|NICE and specialist advice|
|Friday, 01 April 2011|
An update on the relationship between the National Institute for Health and Clinical Excellence and its network of specialists
A fundamental principle of all NICE guidance is that it is based on the best available evidence. Whatever the amount and quality of published evidence (which is often limited) there is always a need for contributions from stakeholders. Clinical specialists are particularly important and NICE relies heavily on them for knowledge and advice.
All NICE’s advisory committees and guideline development groups have a range of specialists – all appointed after advertisement. They in turn depend on the contributions of many other specialists relevant to each topic. These specialists are generally identified and ratified by their specialist organisations: the aim is to get advice from people who are recognised by their peers as respected opinions for each topic. Specialist organisations may receive a variety of requests for advice from NICE for its different guidance programmes. The different programmes use different terms (italicised in the text) to refer to the specialists who help them.
"The aim is to get advice from people who are recognised by their peers as respected opinions for each topic"
NICE’s Technology Appraisals Programme produces guidance on the clinical and cost-effectiveness of licensed medications and other technologies. Surgical interventions studied have included laparoscopic procedures, endovascular stent grafts for aneurysms and hip surgery. Requests for advice from clinical specialists are directed through professional organisations. Advice on each topic is prepared by these specialists in an anonymous format. Once all of the available evidence has been assembled, Clinical Experts nominated by their organisations come to the Appraisals Committee meeting where they answer detailed questions.
The Interventional Procedures (IP) Programme publishes guidance on the safety and efficacy of procedures (including open, percutaneous and endoscopic procedures). The published evidence is often limited, so specialist advice is of great value. Specialist Advisers are normally requested via specialist societies and Royal Colleges for each procedure. They complete a proforma of questions about the procedure. When there is no relevant specialist on the Advisory Committee, then NICE calls on one Specialist Adviser to join the committee meeting by telephone to offer comments and to answer any questions. Getting specialist advice remains the ratelimiting step for the IP programme.
The Evaluation Pathway Programme for Medical Technologies is one of NICE’s newest work programmes. It aims to identify devices and diagnostics which offer advantages to patients and/or to the health service. The goal is to encourage their adoption into the NHS. Guidance may also recommend research into promising new technologies. All this is driven by the Medical Technologies Advisory Committee (MTAC), which depends on Expert advisers for their help. Published evidence on new devices and diagnostics may be as sparse as for interventional procedures; and so the contributions of Expert Advisers are crucial. The Diagnostics Assessment Programme started its work last year. Here, specialists nominated by their professional organisations attend scoping meetings. Their model for specialist advice is a hybrid between other standing committees and guideline development groups – advertising for Specialist Committee Members who join the committee for the meetings relating each specific technology.
NICE Clinical Guidelines on the management of particular conditions or symptoms are produced by specifically appointed groups, made up of specialists, lay members and others appointed by advertisement. In some cases, guideline groups may request advice from other specialists about specific matters. Similar principles apply to the groups devising NICE Quality Standards.
Specialist advice can be hugely influential. Specialists offer thoughtful insights about the use, context and place of interventions, and about patient preferences, training or effects on related services. With the pressure of time that often exists, prompt advice (or even a prompt refusal) is of great value, and NICE welcomes close engagement with the specialists who are helping them.