From guidance to practice: Why NICE is not enough
BMJ 2002; 324 doi: https://doi.org/10.1136/bmj.324.7341.842 (Published 06 April 2002) Cite this as: BMJ 2002;324:842All rapid responses
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Dear Sir:
Clinical excellence has an important role in the health service. Health professionals are expected to take it fully into account when exercising their clinical judgment.
Expectations and universal implementation of clinical excellence are largely different. They need more initiatives to fill the gaps in health service. Implementation of timely guidance and proper training will give a better chance to strengthen the service.
Feedback, pilot monitoring and supervision are expected to promote better understanding of clinical excellence.
Competing interests: No competing interests
BMJ readers may be interested in additional perspectives on NICE following the recent article by Dent and Sadler1. Our attempts to integrate NICE guidance with the decision-making, service planning and monitoring processes in the East Riding and Hull area have been published and confirm some of the their findings2.
We identified four main contributory causes for the limited progress including money, time, feasibility and lack of information. Whilst supportive of the NICE, we felt that it needed to be augmented by thousands of LICE (local institutes of clinical excellence) in order to succeed in its aims of faster and equitable uptake of new treatments.
The recent budget announcement offers opportunities but given the reorganisation of the NHS making the best use of extra money will require remarkable leadership to align the NICE agenda with local efforts, especially given the continuing focus on waiting lists and times.
Reference List
1. Dent T,.Sadler M. From guidance to practice: Why NICE is not enough. British Medical Journal 2002;BMJ2002:842-5.
2. Madhok R, Taylor A, Soltani H, Ireland K. NICE and LICE: lessons from a health district. Journal of Public Health Medicine 2002;24:2-5.
Competing interests: No competing interests
Not So NICE
(Further to the article by Dent & Sadler, BMJ 2002 842-845)
If the NHS is even to begin to feel ownership of the NICE guidelines, they should be referenced, but they are not. The effect is that NICE guidelines must be trusted or believed as they cannot be checked easily. This is not a good time to ask doctors to base their practice on trust, particularly as nearly one third of the NICE Approval Committee members are managers and all the medical members are usually giving opinions outside their area of expertise. I understand experts in the field under consideration tend to be consulted for approval only and late in the process. Few of us would look for the best treatment for our mother like this.
I have written to NICE about referencing, Chief Executive, Andrew Dillon, replied ‘Our view is that to reference it would clutter the text unnecessarily’. I think he is wrong, proper referencing is essential for us to feel ownership. It does not ‘clutter’ the BMJ, nor the other medical journals we read.
Yours sincerely
Dr. Michael Prendergast FRCP FRCPsych FRCPCH DCH
Consultant Child & Teenage Psychiatrist
Competing interests: No competing interests