I don’t have a kind word for most authority figures, partly because I’m not kind, but mainly because, obviously, they don’t deserve one. But with Professor David Haslam, I’ll make an exception. He’s a good guy, and he’s ’one of us’. So I’m quite prepared to do him a favour. Specifically, to help him in his quest to ‘go back to square one’ with NICE. Here’s my 14-point plan.
1. Involve more GPs.
2. Decide what NICE is actually for. If the idea is to act as a repository of irrelevant and impenetrable nonsense generated by rarefied academics and special interest groups to be ignored by everyone on the frontline except those looking for a giggle/material for a blog, then carry on as you are. If, on the other hand, NICE is to be taken seriously by the frontline, then proceed to ‘3’.
3. Involve more GPs.
4. Rebrand. The name ‘NICE’ has always been a hostage to fortune. Besides, there’s absolutely no point holding up ‘excellence’ as the standard we should aspire to because that’s doomed to failure – have your sights set to the more realistic level of ‘adequate’. And if you don’t want to veer too far from your original brand, feel free to adapt an acronym I’ve previously suggested – ‘NICA’, with a soft ‘c’ (the National Institute for Clinical Adequacy).
5. Involve more GPs.
6. Have a reality check. Literally. If you do still insist on ‘NICE’, excellence and input from those whose knowledge of a subject is huge but whose experience of frontline practice is zilch, then develop a two stage process: the aspirational (which we will all ignore) and the practical (which we might take some notice of). And achieve the latter by sieving the pontifications of experts through the minds of grassroots GPs with a special disinterest.
7. Involve more GPs.
8. Find out what GPs are already doing. The best ‘new’ guidelines are those that closely mirror what we do already. That shouldn’t dictate the guidance, but it should inform it – and would also give an idea of what workload will be manageable, the principle being, ‘like for like’. Better still, churn out some guidance that lessens workload or encourages us to stop doing stuff.
9. Involve more GPs.
10. Stop pretending they’re ‘just guidelines’. We know that’s what you say, but you know no one believes it any more.
11. Involve more GPs.
12. Let GPs set some agendas. Why not find out what guidance I’d really like? For example, I’m actually fine diagnosing asthma, thanks, so why ruin it for me? Whereas I’ve got issues – lots of them – with fibromyalgia, some of which might be tackled with a judiciously applied, rolled up NICE guideline.
13. Involve more GPs.
14. Once you’ve done 1-13 above, ensure that what comes out of the process can be summed up on one A4 piece of paper.
NICE, just like QOF, was quite a good idea to begin with but, also like QOF, has become a bloated parody of itself. A radical rethink might just get general practice taking it seriously again. Which reminds me, did I mention that you need to involve more GPs? Good luck finding any.
Dr Tony Copperfield is a GP in Essex. You can follow him on Twitter @DocCopperfield
