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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