LMC leaders in Wales have called for more GPs to be involved in developing clinical guidelines for NICE and other organisations, warning that guidelines are often irrelevant and unhelpful in general practice.
A motion carried unanimously at last weekend’s Welsh LMCs conference called for primary care guidelines panels to ‘include significant representation from generalist primary care clinicians’ and to ‘make it clear’ where evidence for guidance ‘is based on studies looking at secondary care populations’.
Putting the motion on behalf of North Wales LMC, Dr Sara Bodey said guidelines panels are dominated by single-condition specialist doctors looking at evidence derived from secondary care, meaning the recommendations were often unworkable once they reached front-line general practice.
Dr Bodey said: ‘Much of the evidence is based on secondary care populations from studies that excluded the vast majority of our patients with their comorbidities and outside the target age ranges.
‘And when the evidence is not there, or is not of good quality, the panel will fill it in with “opinion”. If your panel consists predominantly of people from single-system specialist backgrounds, you end up with a guideline that doesn’t work when it comes out into primary care.’
A recent study suggested two-thirds of NICE guidelines for GPs came from research that was largely irrelevant to primary care patients.
Dr Bodey called for GP involvement on primary care guidelines to be made mandatory and urged GPs to send their feed back on guidelines consultations – suggesting they might be ‘very frightened’ by NICE’s planned guidelines on suspected cancer.
She said: ‘I’d like to see a requirement for sensible primary care input into these guidelines… They are apparently keen for GPs to get involved, you can read the guidelines in development and feed back and they welcome that.
‘You might want to do that – have a look at the proposed cancer guidelines and be very frightened.’
Motion in full
That conference believes that guideline panels producing documents that are applied to primary care populations should include significant representation from generalist primary care clinicians and should make it clear when the evidence base from which guidelines are derived is based on studies looking at secondary care populations.
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