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So, we should be ignoring NICE after all?

AndBreathe

AndBreathe

Master
Retired Moderator
The following was published today on GP Online, so I thought I'd copy it into here.

The following article was published today on GP Online. Interesting...........

GPs and patients must choose when to ignore NICE advice, says Haslam

By David Millett on the 13 October 2015 Be the First to Comment


NICE guidance 'may not be appropriate' for every patient, and it is important that GPs talk through treatment options with patients, NICE chairman Professor David Haslam has said.

Speaking at the NICE annual conference in Liverpool on Tuesday, Professor Haslam told delegates that although NICE guidance represents the ‘gold standard’ of treatment, it is not meant to be prescriptive and should not replace a doctor’s clinical judgment.

He said the health and social care system in the UK had changed ‘significantly’ since NICE was founded in 1999. Doctors of today are facing new challenges as multimorbidity and long-term conditions become rife in the population, he said.

NICE will play a pivotal role in helping doctors tackle these issues, with new guidance on multimorbidity due next year.

Professor Haslam said: ‘NICE guidelines give a population-level steer on what the most clinically and cost-effective ways are to treat different diseases and conditions. Nationally, the guidance helps the NHS make sure that it’s getting the best value for taxpayers’ money.

NICE GP guidance

‘But it is essential to remember that on an individual level, our recommendations might not always be appropriate for individual patients. The guidance is not intended to replace a doctor’s clinical judgment or the joint decisions they make with their patients about their specific and individual needs.

‘Our job at NICE is to ensure clinicians and social care professionals are supported to give the very best care to people.

‘Equally we understand that each discussion between a patient and their clinician is unique.

‘NICE guidance is a gold-standard which professionals should take very seriously. But the role of the clinician is to interpret our guidance together with their training and experience in the interests of the patient before them.’

The article url is: http://www.gponline.com/gps-patients-choose-when-ignore-nice-advice-says-haslam/article/1368070
 
I think allowing GPs a get out clause disadvantages a lot of T1s. I'd like to to know how many T1s really should be treated differently from the NICE guideline and what % of the T1 population do they represent? I'd put money on them being a minority.
 
Blackers183 said:
I think allowing GPs a get out clause disadvantages a lot of T1s. I'd like to to know how many T1s really should be treated differently from the NICE guideline and what % of the T1 population do they represent? I'd put money on them being a minority.
Click to expand...

Hello there.

I'm unsure I really understand your post. Do you mean that only a minority of T1s would benefit from their GPs treating them outside NICE guideline?

There's no judgement in me asking my question. I just not sure I see which way you feel.
 
You can lead a horse to water......

Offer the gold standard.
If the patient rejects it, let them get on with it their way.
Don't get involved in a futile argument.
Just make a note you offered the gold standard, and the patient refused it.

But, as @Blackers183 says, if there is an even cheaper way.......
Maybe that's another more cost effective answer.
 
NICE guidelines are just that, GUIDELINES. There is no one shoe fits all with any disease or condition (would be a lot simpler all round there was) guidelines and recommendations will not fit everybody's needs and HCP (and patients) need to realise that although it can work in our favour when NICE recommend something the docs aren't keen on! NICE aren't a group of magicians, those who write the guidelines tend to be experts in their area working off best available research and practice. It's not infallible and new research is going on all the time. It also needs to ensure treatments are cost effective and able to reach the largest amount of people. Its this last point that annoys me as I feel often NICE doesn't look at the future picture, eg pumps and CGMs are a lot more expensive short term than MDI however if it reduces complications in the future and enables us to avoid expensive complications and treatment of these for and be a tax paying productive member of society for longer then is it still so expensive?
(rant over!)
 
Last edited by a moderator:
AndBreathe said:
Hello there.

I'm unsure I really understand your post. Do you mean that only a minority of T1s would benefit from their GPs treating them outside NICE guideline?

There's no judgement in me asking my question. I just not sure I see which way you feel.
Click to expand...

I feel that only a small number of T1s might actually require treatment outside what NICE recommends. 'Allowing' GPs to vary treatment outside the guideline introduces inconsistencies to T1s treatment resulting in a lot of T1s not getting the treatment which results in better outcomes, eg lower HBA1C, less hypos, etc.
I have been a T1 for 24 years and every GP and specialist I have had had different ways of treating and explaining the treatment to me. Yes I have always had the target of lowering my BGL but 'how' was always the question with which I could not get (in my mind) a consistent answer. Fortunately I do have it I do have it know after attending DAFNE program, mentioned in the guidelines, 12 months ago.
David
 
AndBreathe said:
The following was published today on GP Online, so I thought I'd copy it into here.

The following article was published today on GP Online. Interesting...........

GPs and patients must choose when to ignore NICE advice, says Haslam

By David Millett on the 13 October 2015 Be the First to Comment


NICE guidance 'may not be appropriate' for every patient, and it is important that GPs talk through treatment options with patients, NICE chairman Professor David Haslam has said.

Speaking at the NICE annual conference in Liverpool on Tuesday, Professor Haslam told delegates that although NICE guidance represents the ‘gold standard’ of treatment, it is not meant to be prescriptive and should not replace a doctor’s clinical judgment.

He said the health and social care system in the UK had changed ‘significantly’ since NICE was founded in 1999. Doctors of today are facing new challenges as multimorbidity and long-term conditions become rife in the population, he said.

NICE will play a pivotal role in helping doctors tackle these issues, with new guidance on multimorbidity due next year.

Professor Haslam said: ‘NICE guidelines give a population-level steer on what the most clinically and cost-effective ways are to treat different diseases and conditions. Nationally, the guidance helps the NHS make sure that it’s getting the best value for taxpayers’ money.

NICE GP guidance

‘But it is essential to remember that on an individual level, our recommendations might not always be appropriate for individual patients. The guidance is not intended to replace a doctor’s clinical judgment or the joint decisions they make with their patients about their specific and individual needs.

‘Our job at NICE is to ensure clinicians and social care professionals are supported to give the very best care to people.

‘Equally we understand that each discussion between a patient and their clinician is unique.

‘NICE guidance is a gold-standard which professionals should take very seriously. But the role of the clinician is to interpret our guidance together with their training and experience in the interests of the patient before them.’

The article url is: http://www.gponline.com/gps-patients-choose-when-ignore-nice-advice-says-haslam/article/1368070
Click to expand...
Sounds perfectly reasonable to me. I think doctors are trained in medical school to take this approach, ie use their knowledge, the guidelines, research, and the patient's circumstances and wishes to recommend a course of action.
 
From my experience, I haven't seen much signs of my doc following the NICE guidelines up until now - so I expect he will just carry on as normal.
 
Blackers183 said:
I feel that only a small number of T1s might actually require treatment outside what NICE recommends. 'Allowing' GPs to vary treatment outside the guideline introduces inconsistencies to T1s treatment resulting in a lot of T1s not getting the treatment which results in better outcomes, eg lower HBA1C, less hypos, etc.
I have been a T1 for 24 years and every GP and specialist I have had had different ways of treating and explaining the treatment to me. Yes I have always had the target of lowering my BGL but 'how' was always the question with which I could not get (in my mind) a consistent answer. Fortunately I do have it I do have it know after attending DAFNE program, mentioned in the guidelines, 12 months ago.
David
Click to expand...

Thanks for clarifying.
 
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