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NICE considering GP advisory body after criticism from profession

Exclusive GP leaders have met with NICE chiefs to discuss a new GP advisory body that will advise on the development of more practical guidelines for primary care, Pulse can reveal.

The GPC discussed the new board with NICE chair and former GP Professor David Haslam at a meeting last week in London, with a view to improving how NICE guidelines and standards are produced for primary care.

The move comes after a series of criticisms from GPs of clinical guidelines, or proposed guidance, across a range of areas from NICE – leading to accusations the organisation was ‘becoming a laughing stock’.

Dr Andrew Green, chair of the GPC’s clinical and prescribing subcommittee, said the GP advisory board was one of the measures discussed with Professor Haslam, and that the GPC was in support of the idea.

Dr Green said: ‘The GPC has met with Prof Haslam and the idea of an advisory board was one of the items discussed; we would be very supportive of this concept.

‘We had a wide ranging and constructive talk which included ways to improve GP representation on NICE committees, and how to best make NICE guidance relevant, practical, and deliverable. We look forward to continue to work with NICE on these areas which are clearly worthwhile aims of both organisations.’

Cover - March 2015



GP experts have repeatedly raised concerns over the past year over guidelines, with, for example, diabetes recommendations described as ‘bonkers’, asthma diagnosis advice as ‘dangerous’ and cancer referral instructions as ‘overwhelming’.

LMC leaders have also demanded more GP involvement in the development of guidelines, while concerns about the feasibility of implementing recommendations at the frontline of general practice have been ramped up further by plans to make it harder for commissioners to allow GPs to deviate from NICE, and warnings about direct legal threats to GPs who fail to follow guidelines for individual patients.

Professor Haslam has previously acknowledged the challenges GPs face in following guidelines and has backed the development of so-called ‘multimorbidity’ guidance to offer more practical advice in patients with a number of long-term conditions, particularly with stopping unnecessary medications in older patients.

In an email seen by Pulse, Professor Haslam has also now conceded that some NICE guidelines were not acceptable to GPs – in large part because they are impossible to deliver in frontline care.

Professor Haslam said: ‘I am very aware that not every publication from NICE meets with universal applause from the world of primary care. I think one of the real tensions lies between the enormous gap there is between the reality of what General Practice could deliver, and what it is able to deliver (with the current workforce crisis, workload, etc).’

A spokesperson for NICE said the organisation was committed to ‘improving the way we work’ and that Professor Haslam was ‘delighted’ that the GPC was enthusiastic about potential advisory group.

Dr Nick Summerton, former NICE advisor who has recently criticised NICE over proposed cancer guidelines, said an advisory group would be a ‘positive step’ provided GPs involved were willing to challenge the organisation.

He said: ‘Provided NICE recruit GPs who have the ability - and the courage - to constructively challenge the work of NICE, then it would be a very positive move. Primary care medicine is a growing and unique speciality and patients would be served much better if this was better recognised by those developing guidance for GPs.’

Dr Summerton added that having had positive discussions with David Haslam recently, he ‘would be keen to apply to join such a group’.

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Readers' comments (11)

  • This is a good idea but it should have happened from the beginning.

    Unfortunately there may not be any GPs left by the time this is set up...

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  • I suspect there will be plenty of GPs wanting the job(s), anything but real general practice

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  • Sorry. No time. Will be out checking heating systems! I think. No time to read the guidance in detail

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  • Another body, committee, GP board with invested interest, subscription, big Pharma push on us, small print you have no time to read, iPhone app and then someone will say - why didn't you read the proper NICE guidance?

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  • They lost the GP input they had in the first place because the GPs who were keeping them vaguely in touch with reality were not remunerated enough to even cover their locum expenses.

    Will they make the same mistake again?


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  • Vinci Ho

    About time but also quite correctly to challenge the feasibility of recruiting GPs on board as there is no time ......

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  • jesus wept.

    stick on a few more sensible jobbing GPs on those "its not what you know but who you know" committees writing the guidelines and there wouldnt be this idiotic issue in the first place!

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  • If it can't be done in the 10 minutes GPs have for an appointment, it should either, never see the light of day, or Government needs to actually fund it.

    If the guidelines can't cope with multi-morbidity it should be acknowledged specifically that this is the case and that clinicians should take a pragmatic view on implementing the guidance.

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  • Dear all,
    This quote is something I have kept and roll out when the latest "lead" or "Expert" or "advisor" arrives on the doorstep. It is from Sir Michael Rawlins, Chair of NICE written by him in 2012. He wrote in Pulse. Selected extracts.

    "The institute’s recommendations are advisory for GPs and sometimes almost aspirational in nature" writes NICE chair Sir Michael Rawlins

    "There appears to be confusion about the circumstances in which it is obligatory for GPs to follow NICE guidance. The quick answer is ‘never’".

    "Then there are clinical guidelines, which provide GPs and other clinical staff with guidance on the management of specific clinical conditions, for instance, for antenatal care, breast cancer and schizophrenia. These guidelines are very unusual in taking account of both cost effectiveness as well as clinical effectiveness."

    "There is no expectation, however, that all patients with a particular condition will be treated according to the provisions of NICE guidelines, for two reasons."

    "First, it is impossible to define an appropriate pathway of care for every encounter between a doctor and a patient. Some patients, for example, are intolerant of particular medicines even though – at a population level – they provide substantial benefit."

    Second, the provision of care according to NICE guidelines may require infrastructure changes that take time to accomplish. NICE’s guideline on depression, for example, proposed much wider use of cognitive behavioural therapy (CBT) than was currently available. Substantial investment in clinical psychology has now put CBT within the reach of most patients who need it.

    "So NICE’s guidance is never clinically mandatory, but is accompanied by the following statement: ‘This guidance represents the views of NICE and was arrived at after careful consideration of the evidence available. Healthcare professionals are expected to take it fully into account when exercising their clinical judgment. However, the guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient in consultation with the patient and/or guardian or carer.’ (And we mean it!)"

    Sir Michael Rawlins, Chair of NICE, Oct 2012

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  • Dear Paul, I agree with the sentiment of your comment, however it was never Prof Rawlings but a certain clone of nhs managers of limited intellect with nothing useful to do that got a kick out of forcing more intelligent and better qualified people to waste time and effort so they could feel important that where and are the problem with NICE.
    At least the majority of them moved to NHS England rather than CCG's and professional non GP CCG managers are telling them to xxxx off.

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