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At the heart of general practice since 1960

Since when did guidelines bind us by law?

I was surprised at the reported comments of Baroness Young that GPs will have to demonstrate they follow NICE guidance or they could face prosecution.

Prosecution? Does this mean there will be a new criminal offence of 'failure to follow NICE guidelines'?

NICE guidance has its place. It sets standards of clinical care and has a significant role in rationing it. Compliance with NICE guidance means doctors are likely to have acted in line with a responsible body of medical opinion. NICE does not, however, have a monopoly on responsible medical opinion, and it may be that for some patients, it is appropriate not to follow NICE guidance.

As Harvey Teff, an expert in medical law, has written: 'Bullet-point care is inimical to the therapeutic alliance. It minimises the very patient involvement the profession's leaders also rightly exhort.'

NICE itself has indicated that its guidance should not be compulsory: 'The institute has always indicated that health professionals, when exercising their clinical judgment, should take its guidance fully into account, but that it does not override their responsibility for making appropriate decisions in the circumstances of the individual patient. Even the best clinical guideline is unlikely to be able to accommodate more than around 80% of patients.'

To suggest departure from NICE guidance might result in prosecution is frightening. It might conceivably encourage doctors to apply guidelines that are not appropriate for individual patients, which itself could lead to harm. Such harm could in turn give rise to civil and criminal liability, and of course GMC disciplinary proceedings.

Does Baroness Young, the Care Quality Commission chair, understand clinical medicine? If not, why is she in post?

From Dr Peter Gooderham, retired GP and associate tutor at Cardiff Law School


This is the usual load of top-down political tosh from folk who never actually see one of those strange things called a 'patient'.

How can it be a guideline if it is enforced dogmatically?

Baroness Young might also not want to trumpet so loudly about her powers being 'draconian' since it is never good to base your approach on the tactics of a nasty piece of work from 620BC who felt the death penalty was really rather a good thing. Draco advocated a system of punishments that were particularly cruel to the poor and underclasses and more lenient to the rich and powerful. Good old New Labour, eh? Why have political heroes like Bevan and Attlee when you can delight in the powers of Draco?

From Dr Andy Jones, Hereford

I always thought guidelines were exactly that - a guide for professionals to consider when presented with a unique set of circumstances relating to the individual in front of them.

I look forward to a new army of highly paid managers who will interrogate doctors about each individual deviation from the NICE diktat. In these times of increasing unemployment, I suppose I should welcome such a well-thought-out way to spend public money.

On a more serious note, I signed up for GMS2 on the basis that GPs were a limited resource and any new work would be funded. I foolishly thought our negotiators sat down with the Government's representatives and agreed what level of work we would be able to do and this became part of the QOF.

It seems that our contract is no longer valid and I am looking forward to the GPC initiating negotiations on a new one. I hope this time fresh memories of Government deceit will lead to a more watertight agreement.

From Dr Stephen Gardiner, Bridgwater, Somerset

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