Punctuation, formatting and bullet points


Do not use block capitals as they are difficult for people to read.

The first letter of the first word in titles should be capitalised, the remainder in lower case except for proper nouns.

Exceptions to this rule include:

  • Acronyms should be explained at first use and capitals should be used for each word. For example, DLQI (Dermatology Life Quality Index).
  • Capitalise government legislation ('the Care Act 2014'). If the context is clear, refer to legislation as 'the Act' after the first mention.
  • Titles of projects or campaigns should have initial capitals (Active for Life, No Smoking Day).

Use lower case for all other text, including adjectival forms of proper nouns (caesarean, darwinian, parkinsonian) and words that derive from a proper name but that have passed into common use (braille, doppler, gram stain, hoover).

Note: X-ray has a capital X.

Use a lower case n and p for patient numbers (n=43) and p values (p=0.001).


Do not use italics for emphasis.

Italicise Latin names of bacteria, viruses and fungi (for example, 'test for S. typhimurium'). Do not italicise a virus name when used generically ('people with any hepatitis virus'). For more information see the Centers for Disease Control and Prevention's guide on scientific nomenclature.

Headings and subheadings

The editor in consultation with the guideline author(s) should decide what looks clearer for their content and apply the same format throughout.

Headings and subheadings should never be a smaller font size than the body text. Use ‘Subsection Title (H4)’ format throughout although the following may also be appropriate:

  • For sections of content with a lot of text to break up, ‘Info Panel’ format followed by ‘subsection title (H4)’ format can be a useful combination of headings.
  • ‘Section title (H3)’ format followed by ‘subsection title (H4)’ can also be used (but ‘info panel’ format may make things clearer).

As a general rule, do not use bold or italics for emphasis. Use headings and bullet lists instead, and structure your content logically. Where necessary, bold may be used within text for emphasis when it is not appropriate to use a heading.

Bullet points

This is a general guide and editors/authors should use their judgement to decide what style looks better for their particular content and take care to use the same approach throughout.

With the exception of task/process lists (see below) use bullet points to break up large chunks of text and to avoid long lists in sentences.

Do not use a bullet if you only have 1 item.

As a general rule there are two bullet styles, for short lists and long lists. For both types, every bullet should follow from the stem. An extra layer of bullets can be added if necessary.

Short lists should:

  • start with a lower case letter
  • not have a full stop
  • until the last bullet.

For longer lists, treat each bullet as a separate sentence:

  • Each bullet should start with a capital letter and end with a full stop.
  • You can include as many bullets as necessary in the list.

Aim to avoid more than one sentence in a bullet point but if more than one sentence needs to be used a full stop should be added at the end of each sentence.

Avoid ending a bullet point with "and" and "or".

Numbered lists

Use numbered lists instead of bullet points to guide a user through a process. Start each point with a capital letter and end with a full stop because each step should be a complete sentence.


How to gargle with salt water

  1. Dissolve half a teaspoon of salt in a glass of warm water.
  2. Gargle with the solution then spit it out – do not swallow it.
  3. Repeat as often as you like.


Use brackets sparingly and avoid them if you can for subclauses in sentences as they can be confusing.

Do not put 2 sets of brackets next to each other. Use 1 set of brackets and other punctuation like commas, semi-colons or dashes to separate the text: (23.4 compared with 56.9; p<0.05) instead of (23.4 compared with 56.9) (p<0.05).

For brackets within brackets, use round brackets then square brackets (like this [for example]).


Use a hyphen if not using one could cause confusion or it looks strange.

Always hyphenate 'non-'.

Do not hyphenate compound words in common use (healthcare, childcare, crossover, wellbeing, baseline, breastfeeding, birthweight).

Do not hyphenate prefixes like pre, post or peri.

Do not use hyphens for time and date ranges. Instead, use 'from ... to' or 'between ... and':

  • the ages ranged from 4 to 42 years
  • he usually went to bed between 10pm and 11pm
  • 95% confidence interval -78 to 87.


Use UK English spellings (for example, colour, tumour, authorise, optimise and leukaemia).

See the table below for some important examples and exceptions that are standard practice with national guideline organisations – e.g. NICE, SIGN.

Spellings –exceptions to UK English spelling rule.  

Do use

Do not use









Focused Focusing

Focussed Focussing













World Health Organization

World Health Organisation


Do not use negative contractions like can't and don't. Research from the Government Digital Service shows that many users find negative contractions harder to read and they sometimes misread them as the opposite of what they say.

You can use common positive contractions (like it's or you'll).

Drugs and medicines

The reference work for all medicines spellings is the British National Formulary.

Use generic names for drugs unless a brand name makes more sense in context (for example, in some information for the public). Use lower case for generic names and always say generic, not non-branded.

Avoid Latin phrases if there are clear English alternatives. If there is no simple English alternative (e.g. de novo, vice versa), do not italicise the Latin. Do not use shorthand dosing schedules ('as needed' not p.r.n.; '3 times daily' not t.d.s).


Avoid abbreviations whenever possible.

However, recognise that many common abbreviations are better known than what they stand for, so they do not need to be replaced by long hand or defined (in fact, to do either may make things less clear!). Use common sense and think about what the user is likely to be familiar with.

If it is necessary to use abbreviations that require definitions, provide the definition for each abbreviation the first time you use it in a section. For example, disease-modifying antirheumatic drugs (DMARDs).

Do not use the abbreviation if it only appears once, unless it's more commonly used than the full term.

Do not use full stops in abbreviations (US, NHS), contractions (Ms, Dr) or initials (Dr HJ Baker).

Numbers, units and symbols


Use numerals (including for 1 to 9) except when it's part of a common expression and it would look strange ('one of the first'). Use common sense.

Avoid long strings of zeros by spelling out millions and billions (£4.2 million not £4,200,000).

Use a comma for 4-digit numbers and above (4,000, 10,000).

If you need to write a minus (negative) number, use a hyphen.


Do not put a space around symbols (p<0.01; -12°C; p=0.012).

Do not leave a space between numbers and units (8ml, 37°C, 76%). This will prevent them from being split between lines of text.

Use the International System of Units (SI units) except for mmHg for blood pressure and other situations in which non-SI units are standard (for example, ml for millilitres). For some audiences you might want to use imperial measurements, for instance to describe weight. In these cases, always include the metric equivalent in brackets and spell out imperial units rather than abbreviating them (inches not ").

Be consistent throughout a document - do not use 100ml in one place and 0.1 litres in another.

Always spell out:

  • litre
  • microgram (the app doesn’t recognise the symbol)
  • microsecond

Repeat units in lists and ranges to avoid ambiguity (5%, 15% and 25%; 5 ml to 15 ml).

Date and time

For dates, use the format 3 June 2019. The format 3/6/2019 is okay to save space in a table. Use 2014/15 or 2014 to 2015 for ranges of years.

Write time in format 4:15pm.


Try not to use <, >, ≤, ≥, × (multiply) and = in text except for expressing p values and other measures of significance. You can use them in tables and pathways/ Q and A options if space is tight.



All internal links should be set to open in the same window.

Add pdfs and images to media files in the CMS to enable links through the app rather than to external or intranet sites.

Organise media files in folders according to their associated guidelines.

 DownloadThis icon should go to the right of any download links (sized at 20 pixels). It can be downloaded as a free icon and saved in media files. (This is available in the accessibility folder in the shared media area)

Do not tell the user to 'click here' or 'see here' when providing a hyperlink. Include enough information in the link for users to understand what it is and where it goes. Make sure the words in the link match the destination.

External links

  external linkThis icon should go to the right of any external link (sized at 20 pixels). It can be downloaded as a free icon and saved in media files. All external links open in a new window.  (This is available in the accessibility folder in the shared media area)

If the link is to a different guideline, pathway or document, make it clear the reader is going to be taken somewhere else by naming the organisation, and make it clear what they'll find when they get there, for example: see the section on preoperative rehabilitation in the NICE guideline on joint replacement or see NICE's topic page on anxiety.


If a guideline contains references add them in a separate content section within the guideline. If the author has not specified a referencing format, use Vancouver style as shown in the example below:

Kanneganti P, Harris JD, Brophy RH, Carey JL, Lattermann C, Flanigan DC. The effect of smoking on ligament and cartilage surgery in the knee: a systematic review. Am J Sports Med. 2012 40(12):2872-8. Available from: http://ajs.sagepub.com/content/40/12/2872 DOI: 10.1177/0363546512458223

Further examples of Vancouver style can be found in Citing and referencing Vancouver style.

Use superscript numbers within text to indicate the refence number, for example, reference1.

Include URLs and/or a Digital Object Identifier (DOI) of articles where available.

Style and structure

Active voice

Use the active rather than passive voice wherever possible.

For example – “Discuss the risks of perioperative and postoperative COVID-19 infection with patients, parents/carers…” rather than “The risks of perioperative and postoperative COVID-19 infection should be discussed with patients, parents/carers…”

Chunking content 

Try to break up digital content into easily digestible chunks. Use headings and subheadings to steer the user quickly to the content that will meet their needs.


Bring to the front of each section of content the most important information for the user.

Progressive disclosure

Sequence information and actions across several screens to lower the chances that users will feel overwhelmed by too much information.  By moving from critical information progressively to greater detail and associated tools and resources, you can help users to navigate complex content. 

Use white space  

Large sections of dense text are disengaging for the user. So in addition to chunking content into digestible sections, try to allow for plenty of white space that draws the user’s eye to the critical content.

Last reviewed: 23/09/2023

Next review date: 30/04/2024

Author(s): Ann Wales, Pauline Neison.

Version: 1.1

Author email(s): ann.wales3@nhs.scot.

Reviewer name(s): Ann Wales.