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News – December 2005

Contents

NICE launches implementation guide in drive to improve uptake of its guidance

Identifying a clinical lead to champion the guideline is the first key step towards successful implementation, according to a new guide from NICE.

The clinical lead may also need input from a specialist group or network depending on the disease area.

How to put NICE guidance into practice sets out a pathway for implementing clinical guidelines. The guide was launched at the NICE annual conference in Birmingham, earlier this month, as part of the organisation’s ongoing drive to increase uptake of its guidance.

Once a clinical lead has been chosen, the next step is to undertake a baseline assessment to compare current practice with the guideline recommendations.

Patient numbers, staffing, equipment and training, budgets and service provision all need to be taken into consideration.

NICE recommends using its costing templates to assess the cost of implementation.

The next crucial stage is to develop an action plan setting out the steps that need to be taken to achieve compliance.

The plan then needs to be disseminated and implementation reviewed and monitored.

As well as giving practical advice on implementation the guide also contains information for commissioners to ensure that the services they receive are in line with NICE guidance.

“Our guidance must be both implementable and implemented,” said Professor Sir Michael Rawlins, chairman of NICE in his introduction to the conference.

“NICE guidance is being implemented but not at the rate or to the extent we would wish,” he added.

NICE’s implementation strategy has five strands: active engagement with the NHS, particularly in topic selection; dissemination; implementation tools such as costing templates and slide sets; education eg ensuring NICE guidance features in undergraduate, postgraduate and continuing professional development curricula; and evaluation.

“Evaluation is a polite term for describing the very active role that the Healthcare Commission will be taking in 2006 to ensure that the implementation of NICE guidance figures prominently in its clinical governance reviews of PCTs and hospital trusts,” explained Professor Rawlins.

Copies of the guide can be downloaded from the NICE website: www.nice.org.uk

Age no bar to treatment

Patients should not be denied effective treatments on the grounds of age. Clinical guidance should only recommend a treatment for a particular age group where there is clear evidence of a difference in that treatment’s effectiveness for that age group, according to a new report from NICE.

Copies of Social Value Judgements - Principles for the development of NICE guidance can be downloaded from the NICE website: www.nice.org.uk

Public health guidance

NICE will be publishing two types of evidence-based guidance on public health from the end of March 2006. Public health interventions will be single measures to help to promote or maintain health and public health programmes will cover broader activities.

Guideline will help identify patients with obsessive-compulsive disorder

NICE has developed a guideline to improve detection and management of obsessive compulsive disorder and body dysmorphic disorder.

Obsessive-compulsive disorder is a common condition with a lifetime prevalence of 1-2% and despite the existence of effective treatments it often goes undetected and untreated.

“Many people with obsessive-compulsive disorder don’t come forward for treatment for many years. Because people may not spontaneously talk about their difficulties, health professionals need to be better at asking the right questions and offering the right treatments,” explained Professor Mark Freeston, chair of the guideline development group.

“Accurate and early diagnosis, as well as effective treatment, can make a real difference,” added Professor Freeston, Professor of Clinical Psychology, University of Newcastle upon Tyne.

The evidence-based guideline recommends cognitive behavioural therapy (CBT), including exposure and response prevention, as firstline treatment for children and adults with mild to moderate obsessivecompulsive disorder.

Patients with more severe illness, those who decline or do not respond to CBT should be offered treatment with selective serotonin reuptake inhibitors (SSRIs).

Adults with body dysmorphic disorder should be offered a choice of either an SSRI or a suitable form of CBT.

Dr Alan Cohen, Director of Primary Care, Sainsbury Centre for Mental Health, commented, “Once again a NICE guideline for a mental health condition has recommended a stepped care approach to management and then the provision of CBT as a major intervention for those with mild or moderate disorders.

“It should be welcome news that there is an effective intervention but noted with regret that CBT is not more widely available,” he told Guidelines in Practice.

“The Labour Party manifesto made a commitment to making more CBT available to primary care. It is now up to the Department of Health to ensure that this service is accessible to the large number of people who will benefit from the intervention,” added Dr Cohen.

Copies of NICE Clinical Guideline 31. Obsessive-compulsive disorder: core interventions in the treatment of obsessive-compulsive disorder and body dysmorphic disorder can be downloaded free of charge from the NICE website: www.nice.org.uk

Revised QOF due to be published by end of year

The first revision to the quality and outcomes framework (QOF) of the nGMS contract, introduced in April 2004, is due to be published later this month.

The QOF has been under review to update the evidence base.

The revised version will come into effect in April 2006.

In our January issue, Dr Laurence Buckman, deputy chairman of the BMA General Practitioners Committee and co-chair of the QOF review will discuss the new recommendations in detail.

Our series on implementing the nGMS contract continues in this issue. See ‘All practices should achieve full points for hypothyroidism,’ by Dr Matthew Lockyer.

Guidelines in Practice Awards

A meticulous evidence-based project to tackle the clinical indicators for hypertension in the nGMS contract has enabled Dr Peter Standing’s practice to set high standards of care for their patients and won them the overall Guidelines in Practice Award 2005.

Their winning entry,‘A 10-step approach to successful hypertension management in practice’ is published in full in this issue. Full details on how to enter the Guidelines in Practice Awards 2006 will be published in the journal early next year.

Guidelines in Practice, December 2005, Volume 8(12)
© 2005 MGP Ltd
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