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Finding GP-relevant recommendations in guidelines difficult, NICE admits

NICE experts have admitted it is taking longer than expected to come up with new multimorbidity guidance, because of the difficulty extracting useful information for GPs from existing guidance.

Dr Martin Allaby, a GP in Oxford and clinical advisor to NICE’s centre for clinical practice, said the process had revealed how hard it was for GPs to put guidance to use in the real world.

NICE has embarked on developing guidance for managing patients with multimorbidities that is more relevant for GPs, in the face of growing concerns over polypharmacy and calls for better advice on the relative benefits and risks of different treatments to patients with multiple conditions and differing priorities.

Speaking at a session on the ‘comorbidities conundrum’ at NICE’s annual conference in Birmingham, Dr Allaby said the initial aim was to pull together the most relevant figures on risk reductions from existing guidance to help GPs faced with challenging consultations.

However, simply finding the data is proving challenging.

Dr Allaby said: ‘A NICE fellow has started the process of trying to pull out those sorts of numbers from existing NICE guidance and he has been finding it really hard work. He has spent days wading through just one guideline trying to find the relevant figures.’

He added: ‘There’s a story there when you think about how easy we have made it to date for practitioners to pull out some of this kind of information that would really be useful in these kinds of conversations.’

In the same session, Dr Julian Treadwell, a GP in Somerset, described a typical case of an elderly woman on multiple treatments who he ended up cutting down to just two or three drugs once he looked closely at the absolute benefits of each drug for her.

Dr Treadwell said: ‘I don’t think most of us have these kinds of numbers at our fingertips and we should at least start by GPs having that information.

‘How we then discuss that with the patient is the next step - sometimes we may have a non-specific conversation and we make the technical conversation for [the patient]. But there may be younger people who would like to know the numbers and it does start to get much more challenging.’

Speaking to Pulse after the session, Dr Allaby said the guidelines would likely take another two years to develop and he hoped it could ultimately lead to a tool that would give an overall estimate of the likely benefit of adding in new drugs to a patient’s profile.

Dr Allaby said: ‘It would be good if NICE can redress the imbalance between recommending doing things on the one hand and having some guidance to facilitate conversations about not doing things or stopping things - and picking priorities.’

Readers' comments (2)

  • Vinci Ho

    It is particularly 'artistic' rather than scientific in dealing with this group of patients particularly because every individual is different on a different circumstance . Is it really that wise to 'quantify' with figures with each morbidity . It requires instead a more global approach which relies heavily on doctor-carer(s)- patient relationship .
    Remember so often the biggest morbidity is loneliness and isolation which I doubt any government would ever know how to tackle..........certainly not under this fallacy of efficiency saving as well as the encouragement of a widening gap between the very poor and the very rich......:...

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  • What! Multimorbidity and complexity cannot be reduced to an algorithm! I suggest immediately training a cohort of super specialist doctors to deal with uncertainty, complexity and multi morbidity. Let's not given them disease specific targets and allow them to use their specialist judgement.
    What to call them...'general' 'practitioners'....

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