Introduction The British Society of Gastroenterology (BSG) recently published guidelines on the diagnosis and management of lower gastrointestinal bleed (LGIB) – the first UK national guideline to concentrate on LGIB. Although comprehensive, these guidelines are demanding and pose a number of challenges to a district general hospital (DGH). Methods Over a 6 month period we reviewed the cases of all patients who presented to emergency department with LGIB and retrospectively applied the new guidelines to evaluate our current performance against the new BSG standards. We intended to expose which aspects of diagnosis and/or management a typical DGH may struggle with. Using the data in conjunction with the existing literature base and the experience of senior medical staff, we reconstructed a modified version of the guidelines with a view to implement them locally. Results In total, 113 patients met our selection criteria. Patients had an average Oakland risk score of 13. According to the BSG guidelines 54.87% of patients were correctly admitted or discharged. Of those correctly discharged, 30.43% received urgent outpatient endoscopic investigation. The average time till patients received outpatient investigation was 8 weeks. Of the 113, 5 patients were stratified as unstable LGIBs. 0.00% of these patients received CT angiography. In the absence of CTA, 2 of the 5 received urgent inpatient endoscopy. Of those correctly admitted, 20.51% received urgent inpatient colonoscopy. Average time till patients received urgent inpatient endoscopy was 2.88 days. Of 15 patients who required transfusion, 12 were correctly transfused. 57.80% of patients had warfarin or DOAC stopped at presentation. 5.26% of patients had anticoagulation correctly restarted following haemostasis. Similarly 40.00% of patients had aspirin stopped at presentation and 0.00% and 15.38% of patients had aspirin restarted correctly for primary and secondary prevention respectively. Conclusions Auditing against a new standard has revealed worrying data and highlights the importance of change to practice that these guideline provide. This is best seen with the improper management of patients on anticoagulant and antiplatelet agents. However, the guideline is arguably overly cautious and strict adherence would place significant strain on a DGH. We propose several amendments to the guideline such as redefining admission criteria and the approach to managing unstable LGIB. Our modified guideline shows minimum expected clinical practice that is conducive to high quality patient care within the limits of hospital resources.