Letters Mistrust of clinical guidelines

NICE accredits guidelines using international AGREE criteria

BMJ 2013; 347 doi: http://dx.doi.org/10.1136/bmj.f4771 (Published 30 July 2013) Cite this as: BMJ 2013;347:f4771
  1. Gillian Leng, deputy chief executive1,
  2. Mark Baker, director, Centre for Clinical Practice1
  1. 1National Institute for Health and Care Excellence, London SW1A 2BU, UK
  1. gillian.leng{at}nice.org.uk

Guidelines are systematically developed statements designed to inform practitioners: they are not rules. They are designed to inform patient care by bringing together all the available evidence on a particular topic, but they do not replace the need for individualised patient care and will never apply in all situations. They provide a benchmark of best practice against which a clinician needs to make informed decisions with individual patients. When the advice in a guideline is considered inappropriate for a particular patient, this should be documented in the patient’s notes.

Of course, some guidelines will have been developed more rigorously than others.1 In 2009 the National Institute for Health and Care Excellence (NICE) established a formal guideline accreditation programme to help practitioners to identify guidelines that have been developed using international standards for guideline development (the AGREE instrument (appraisal of guidelines for research and evaluation); www.agreetrust.org).2 Guideline producers who meet these high standards are awarded an accreditation mark, which is displayed on paper copies and all online versions.

A core component of the accreditation criteria is the avoidance of bias, including a robust process for declaring conflicts of interest, in particular any financial interests. NICE guidelines meet all the AGREE criteria, and were formally accredited in 2009.

With the publication of hundreds of thousands of new research articles each year, guidelines are essential to help clinicians keep up to date with new evidence. These guidelines need to be high quality, unbiased, and developed according to international standards.


Cite this as: BMJ 2013;347:f4771


  • Competing interests: None declared.