NICE CKS Round-Up — September 2026: Recent Updates for UK Primary Care

Seven topics were updated in September 2026, all of them scheduled reviews. One changes what you might prescribe: the palliative care cough topic no longer recommends weak opioids such as codeine for dry cough.

NICE Clinical Knowledge Summaries (CKS) are updated on a rolling basis. This round-up gives a one-line takeaway for each of the month's changes, with a link to the source. The authoritative record is the NICE CKS site; this is a summary for awareness, not a substitute for the topic page itself.

This is part of our monthly series — the August 2026 edition is here if you missed it.

The updates that matter this month

• Palliative care — cough. Reviewed against a July 2026 literature search. The recommendations have been updated in line with current evidence. The recommendation to use weak opioids such as codeine for dry cough has been removed, in line with evidence in the literature. Prescribing information on Pholcodine Linctus BP has been removed following its withdrawal from the UK market, and replaced with information on Simple Linctus BP. The Assessment section has been consolidated into one node, and web links to patient and carer information have been added. Takeaway: the one to read in full this month. If a weak opioid such as codeine has been your reflex for dry cough in palliative care, the topic no longer recommends it — check what it now advises before the next prescription. Our palliative care digest covers the wider evidence picture in this specialty.
• Otitis externa. Reviewed against an August 2026 literature search. The recommendations have been updated in line with current evidence. The term "malignant otitis externa" has been replaced with "necrotizing otitis externa", the preferred term in the ENT UK guideline. Takeaway: more than a change of name — the recommendations moved as well, so re-read the topic rather than assuming only the term changed. Necrotizing otitis externa is the term to search for, and the one to use in a referral.
• Heart failure — chronic. Reviewed against a May 2026 literature search. The classification of heart failure has changed, in line with the 2026 European Society of Cardiology (ESC) heart failure guidelines. No major changes to clinical recommendations have been made, and the topic has been restructured to improve flow and usability. Takeaway: a change of classification rather than of treatment. Check the topic for the categories now used before your next review or referral letter. For the NICE guideline itself, see our summary of the NG106 heart failure update.
• Vitamin D deficiency in adults. Reviewed against an August 2026 literature search. Two changes on pregnancy: the recommendation to seek specialist advice has been clarified, and a recommended daily dose to manage vitamin D deficiency in pregnancy has been added. Takeaway: relevant if you manage vitamin D deficiency in pregnancy. The dose is on the topic page — take it from there rather than from a summary.
• Haematospermia. Reviewed against a July 2026 literature search. Minor structural changes, including new sections summarising risk factors and complications. Minor additions and clarifications bring the recommendations into line with recent guidelines and expert opinion review articles. Takeaway: additions and clarifications rather than a change of direction.
• Gastroenteritis. Reviewed against a June 2026 literature search. No major changes to clinical recommendations. The topic has undergone minor restructuring to improve clarity and navigation. Takeaway: no practice change; the topic has been confirmed as current.
• Pruritus ani. Reviewed against an August to September 2026 literature search. No major changes to clinical recommendations. Some minor restructuring. Takeaway: no practice change; the topic has been confirmed as current.

How to use this

Three things are worth your time this month: the palliative care cough topic if you prescribe for cough in palliative care; the otitis externa topic, because its recommendations changed alongside the change of term; and the chronic heart failure topic if the classification you use day to day came from the previous version.

Everything else is awareness. A review that changes nothing still tells you something: the topic has been checked against a recent literature search and confirmed as current. NICE fully reviews every CKS topic on a five-year cycle, and sooner when significant new evidence appears.

We also summarise NICE guideline changes for primary care: suspected-cancer referral (NG12), hypertension (NG136) and asthma (NG245).

A note on what this post is — and is not

This is a summary for awareness. It is not a substitute for the NICE CKS topic pages, which are the authoritative and current source. Always confirm the recommendation on the CKS topic page before acting on it — that matters most for the palliative care cough, otitis externa and vitamin D changes above. Clinical decisions remain the responsibility of the treating clinician.