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Headline

GPs defending patient complaints to be asked which guidelines they followed

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Dear All, The guideline i follow is the one espoused by the Chairman of NICE, Sir Michael Rawlins, in October 2012; "The institute’s recommendations are advisory for GPs and sometimes almost aspirational in nature, writes NICE chair Sir Michael Rawlins There appears to be confusion about the circumstances in which it is obligatory for GPs to follow NICE guidance. The quick answer is ‘never’. Then there are clinical guidelines, which provide GPs and other clinical staff with guidance on the management of specific clinical conditions, for instance, for antenatal care, breast cancer and schizophrenia. These guidelines are very unusual in taking account of both cost effectiveness as well as clinical effectiveness. There is no expectation, however, that all patients with a particular condition will be treated according to the provisions of NICE guidelines, for two reasons. First, it is impossible to define an appropriate pathway of care for every encounter between a doctor and a patient. Some patients, for example, are intolerant of particular medicines even though – at a population level – they provide substantial benefit. Second, the provision of care according to NICE guidelines may require infrastructure changes that take time to accomplish. NICE’s guideline on depression, for example, proposed much wider use of cognitive behavioural therapy (CBT) than was currently available. Substantial investment in clinical psychology has now put CBT within the reach of most patients who need it. So NICE’s guidance is never clinically mandatory, but is accompanied by the following statement: ‘This guidance represents the views of NICE and was arrived at after careful consideration of the evidence available. Healthcare professionals are expected to take it fully into account when exercising their clinical judgment. However, the guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient in consultation with the patient and/or guardian or carer.’ (And we mean it!) Rgeards Paul C

Posted date

31 Aug 2018

Posted time

11:49am

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