An ambitious national strategy

The NHS Executive has published its approach to the development, appraisal, and application of clinical guidelines.1 In principle, guidelines are attractive because of the potential of standardising clinical practice around an appropriate norm. Concerns about them include the amount of time and effort required to produce and update really good guidelines, the variable quality of existing guidelines, and the danger of inadvertently suppressing innovative or patient centred care by imposing an imperfect external standard.2 3 Many of these concerns have been addressed by the NHS Executive in its document, which conveys throughout a non-directive, “light touch” approach to the effectiveness initiative.

Clinical guidelines are defined as “systematically developed statements which assist clinicians and patients in making decisions about appropriate treatment for specific conditions,” a definition which is likely to be widely accepted. The authors advise against using the term “protocol” and reinforce the distinction between nationally and locally developed clinical guidelines. The status of guidelines as guidance, rather than …