Development of Clinical Practice Guidelines for the NHS

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

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

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

Clinical guidelines cover...

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

Guidelines should be:

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

Development Process

1.

Topic Selection 2.

Scope 3.

Workplan 4.

Development of the guideline (GDG) 5.

Validation 6.

Dissemination 7.

Update

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.

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 Children’s Health  Patient Involvement Unit

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".

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.”

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.

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

3. Workplan

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

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

Role of GDG

Oversee, contribute to and agree ...

 Clinical questions  Search strategy  Consensus opinion  Patient and carer involvement  Recommendations  Final documents.

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.

   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.

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.

6. Dissemination

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

7. Update

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

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

Who is involved in the dental recall guideline?

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

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

Timelines

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