Clinical guidelines for managing 11 common conditions, and waiting time limits for referrals from general practitioners to specialists, have been drafted by the National Institute for Clinical Excellence (NICE). It is the first time that symptom specific advice for referring conditions into specialist services has been produced by a government agency.
The guidance has been drafted by subject specific advisory groups whose members included GPs, hospital specialists, and patients' representatives. The guidelines will undergo trials in a number of selected sites over the next six months.
In a letter to primary care groups, health authorities, trusts, professional bodies, and patient groups, Andrew Dillon, chief executive of NICE, says the aim is to “support and complement appropriate evidence based and consistent practice.” The pilot will be organised by a collaboration of NICE, the NHS R&D Programme, and the National Patient Access Team.
The draft advice proposes that GPs should classify patients requiring referral to specialist services according to one of four time categories: immediate (within a day); urgent (within two weeks); soon; and routine (the latter categories to be determined locally).
The adoption of the final guidance should be implemented in the context of local strategies for achieving outpatient waiting times and inpatient waiting list targets, the letter says.
The draft guidance, entitled Referral Practice, deals in detail with the management and treatment of the following conditions: acne; acute lower back pain; atopic eczema in children; menorrhagia; osteoarthritis of the hip and of the knee; glue ear in young children; psoriasis; recurrent episodes of acute sore throat in children up to 15; prostatism; and varicose veins.
The guidance should help to end “postcode lotteries,” where treatment is available for some conditions only in some parts of Britain.
Joe Collier, consultant to the project and one of the editors of the advice, commented: “Uniquely for the institute, advice is being offered in a clinical setting across the primary and secondary divide where the evidence base is sparse. It is imperative that GPs and others comment so this advice can be consolidated and the work extended to other topics.”
The guidance can be seen on the web at www.nice.org.uk/ updates/upd_ind.htm.