with whole-body CT in adults but not routinely in children.
• Renal colic: low-dose CT KUB within 24 hours and an NSAID, with no antispasmodics.
• Peripheral arterial disease: clopidogrel rather than aspirin, and supervised exercise before angioplasty.
• Low back pain: no paracetamol alone, no gabapentinoids, no opioids for chronic pain, no spinal injections and no acupuncture.
• Glaucoma: laser trabeculoplasty is offered before eye drops for new glaucoma.
• Impetigo: hydrogen peroxide 1% cream first for localised disease, before an antibiotic cream.
• Most ear infections and sore throats are managed without antibiotics, or with a back-up prescription.

Women's and sexual health

• Group B streptococcus is not screened for routinely. Antibiotics in labour are offered for specific risk factors.
• Obstetric cholestasis: ursodeoxycholic acid is no longer given to protect the baby.
• Chickenpox exposure in pregnancy: oral aciclovir first, not immunoglobulin.
• Heavy menstrual bleeding is defined by its effect on the woman's life, not a measured volume, and the LNG-IUS is first line with no structural cause.
• Cervical screening: HPV testing first, every 5 years if HPV negative.
• Chlamydia: doxycycline for 7 days, not single-dose azithromycin, outside pregnancy.
• Gonorrhoea: ceftriaxone 1 g IM alone. A test of cure is now only for set situations.
• Abortion: both medicines can be taken at home up to 10 weeks.

Child health

• The immunisation schedule changed in 2025 and 2026: MenB at 8 and 12 weeks, PCV at 16 weeks and 1 year, MMRV at 1 year and 18 months, and a new 18-month visit.
• Antipyretics are given for distress, not to lower a temperature or prevent febrile seizures. Paracetamol and ibuprofen are not given together.
• Bronchiolitis: supportive care only. No salbutamol, steroids or antibiotics.
• Croup: one dose of dexamethasone for every child with croup, whatever the severity.
• Bedwetting from age 5: an alarm first, with desmopressin for short-term control such as a sleepover.
• FGM in a girl under 18 is reported to the police by the doctor personally.

Mental health

• Depression is graded as less severe or more severe, and psychological treatment comes first for less severe depression.
• Self-harm: risk scales are not used to predict suicide or decide care. Everyone is offered a psychosocial assessment.
• Section 136 allows up to 24 hours in a place of safety, not 72.
• The Mental Health Act 2025 became law in December 2025, but most of it is not yet in force. Answers still follow the 1983 Act as amended.

Primary care and professional practice

• The GP is the gatekeeper: most specialist care starts with a GP referral, and suspected cancer is referred on NICE criteria.
• Death certification changed in September 2024: every death is reviewed by a medical examiner or coroner, and any doctor who attended in life can complete the MCCD.
• Consent follows Montgomery: tell the patient about material risks that a reasonable person, or this patient, would consider significant.
• The patient tells the DVLA about a condition that affects driving. The doctor does so only if the patient will not.
• Falls: ask everyone aged 65 or over, and people aged 50 to 64 at higher risk, about falls at routine contacts.