Research findings are often poorly translated into clinical practice. One example is the management of acute myocardial infarction, where the evidence of the effectiveness of aspirin and early thrombolysis is overwhelming.1,2 Despite this the proportion of patients receiving the treatment may be low.3,4 Ensuring that patients receive the best possible care should be important for all doctors.

Should purchasers care as well? The NHS Executive thinks so and believes that the issue should be addressed through contracting. Last December all fundholding general practitioners, trusts, and health authorities received a letter from the executive urging them to take clinical effectiveness and clinical guidelines into account in contracting.5 Seven guidelines were attached for consideration, with the hope that purchasers would include at least one of them in their contracts.

The NHS Executive clearly believes that clinical effectiveness should form …