As if 2015 wasn’t tricky enough for GPs to negotiate - both clinically and otherwise - 2016 is likely to throw up yet more potential changes to the way they assess and treat their patients. Here, in no particular order, are some of the things GPs should be looking out for over the forthcoming 12 months. 1. NICE asthma guidelines NICE’s first foray into asthma guidance covers diagnosis and monitoring only. The draft version, published last year, controversially recommended GPs employ a battery of testing to aid diagnosis, and was widely criticised. NICE then took the step of delaying publication of the final version (it was due to be published late 2015) in order to ‘allow additional time to work with commissioners and healthcare professionals in asthma care to make sure the recommendations can be introduced effectively and efficiently’. Despite the criticism and subsequent delay, a complete U-turn on the diagnostic recommendations would be surprising, and perhaps unlikely. Should the recommendations make the final version, GPs may well be left with a choice of following the stringent NICE guidelines when it comes to making a diagnosis of asthma, or the slightly less test-heavy approach of the BTS/SIGN guidance. 2. The NHS Diabetes Prevention Programme The scheme - a collaboration between Public Health England, NHS England and Diabetes UK - will encourage GPs to screen patients who are at high risk of developing diabetes, before referring for various lifestyle change interventions to prevent, or reduce the risk of, the development of type 2 diabetes. The programme will be launched nationally in April, with recent figures showing 78% of CCGs had signed up to be one of the first to implement it. But the evidence behind the initiative has been questioned by a number of GPs, while others have stated that the programme overmedicalises the population and will not significantly cut diabetes incidence. 3. New oral anticoagulants (NOACs) In December last year, the NICE QOF advisory panel proposed three new indicators for anticoagulation control in patients with atrial fibrillation – aiming to reward GPs for checking a patient’s control more regularly – in response to experts’ view that too many patients have poor anticoagulation control on warfarin. But with NICE’s own guideline on AF recommending the prescribing of a NOAC, which require far less frequent monitoring, instead of warfarin for patients unwilling to undergo regular monitoring, the proposed QOF additions could see more GPs being forced to prescribe the newer drugs if they are unable to provide, or patients unwilling to undergo, more regular monitoring. Given that the NOACs are still on patent, and therefore considerably more expensive than warfarin, there is a potential conflict for CCGs and prescribing leads between keeping costs under control, and ensuring patients achieve optimal anticoagulation control. 4. Cancer referral The new suspected cancer guidelines, published in 2015, lowered the referral threshold for a suspected cancer diagnosis, leading to claims cancer services would become overburdened, one which NICE refuted. This year should give some indication as to how services are coping with the new guidelines, and whether GPs are able to follow the referral guidelines or if their ability to refer is being restricted by provisions locally. 5. NICE multimorbidity guidelines An effort to give GPs guidance on managing complex patients with multiple conditions is slated to be published in September, with the draft expected sometime in March. Given that the NOACs are still on patent, and therefore considerably more expensive than warfarin, there is a potential conflict for CCGs and prescribing leads between keeping costs under control, and ensuring patients achieve optimal anticoagulation control.