Guidelines exist to help, not hinder, GPs
Letter from Professor David Haslam, NICE chair
For over 350 years, science has progressed at an extraordinary rate. This progress is based on challenging the status quo and questioning perceptions. So I was delighted to see Nigel Praities’ New Year editorial ('My vision for 2017? Let’s ditch guidelines for a start') calling for a year of 'no-holds barred discussion about where general practice is heading'.
We want them to be a source of support
Of course, we should continuously consider ways to improve, to do our jobs more effectively and efficiently. Open debate helps bring new ideas forward and creates opportunities to innovate and improve. And although I welcome the challenge to justify the use of guidelines in general practice, unlike Nigel, I believe they are essential to support doctors in their day-to-day work.
General practice is extraordinarily complex. It requires a depth and breadth of knowledge, an ability to synthesise and adapt to an ever changing world, and, of course, great resilience.
Having spent a working lifetime as a GP, I now chair NICE, the National Institute for Health and Care Excellence, one of whose central roles Nigel would like to abolish: guidelines.
NICE doesn’t produce guidelines to hamstring primary care. We want them to be a source of support. And if we didn’t produce them, either family doctors would have to read all the new research and evidence, or rely on someone else to do it. Every GP is focused on the quality of care for patients. But how can patients’ expectations be met without a credible and independent review of the evidence and conclusions drawn by experts? Our guidelines help GPs to offer safe and effective care.
To write them, we identify the issues the guideline is intended to address, pull together the best evidence from around the world, convene an independent committee of experts – including GPs and lay members – who deliberate on the evidence, synthesise it into practical recommendations, then we consult on the draft. It is an extremely thorough process – underpinned by evidence and expertise.
The final guideline is not the final word on how to treat someone. It is an important factor which should be taken into account with the preferences and values of the patient. But the responsibility for treating the particular patient and their particular circumstances must and does rest with the clinician.
Last year, we produced a wide range of important new guidelines and standards, and many of these cover the conditions and diseases GPs deal with day in, day out. Others were in areas where a GP may have referred a patient on but where they can find out what good care looks like for the person at the receiving end.
In September we published our much anticipated guideline on multimorbidity – which is rightly praised in Nigel’s editorial. The guideline cannot hope to detail every single combination of condition which a patient may present with. It sets out how we should put patients with complex health issues at the heart of decisions about their care, including how to decide between different medicines and treatments.
We aim to have at least one GP on every guideline committee. They have helped to produce widely welcomed guidance on sepsis, managing menopause, end of life care (for both adults and children) to name a few.
GPs have played a key role in improving our draft guidance on asthma diagnosis and monitoring. When GPs raised concerns about the practicality of implementing this guidance in primary care we halted publication and began work on a new project to test the recommendations in question. The support from primary care teams in this project has been outstanding. Seven primary care sites across England, which use different asthma service delivery models, were recruited to the project and their findings will be considered before the guidance publishes in the summer.
Every year, GPs are involved in helping us to improve. They become a member of our independent committees. They comment on our draft guidance, join the NICE fellowship, take part in debates at our annual conference or public board meetings. I often hear how rewarding working with NICE is.
I would urge any GP to work more closely with us – creating guidance that will support family doctors, the people working with them in primary care, and most importantly helping to provide the best care to patients and their loved ones. You can visit our website to find out more.
Professor David Haslam is Chair of NICE. He is also past President and past Chairman of Council of the RCGP, and past President of the BMA