What is the legal status of guidelines?

Fifty years ago the regius professor of physic at the University of Cambridge wrote in praise of medicine that its satisfaction lay “in the personal and individual character of its practice: the latitude with which a qualified doctor may exercise his own judgment, express his own opinions and practise his own art.”1 In the same year (1946) the BMA, sensing a threat to this latitude from proposals to establish a national health service, declared that “the medical profession should remain free to exercise the art and science of medicine according to its traditions, standards and knowledge … without interference.”2

Yet clinical practice is now governed by a vast array of regulations in the form of protocols, practice policies, clinical guidelines, and codes of practice. Their current ascendancy is not simply due to state intervention. It reflects a change in the balance of power within the framework adopted for the delivery of health care. Professional stewardship of clinical standards, health services, and the deployment …