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The waiting game

NICE is painting itself into a corner of irrelevance


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I realise that, in the great scheme of things, and even in the NICE scheme of things, it’s only a teensy weensy point. But still, camels/straws.

I’m referring to NICE’s draft heart failure guidance which suggests that we, in primary care, should see all heart failure patients every six months, at which point we should review/update/communicate their care plan.

Yes. Another Thing To Do. More than that, another arbitrary, prescriptive and low-yield Thing To Do from the Department of Do More and Better without the counterbalance of a Department of Do Less and Averagely to even things up.

I can’t believe I need to type this sentence, but here goes: we GPs cannot currently cope with the basics of the day job. That message has been coming across loud and clear from primary care for some time, and no matter how far up that Ivory Tower you think NICE is, it surely must have heard the cries of distress by now.

Following NICE is like producing Michelangelos with crayons

Ah, they will say, because they always do, these are guidelines, not tramlines. Yet the ‘guidance’ states: ‘The primary care team should… recall the person at least every 6 months and update the summary and care plan.’ That’s ‘should’, not ‘could’, ‘might’, or ‘would if they had the slack in the day for a satisfactory bowel movement’. So it sounds like a diktat to me.

If the asthma guidelines debacle hadn’t already convinced you, maybe this tiny last straw will: NICE ignores, or is ignorant of, the current reality of general practice. It should self impose an embargo on all primary care guidance until it wises up, adapts its approach or general practice has recovered from its current parlous state.

Otherwise, I assume it will continue to persuade us to produce Michelangelos with crayons - while it paints itself into a corner of irrelevance.

Dr Tony Copperfield is a jobbing GP in Essex

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Readers' comments (17)

  • Spot on Tony.
    National Institute Clinical Excrement.

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  • NICE costs huge amount of money to run and even more in the resulting legal bills. It should be closed, the money would be better spent elsewhere.

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  • Dear Colleagues,

    On the contrary, NICE may very well be right, they are probably right actually...

    What is wrong is we do not push back enough as a fraternity to embolden the voice of GPs.....and then to ask for more funding and resources...that i submit to you is the weakest link.

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  • A criteria for local NHS England performance investigations is that practices will be judged on being ‘NICE Compliant’. From the evidence I’ve seen, assessors will latch onto any perceived deviation from guidance and highlight that in their reports. GPs deviate from NICE guidance at their peril - all 20k pages of it - because that could see them being referred to NCAS or worse.

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  • Someone should print out all the current NICE guidance related to general practice and display it in a glass box room with a consultation couch and a non functioning computer.

    It could be installed into the Tate Modern and punters take turns to sit in the doctor's worn out chair with a stethoscope around their necks.

    Title of the piece would be 'Not Good Enough'.

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  • AlanAlmond

    NICE guidance is used as a template for ‘normal acceptable practice’ by a whole range of non medical folk including lawyers. You can very well get sued for not following guidelines if anything subsequently goes wrong. NICE doesn’t produce ‘guidelines’ - in reality that’s a shameful lie. They spray poison from their chalice onto the surfs below and demonstrate ‘wilful blindness’ to the unintended consequences of their work.

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  • AlanAlmond

    Wikipedia - wilful blindness:
    Willful blindness is a term used in law to describe a situation in which a person seeks to avoid civil or criminal liability for a wrongful act by intentionally keeping oneself unaware of facts that would render liability.

    Although the term was originally—and still is—used in legal contexts, the phrase "willful ignorance" has come to mean any situation in which people intentionally turn their attention away from an ethical problem that is believed to be important by those using the phrase (for instance, because the problem is too disturbing for people to want it dominating their thoughts, or from the knowledge that solving the problem would require extensive effort).

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  • @Big and Small. Lol. That would certainly win the Turner Prize in my book! Unfortunately in our beloved NHS and austerity Britain I think you will have to be grateful for being award the Turnip Prize !

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  • Another great disaster in our public life you can sheet home to the UK labour oarty

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  • Maverick

    Maverick | Locum GP16 Apr 2018 8:35pm

    More for your reading list...
    "Bad Pharma" by Ben Goldacre.
    "Overdiagnosed - making people sick in pursuit of health" by Dr H. Gilbert Welch.
    Makes you think... make of it what you will.
    Food for thought!
    Viper's coming down....

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