Development of Clinical Practice Guidelines for the NHS

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Development of Clinical Practice Guidelines for
the NHS

• Dr Jacqueline Dutchak, Director
• National Collaborating Centre for Acute Care
• 16 January 2004

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NCC-AC

• One of seven Centres set up by NICE in April 2001
• Based at the Royal College of Surgeons of England
• Staff team comprises systematic reviewers, health
  economists, statisticians and information
  scientists
• Commissioned by NICE to produce clinical
  guidelines for the NHS

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Clinical guidelines are...

• recommendations for the care of individuals by
  healthcare professionals
• based on the best available evidence
• advisory they assist the practice of healthcare
  professionals, but do not replace their knowledge
  and skills

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Clinical guidelines cover...

• management of diseases/conditions
• any aspect of management from prevention
  self-care through primary and secondary care to
  more specialised services

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Guidelines should be

• Valid
• Reproducible
• Cost-effective
• Representative/multidisciplinary
• Clinically applicable
• Flexible
• Clear
• Reviewable
• Amenable to clinical audit

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Development Process

1. Topic Selection
2. Scope
3. Workplan
4. Development of the guideline (GDG)
5. Validation
6. Dissemination
7. Update

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1. Topic selection

• Topics selected by the Dept of Health and
  National Assembly for Wales
• Criteria
• Potential to improve health
• Need to reduce variations in clinical practice
• Link with Government priorities.

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Topics allocated to NCCs...

• Seven National Collaborating Centres
• NCC Acute Care
• NCC Cancer
• NCC Chronic Care
• NCC Mental Health
• NCC Nursing and Supportive Care
• NCC Primary Care
• NCC Women and Childrens Health
• Patient Involvement Unit

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NICE delivers remit to the NCC

• "To prepare clinical guidelines for the NHS in
  England and Wales for the diagnosis and treatment
  of lung cancer. This is to supplement the
  existing service guidance published by DH in 1998
  and this commission replaces the earlier
  commission to update that guidance".

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Another remit.

• To prepare guidance for the NHS in England and
  Wales, on the clinical and cost effectiveness of
  a dental recall examination for all patients at
  an interval based on the risk from oral disease.

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2. Scope

• Prepared by the NCC and it outlines ...
• Aspects of care to be covered
• Background epidemiology
• Population covered
• Healthcare settings covered
• Diagnostic procedures, treatments and
  interventions to be included or excluded.
• Must be a manageable size.

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• Submit Draft Scope to NICE
• Consultation with stakeholders (4 wks)
• Scope modified
• Final scope (and comments) on website
• Cannot normally be changed after this.

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3. Workplan

• NCC prepare a workplan setting out...
• GDG membership
• Development process
• Timescales
• Costings
• Agreed with NICE following negotiation.

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The GDG

• Multidisciplinary participation is essential to
  ensure
• Proper evaluation and interpretation of
  specialty-specific evidence
• Relevance to the realities of everyday practice
• Ownership and cooperation of all stakeholder
  groups
• Patient views and preferences are heard

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Role of GDG

• Oversee, contribute to and agree ...
• Clinical questions
• Search strategy
• Consensus opinion
• Patient and carer involvement
• Recommendations
• Final documents.

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4. Development

• Define clinical questions (inform search)
• Identify evidence (literature search)
• Hierarchy of evidence
• Systematic Reviews
• RCTs
• Other well-designed studies
• Expert opinion
• Assess synthesise evidence.

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• Translate evidence into recommendations
• - Graded A, B, C or Good practice point,
  depending on strength of evidence
• Consensus opinion in important areas where there
  is no evidence
• Formal consensus methods or GDG contribution
• Prepare final guideline documents
• Full Guideline
• Algorithms where appropriate.

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5. Validation

• First Draft submitted to NICE - Full version
• 4 weeks consultation stakeholders
• Second draft prepared by NCC
• 4 weeks consultation stakeholders, website,
  guidelines committee, NICE
• Final draft prepared by NCC
• Ratified by NICE.

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6. Dissemination

• NCC publish full guideline
• NICE publish short from and patient version
• Disseminated throughout the NHS
• All versions available on NICE website.

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7. Update

• 2-3 years depending on changes in the available
  evidence
• Same or different development group.

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Dental recall recall interval between routine
dental examinations

• Remit received from NICE in summer 2002
• Scope drafted in early autumn and stakeholder
  meeting held in November 2002
• Guideline development group convened and first
  meeting in January 2003
• Final meeting in January 2004
• First draft submitted to NICE in February

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Who is involved in the dental recall guideline?

• Systematic reviewing staff
• NCC-AC
• Cochrane Oral Health Group
• International Centre for Evidence Based
  Periodontal Health

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Guideline Development Group

• Dentists and dental hygienists representing NHS
  and mixed practices
• Periodontologist
• Researchers
• Patient representatives
• Groups represented include
• BDA, FDS, FGDP, Centre for Evidence Based
  Dentistry, British Society of Periodontology

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Timelines

• First draft out for stakeholder consultation
• 24th February to 23rd March 2004
• Second draft our for consultation
• 3rd May to 31st May 2004
• Published
• September 2004