|Home | About | Journals | Submit | Contact Us | Français|
The clinical guidelines programme of the National Institute for Health and Clinical Excellence (NICE) is arguably the largest in the world and is unique in considering both cost effectiveness as well as clinical effectiveness. This article by Hill and Treasure is the first in a series to be published in the BMJ: each article will give a short account of key features of newly published NICE guidelines. The articles will particularly focus on areas where changes in current practice are recommended.
NICE guidelines are produced by an independent guideline development group. Its members include relevant clinicians, experts in areas such as systematic reviews and health economics, as well as at least two patients or carers. The development process is based on an internationally agreed methodology (box),1 2 and NICE has now published almost 50 clinical guidelines. In a recent survey, NICE's guideline on schizophrenia achieved a higher total score (and by a wide margin) on all internationally agreed elements of guideline development1 than any of the 26 other international guidelines on the same topic.3
There is no point, though, in developing clinical guidelines if they have no significant impact on patient care. Passive dissemination has only a limited effect, and barriers to implementation exist at several levels.4 Difficulties include a perceived lack of resources, clinicians' concerns about the undermining of their autonomy, ingrained practices, and general disagreement with the content.
NICE's implementation support programme aims to erode these concerns in three broad ways. Firstly, it provides practical help for organisations and individuals to overcome some of the initial barriers. These include templates to facilitate calculation of the likely costs and savings of putting a guideline into practice, interactive guides for commissioners based on guideline recommendations, a database of examples of effective implementation, as well as a small team of consultants to provide hands-on advice and support (www.nice.org.uk/usingGuidance).
Secondly, the programme seeks to generate “leverage” to encourage implementation by working with other organisations. These include the Healthcare Commission (an independent regulatory body that assesses organisations in England against the standards set in NICE guidelines) and organisations responsible for undergraduate and postgraduate education. The use of financial incentives is encouraged through the quality and outcomes framework, a mechanism for payment in primary care against a set of measurable indicators.
Thirdly, NICE believes it is particularly important to monitor progress and to identify and tackle the problem of barriers to change. It does this by referring to data on drug use, national audits, and published surveys and through feedback from the NICE implementation consultants. A recent example from a national audit showed that 85% of patients with lung cancer are now being seen by a multidisciplinary team, as recommended in the NICE guideline.5 All these findings are available on the NICE website (www.nice.org.uk/page.aspx?o=ernie).
As research evidence and medical knowledge continue to expand, the use of guidelines will increasingly become essential to inform day to day practice. Organisations such as NICE will therefore have a key responsibility for ensuring that their guidelines are up to date, in an accessible format, and available from a variety of sources.
Contributors: GL and MP had the idea for the article. GL and MR did the literature search and wrote the article. MP revised the article. GL is the guarantor.
Competing interests: None declared.