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NICE to move to multimorbidity guidance, chief says

NICE is committed to developing more relevant guidance for GPs that takes into account the complexity of patients they see in daily practice with multiple long-term conditions, the chairman of NICE told delegates at Pulse Live.

Opening the first day of the conference in London, Professor David Haslam said NICE recognised current single-condition guidance was impractical for GPs dealing with patients with multimorbidities.

And he said NICE shared GPs’ concerns about polypharmacy and over-medicalisation.

Professor Haslam said: ‘Single long-term conditions – which is the way NHS is organised generally apart from primary care – is the rarity.’

‘What I know for certain is taking the NICE guidelines for each [single] condition and adding them together is no way to deliver quality care for that person.’

‘It’s absolutely clear we have to find a way of addressing the whole complex issue of multimorbidity and that’s something NICE is absolutely up for.’

He added: ‘What we don’t believe in is massive polypharmacy, with [a] person taking more and more pills and needing a blood test every third day and having no quality of life – that is not the point of all this. Finding a way to determine what looks good for a patient [with multiple conditions] is extraordinarily important.’

Professor Haslam stressed NICE guidance was not intended to ‘force’ clinical decisions about treatments on GPs and their patients. He said recent criticisms over plans to lower the primary prevention threshold for statin treatments to 10%, suggesting GPs would be compelled to put all patients with a 10% risk on statins, were misleading.

NICE had looked at the evidence for clinical and cost-effectiveness in order to come to an informed decision about the threshold. He said targets based on NICE guidance ‘were another matter’ altogether, and that GPs’ responsibility were to their patients first and foremost.

Professor Haslam stressed: ‘The clue is in the word “guide” in guidelines. These are not tramlines.’

He said GPs should be mindful of the statement applying to all NICE guidance: ‘[The] guidance is not mandatory. Healthcare professionals should take NICE guidance fully into account when exercising their clinical judgement but this does not over-ride their responsibility to make decisions appropriate to their circumstances and the wishes of the patient.’

Readers' comments (1)

  • Part of the problem with NICE Guidance is that most of the EBM comes from secondary care - but is applied to Primary Care.
    Will this Guidance on managing patients with multi-morbidities be applied to secondary as well as primary care?

    Just a thought: how about some decent information on drug interactions, and metabolic/excretion tables?
    -Some drugs are carried on the same site, so one displaces the other e.g. warfarin & amiodarone
    -some share a metabolic pathway
    -the excretion of some are affected by organ function e.g. digoxin by kidney function, and some are haemdialysable whereas others are not.

    I've retired - but while in practice I was unable to find even the information available in 1970 when I was in renal disease!!!

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