This month 810,000 more patients just became eligible for GLP-1s, and many practices don’t know yet.

On 18 February, NICE published the biggest update to type 2 diabetes management in a decade.

That’s just one story this month. We’ve also got an AI stethoscope that detects heart failure 2.3× faster (but 70% of GPs stopped using it), a safety alert on GLP1s and a funding rule change that means more medicines are coming to the NHS. Here’s what’s inside:

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TRICORDER Trial  |  The Lancet.

In Star Trek, Dr McCoy could diagnose any condition by waving a handheld tricorder over a patient. No blood tests. No waiting lists. Just an instant readout: heart failure, arrhythmia, done.

Imperial College London just published the results of a trial called, yes, TRICORDER. An AI-powered stethoscope, tested across 205 NHS GP practices, that detects heart failure, atrial fibrillation, and valvular heart disease from a 15-second recording. The results, published in The Lancet tell a very Star Trek story: the technology works beautifully, but the humans aren’t quite ready for it.

When Clinicians Used It, They Found More Heart Disease

Among patients who received an AI stethoscope examination, detection increased 2.3× for heart failure, 3.5× for atrial fibrillation, and 1.9× for valvular heart disease compared to standard practice. McCoy would be impressed.

But 70% of Practices Stopped Using It

Here’s where the Enterprise hits an asteroid. Despite the diagnostic accuracy, overall heart failure detection rates were not significantly higher in the intervention group. The reason wasn’t the technology, it was uptake. Seventy percent of practices stopped using the device within 12 months.

The barriers were practical: extra steps in already-packed consultations, no EHR integration, and a high false-positive rate, two-thirds of patients flagged for suspected heart failure didn’t have it on further testing.

The Lesson: Innovation Without Integration Is Just a Gadget

The researchers recommend using the AI stethoscope for patients with symptoms of suspected heart conditions, not routine screening. Expanded rollout has begun across South London, Sussex, and Wales, but the next chapter won’t be about whether AI can detect heart disease. It’ll be about whether the NHS can build the workflow to let it.

Source: Kelshiker et al. Triple cardiovascular disease detection with an artificial intelligence-enabled stethoscope (TRICORDER). The Lancet, 2026.

The metformin-only starting point for type 2 diabetes is over.

On 18 February, NICE published a major update to NG28, what it calls the biggest shake-up in diabetes care in a decade. The core change: SGLT-2 inhibitors now move to first-line treatment alongside metformin for most newly diagnosed adults.

The shift is driven by two forces: consistent evidence that flozins reduce cardiovascular death, heart failure hospitalisations, and CKD progression independently of HbA1c - and the arrival of generic dapagliflozin, which NICE estimates will save the NHS £560 million over two years.

What’s Changed

Most patients: Metformin + SGLT-2 inhibitor from day one (introduced stepwise). If metformin isn’t tolerated, SGLT-2 inhibitor alone.

Established CVD: Triple therapy from the start: metformin + SGLT-2i + GLP-1 RA. Semaglutide (up to 1 mg/week) is the preferred GLP-1 RA.

Diagnosed under 40: Metformin + SGLT-2i, then consider adding GLP-1 RA or tirzepatide earlier due to higher lifetime risk.

Frailty: Metformin alone remains appropriate. DPP-4 inhibitor preferred over SGLT-2i if frailty increases adverse event risk.

Around 810,000 more people become eligible for GLP-1 RAs or tirzepatide as a result of these changes.

Why It Matters

NICE’s modelling suggests this could prevent approximately 17,000 deaths over three years. Their analysis also found SGLT-2 inhibitors are currently under-prescribed to women, older people, and Black patients.

In February 2026, the MHRA issued a highly specific safety alert regarding semaglutide (Ozempic, Wegovy, Rybelsus).

A rare but serious condition called NAION (essentially a "stroke of the eye") has been linked to semaglutide use.

While the risk is very rare, the MHRA has mandated that clinicians include vision checks in their safety-netting conversations.

Advise all patients on semaglutide to seek urgent medical attention for sudden vision loss, even in one eye.

Want a handy poster to help patients recognise the signs and symptoms associated with GLP-1s? Visit the website to download.

For 26 years, NICE has used the same yardstick to decide whether a new medicine is worth funding: the cost-effectiveness threshold. From April 2026, that yardstick is changing for the first time, and prescribers will feel it.

The Threshold Is Going Up by 25%

NICE currently assesses whether a new treatment delivers enough health benefit to justify its cost: the quality-adjusted life year (QALY). A QALY combines how much longer a treatment helps someone live with the quality of that extra life. Until now, NICE has applied a cost-effectiveness range of £20,000–£30,000 per QALY gained. If a medicine costs more than that for each year of good-quality life it delivers, it typically won’t be recommended.

From April 2026, that range rises to £25,000–£35,000 per QALY. In practice, it means the NHS is willing to pay more for new medicines – treatments that were previously rejected on cost grounds may now get approved.

3–5 More Medicines Approved Each Year

NICE currently recommends around 91% of the medicines it evaluates – roughly 70 per year. Their own analysis suggests the new threshold could add an additional 3–5 approved medicines or indications annually.

For some appraisals already underway, NICE has paused decisions where the new threshold might change the outcome – meaning a batch of recommendations could land shortly after April.

This Is Part of a Bigger Deal

The threshold change didn’t happen in isolation. It’s part of the UK–US Economic Prosperity Agreement, which committed the UK government to investing around 25% more in innovative treatments. The pharmaceutical industry’s rebate rate under the VPAG scheme is also dropping from 22.9% to 14.5%, making the UK a more attractive market for drug launches.

The government estimates this will increase medicines spending by around £1.5 billion over three years. The NHS will not receive additional funding to cover this – the savings are expected to come from the rebate changes and broader efficiency gains.

It’s worth noting that some health economists have argued that NICE’s existing threshold was already too high relative to the real cost of NHS spending, and that raising it could displace more health than it creates.

A PharmacoEconomics analysis published in December 2025 estimated that medicines approved by NICE between 2000 and 2020 resulted in a net loss of approximately 1.25 million QALYs when displacement effects are factored in.

Either way, the practical effect is clear: the medicines pipeline to the NHS is widening, and primary care will be where many of these treatments land.

Source: NICE. Changes to NICE’s cost-effectiveness thresholds confirmed.

Childhood vaccination is supposed to be one of the most straightforward wins in public health. But a new study published in the BJGP reveals just how far uptake has fallen in some of the UK’s most diverse communities.

37,912 Children, 40 GP Practices, One Borough

Researchers analysed electronic health records for all children eligible for routine vaccinations by age 5 across 40 general practices in Lambeth, south London, between 2010 and 2023. Lambeth is one of the most ethnically diverse boroughs in England.

Just 61% of eligible children were fully vaccinated. Of those who were vaccinated, only 60.8% received their jabs on time - within three months of the scheduled age.

Ethnicity Predicted Under-Vaccination Across the Board

Compared with White British children, uptake was significantly lower across most ethnic minority groups; including, African, Caribbean, Pakistani, Indian, Chinese, and mixed heritage children. No ethnic group had significantly higher uptake than the White British reference group.

Deprivation played a role too, but the ethnic disparities persisted after adjusting for socioeconomic factors, suggesting structural barriers beyond poverty alone.

Children Already Seeing a GP Were More Likely to Be Vaccinated

One finding stood out: children with an existing primary care comorbidity had 58% higher odds of being fully vaccinated. The most likely explanation is simple, they were already in the building. Routine contact with general practice drives vaccination uptake.

What This Means for Your Practice

The UK Health Security Agency’s most recent data shows childhood vaccination rates declining nationally. This study puts real-world numbers on the gap and identifies which families are being missed. For practices serving diverse populations, it’s a prompt to review call/recall systems, consider targeted outreach, and ensure every child contact includes a vaccination status check.

Source: Basta K, Dodhia H, Crompton J et al. Predictors of childhood vaccination uptake and timeliness: a cross-sectional study in a diverse urban UK population. BJGP, February 2026