NICE failing on GP representation

By Gareth Iacobucci

Exclusive: GPs have been outnumbered two to one by non-doctors on the review panel for a series of recent NICE guidelines, even though the areas under discussion were directly relevant to primary care.

A Pulse investigation reveals the institute is failing to attract GPs to its guideline committees, with the profession still grossly underrepresented both on specific clinical panels, and on general steering groups.

Even the recently convened QOF indicator advisory committee has only 10 practising GPs out of 29 members.

Overall, a total of 35 GPs are currently involved with developing clinical guidelines, an average of just one per guideline. The number is exactly the same as five years ago, despite NICE facing frequent criticism over the years for not properly representing GPs.

There is one GP on the review panel for guidelines on chest pain, chronic heart failure and acute coronary syndrome, but two lay members. There are no GPs at all on the review panel for guidelines on colorectal cancer, ovarian cancer, lung cancer, social complications in pregnancy and autism in children.

Each of NICE's four technology appraisal committees has three GPs among 34 members. There are no GPs on the senior management team and one non-executive director on the NICE board, the same as in 2005.

A NICE spokesperson said: ‘It has not always been easy to recruit GPs to clinical guideline development groups, despite paying all expenses including locum cover. We are now in active discussion with the RCGP and GPC to address this.'

But GPs insisted the institute did not fully fund GPs to sit on groups – a key demand of Pulse's Manifesto for General Practice.

Dr Sally Hope, a GP in Woodstock, Oxfordshire, who has worked on the NICE osteoporosis clinical guideline, said: ‘NICE don't even refund fully the cost of a full day's GP locum, so until they do they won't get proper representation.

‘I was horrified to find it cost me to attend NICE meetings, as there was a deficit between what they would refund and what the practice paid. As it was my decision to go to the meeting, I made up the deficit.'

Dr Iain Gilchrist – chair of the Primary Care Rheumatology Society and a GP in Bishop's Stortford, said it would be better for the quality of guidelines if more GPs were involved: ‘At least there are some GPs involved. But probably not enough.'