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DH gets tough on NICE guidance implementation

7 December 2011

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Commissioners will face tough penalties if they choose to ignore NICE guidance under a new Compliance Regime released by the Department of Health.

The DH report Innovation, Health and Wealth said there is “considerable variation” in the implementation of NICE-approved drugs throughout the UK.

In a bid to ensure “rapid and consistent implementation” of NICE guidance, a NICE Compliance Regime will be introduced.

“We are committed to ensuring that NHS patients have access to clinically and cost-effective drugs and technologies, and that NICE appraisal guidance is promptly delivered throughout the NHS,” said the report.

“There should be no local barriers to accessing technologies recommended in NICE appraisals, beyond a clinical decision relating to an individual patient.”

The DH also pledged to develop and publish a “straightforward innovation scorecard” to track adoption of NICE Technology Appraisals at a local level.

The establishment of a NICE Implementation Collaboration (NIC) will bring together a number of NHS bodies including the NHS Commissioning Board, the Clinical Commissioning Coalition and the Royal Colleges to develop implementation guidance.

It is said the NIC will also have an “important role” in supporting QIPP delivery.

“This assumes that NICE has got it right. Guidelines are informative and not a protocol, assuming always that the methodology in constructing the guidance is valid, something which is ever more doubtful as thay are formulated and  dictated more and more by methodologists who are increasingly distanced from the world of front line medicine. Given the over reliance of metanalysis as grade A evidence is where the suspicion of methodological failure begins: metanalysis is a flawed tool, amalgamating evidence from various randomised controlled trials which were constructed in order to answer a specific scientific question: in so doing on average 85% of the population is excluded from the trail in order to answer that scientific question. These results are then amalgamated, re interpreted and the applicability extrapolated to the whole population. Guidelines were meant to be a clinical management tool (and certainly have value as an educational tool and a framework within which to work) but never as a management performance tool” – Dermot Ryan, address withheld