1. Development of Clinical Practice Guidelines for the NHS Dr Jacqueline Dutchak, Director National Collaborating Centre for Acute Care 16 January 2004

2. NCC-AC One of seven Centres set up by NICE in April 2001 One of seven Centres set up by NICE in April 2001 Based at the Royal College of Surgeons of England Based at the Royal College of Surgeons of England Staff team comprises systematic reviewers, health economists, statisticians and information scientists Staff team comprises systematic reviewers, health economists, statisticians and information scientists Commissioned by NICE to produce clinical guidelines for the NHS Commissioned by NICE to produce clinical guidelines for the NHS

3. Clinical guidelines are... recommendations for the care of individuals by healthcare professionals recommendations for the care of individuals by healthcare professionals based on the best available evidence based on the best available evidence advisory – they assist the practice of healthcare professionals, but do not replace their knowledge and skills advisory – they assist the practice of healthcare professionals, but do not replace their knowledge and skills

4. Clinical guidelines cover... management of diseases/conditions management of diseases/conditions any aspect of management from prevention & self-care through primary and secondary care to more specialised services any aspect of management from prevention & self-care through primary and secondary care to more specialised services

5. Guidelines should be: Valid Valid Reproducible Reproducible Cost-effective Cost-effective Representative/multidisciplinary Representative/multidisciplinary Clinically applicable Clinically applicable Flexible Flexible Clear Clear Reviewable Reviewable Amenable to clinical audit Amenable to clinical audit

6. Development Process 1. Topic Selection 2. Scope 3. Workplan 4. Development of the guideline (GDG) 5. Validation 6. Dissemination 7. Update

7. 1. Topic selection Topics selected by the Dept of Health and National Assembly for Wales Topics selected by the Dept of Health and National Assembly for Wales Criteria: Criteria: –Potential to improve health –Need to reduce variations in clinical practice –Link with Government priorities.

8. Topics allocated to NCCs... Seven National Collaborating Centres Seven National Collaborating Centres –NCC Acute Care –NCC Cancer –NCC Chronic Care –NCC Mental Health –NCC Nursing and Supportive Care –NCC Primary Care –NCC Women and Children’s Health Patient Involvement Unit Patient Involvement Unit

9. NICE delivers remit to the NCC… "To prepare clinical guidelines for the NHS in England and Wales for the diagnosis and treatment of lung cancer. This is to supplement the existing service guidance published by DH in 1998 and this commission replaces the earlier commission to update that guidance". "To prepare clinical guidelines for the NHS in England and Wales for the diagnosis and treatment of lung cancer. This is to supplement the existing service guidance published by DH in 1998 and this commission replaces the earlier commission to update that guidance".

10. Another remit…. “To prepare guidance for the NHS in England and Wales, on the clinical and cost effectiveness of a dental recall examination for all patients at an interval based on the risk from oral disease.” “To prepare guidance for the NHS in England and Wales, on the clinical and cost effectiveness of a dental recall examination for all patients at an interval based on the risk from oral disease.”

11. 2. Scope Prepared by the NCC and it outlines... Prepared by the NCC and it outlines... –Aspects of care to be covered –Background epidemiology –Population covered –Healthcare settings covered –Diagnostic procedures, treatments and interventions to be included or excluded. Must be a manageable size. Must be a manageable size.

12. Submit Draft Scope to NICE Submit Draft Scope to NICE Consultation with stakeholders (4 wks) Consultation with stakeholders (4 wks) Scope modified Scope modified Final scope (and comments) on website Final scope (and comments) on website Cannot normally be changed after this. Cannot normally be changed after this.

13. 3. Workplan NCC prepare a workplan setting out... NCC prepare a workplan setting out... –GDG membership –Development process –Timescales –Costings Agreed with NICE following negotiation. Agreed with NICE following negotiation.

14. The GDG Multidisciplinary participation is essential to ensure: Proper evaluation and interpretation of specialty- specific evidence Proper evaluation and interpretation of specialty- specific evidence Relevance to the realities of everyday practice Relevance to the realities of everyday practice Ownership and cooperation of all stakeholder groups Ownership and cooperation of all stakeholder groups Patient views and preferences are heard Patient views and preferences are heard

15. Role of GDG Oversee, contribute to and agree... Clinical questions Clinical questions Search strategy Search strategy Consensus opinion Consensus opinion Patient and carer involvement Patient and carer involvement Recommendations Recommendations Final documents. Final documents.

16. 4. Development  Define clinical questions (inform search)  Identify evidence (literature search)  Hierarchy of evidence:  Systematic Reviews  RCTs  Other well-designed studies  Expert opinion  Assess & synthesise evidence.

17. n Translate evidence into recommendations - Graded A, B, C or Good practice point, depending on strength of evidence n Consensus opinion in important areas where there is no evidence - Formal consensus methods or GDG contribution n Prepare final guideline documents - Full Guideline - Algorithms where appropriate.

18. 5. Validation First Draft submitted to NICE - Full version First Draft submitted to NICE - Full version 4 weeks consultation – stakeholders 4 weeks consultation – stakeholders Second draft prepared by NCC Second draft prepared by NCC 4 weeks consultation – stakeholders, website, guidelines committee, NICE 4 weeks consultation – stakeholders, website, guidelines committee, NICE Final draft prepared by NCC Final draft prepared by NCC Ratified by NICE. Ratified by NICE.

19. 6. Dissemination NCC publish full guideline NCC publish full guideline NICE publish short from and patient version NICE publish short from and patient version Disseminated throughout the NHS Disseminated throughout the NHS All versions available on NICE website. All versions available on NICE website.

20. 7. Update 2-3 years depending on changes in the available evidence 2-3 years depending on changes in the available evidence Same or different development group. Same or different development group.

21. Dental recall: recall interval between routine dental examinations Remit received from NICE in summer 2002 Remit received from NICE in summer 2002 Scope drafted in early autumn and stakeholder meeting held in November 2002 Scope drafted in early autumn and stakeholder meeting held in November 2002 Guideline development group convened and first meeting in January 2003 Guideline development group convened and first meeting in January 2003 Final meeting in January 2004 Final meeting in January 2004 First draft submitted to NICE in February First draft submitted to NICE in February

22. Who is involved in the dental recall guideline? Systematic reviewing staff: Systematic reviewing staff: –NCC-AC –Cochrane Oral Health Group –International Centre for Evidence Based Periodontal Health

23. Guideline Development Group Dentists and dental hygienists representing NHS and mixed practices Dentists and dental hygienists representing NHS and mixed practices Periodontologist Periodontologist Researchers Researchers Patient representatives Patient representatives Groups represented include: Groups represented include: –BDA, FDS, FGDP, Centre for Evidence Based Dentistry, British Society of Periodontology

24. Timelines First draft out for stakeholder consultation First draft out for stakeholder consultation –24 th February to 23 rd March 2004 Second draft our for consultation Second draft our for consultation –3 rd May to 31 st May 2004 Published Published –September 2004