Editor—The National Institute for Clinical Excellence (NICE) has not recently woken up to the issue of implementing its guidance, as Freemantle alleges in his commentary on the paper by Sheldon et al.1 The institute from its inception was acutely aware of the importance of its guidance being incorporated into routine clinical practice.2
In retrospect it was probably a mistake for NICE not to have been given explicit responsibility for monitoring the implementation of its guidance at the outset.3 Nevertheless, the institute's own concerns, from the beginning, led NICE to ask the NHS research and development programme to commission research in this area. In June 2004 the institute launched an implementation support strategy,4 headed by an executive director. In addition, the Healthcare Commission will put in place an inspection regime specifically for NICE guidance.
The study by Sheldon et al covers the earliest period of the institute's existence and pre-dates the direction now requiring trusts to fund NICE's appraisal guidance.1,5 More recent studies—of which Freemantle seems to be unaware—give a somewhat different picture.
The most extensive has been that undertaken by Abacus International (www.nice.org.uk/pdf/Abacus_report.pdf), which covered 28 appraisals, for at least a year and included ones published after the direction came into force. The results show that 12 appraisals were implemented fully, 12 were incompletely implemented, and four over-implemented. More reviews are available on the NICE website (www.nice.org.uk/implementation).
NICE accepts that more needs to be done to secure full implementation of its guidance—hence its implementation support programme. But the facts show that Freemantle's incomplete commentary is very wide of the mark.
Competing interests: None declared.
References
- 1.Sheldon TA, Cullum N, Dawson D, Lankshear A, Lowson K, Watt I, et al. What's the evidence that NICE guidance has been implemented? Results from a national evaluation using time series analysis, audit of patients' notes, and interviews [with commentary by N Freemantle]. BMJ 2004;329: 999-1004. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Rawlins M. In pursuit of quality: the National Institute for Clinical Excellence. Lancet 1999;353: 1079-82 [DOI] [PubMed] [Google Scholar]
- 3.Department of Health. A first class service. London: DoH, 1998.
- 4.National Institute for Clinical Excellence. Supporting the implementation of NICE guidance. London: NICE, 2004.
- 5.Department of Health. Directions to primary care trusts and NHS trusts in England concerning arrangements for the funding of technology appraisal guidance from the National Institute for Clinical Excellence (NICE). DoH: London, 2003.