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Following NICE is just too damn complicated

It's not the case the GPs WON'T follow NICE guidelines, it's that they CAN'T.

It's not the case the GPs WON'T follow NICE guidelines, it's that they CAN'T.

Compare and contrast the previous and current management of diabetes:

Then – use metformin, or a sulphonylurea, or both. And if that doesn't work, it's insulin.

Now – use metformin, unless the patient's not overweight or needs rapid glycaemic control, in which case use a sulphonylurea, then use both unless there's significant risk of hypoglycaemia, in which case use a DP-4 inhibitor or a thiazolidinedione, then, if you haven't already, add that thiazolidinedione or DP-4 inhibitor – but not any old one, it must be sitagliptin – or exenatide under certain circumstances, but only if you're not going straight to insulin, then maybe add pioglitazone and….err…try them all but take away the first drug you thought of, then…err…er…nurse, nurse, the screens…

Of course, these NICE guidelines on diabetes I've simplified, because otherwise you might find them confusing.

OK, I accept that I can't blame NICE for the fact that, nowadays, there are more diabetes drugs than you can shake an insulin syringe at. But, bloody hell, do they make things complicated. Not just with diabetes, either. Their guidance on CKD – to pick a random example – runs to 16 pages. And that's the sodding ‘quick reference' version.

And they wonder why GPs won't follow their words of wisdom. Here's the truth: it's not ‘won't', it's ‘can't'. It's just not possible. Simply navigating our way through the summary flowcharts is enough to drive us batshit bonkers. And the result is, we ignore it all.

So here's a radical suggestion. Accept that general practice is an imperfect world. And accept, too that if we followed NICE guidance to, say, a 50% level – getting the key points right rather than dwelling on the minutiae, where the laws of diminishing returns apply – we'd do a lot of patients a lot of good. Plus, we GPs wouldn't go mental, and we'd be less inclined to say two fingers up at NICE.

It's doable. All that's needed for each NICE diktat is a one page summary – ‘NICE and easy' - of the key points. Written by someone living on planet earth. AGP, in other words – and one with a special disinterest in anything except in clarity and brevity. Prof Rawlins, if you're listening, I'm free on Tuesday afternoons.

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