NICE clinical guidelines are systematically-developed recommendations on how healthcare and other professionals should care for people with specific conditions. The recommendations are based on the best available evidence. Clinical guidelines are also important for health service managers and those who commission NHS services.View guidelines
Clinical guidelines can cover any aspect of a condition. This may include recommendations about providing information and advice, prevention, diagnosis, treatment and longer-term management.
Our clinical guidelines:
- aim to improve the quality of care for patients
- assess how well different treatments and ways of managing a specific condition work
- assess whether treatments and ways of managing a condition are good value for money for the NHS
- set o ut the clinical care that is suitable for most patients with a specific condition using the NHS in England and Wales
- take account of the views of those who might be affected by the guideline (including healthcare and other professionals, patients and carers, health service managers, NHS trusts, the public, government bodies and the healthcare industry)
- are based on the best available research evidence and expert consensus
- are developed using a standard process and standard ways of analysing the evidence, which are respected by the NHS and other stakeholders, including patients
- make it clear how each recommendation was decided on
- are advisory rather than compulsory, but should be taken into account by healthcare and other professionals when planning care for individual patients.
Healthcare and other professionals in the NHS are expected to take our clinical guidelines fully into account when exercising their professional judgement. However, the guidance does not override the responsibility of healthcare professionals and others to make decisions appropriate to the circumstances of each patient. These decisions should be made in consultation with, and with the agreement of, the patient and/or their guardian or carer. Healthcare professionals and others should record their reasons for not following clinical guideline recommendations.
Our clinical guidelines are developed for the NHS, but they may also be relevant to professionals working outside the NHS, such as those working in social care.
Developing NICE clinical guidelines
An overview of the development process.
Guideline topic is referred.
The Department of Health refers clinical guideline topics to NICE.
Stakeholders register interest.
National organisations representing patients and carers, and also health professionals involved in their care can register as stakeholders. Stakeholders are consulted throughout the guideline development process.
The National Collaborating Centre (NCC) commissioned to develop the guideline prepares the scope. This document sets out what the guideline will - and will not - cover. NICE, registered stakeholders and an independent guideline review panel can all contribute to the development of the scope.
Guideline development group established.
The NCC sets up an independent guideline development group for each clinical guideline being developed. Group members include health professionals and patient/carer representatives with relevant expertise and experience. Registered stakeholders are invited to nominate people to join the group. The guideline development group looks at the evidence available and considers comments made on draft versions of the guideline issued for consultation before making final recommendations. The group is recruited during the scoping phase: if required, one member may be recruited at the start of scoping.
Draft guideline produced.
To produce the draft guideline, the group assesses the available evidence and makes recommendations.
Consultation on the draft guideline.
There is at least one public consultation period for registered stakeholders to comment on the draft guideline.
Final guideline produced.
After the guideline development group finalises the recommendations, the collaborating centre produces the final guideline.
NICE formally approves and publishes the guideline.
Short guideline process
Short clinical guidelines address clinical questions which do not meet the topic selection criteria for a traditional clinical guideline or technology appraisal, but nevertheless require guidance.
Short clinical guidelines are developed to the same rigorous methods as clinical guidelines but they are produced within a shorter 9 -11 month timescale. The criteria for their referral to NICE are the same as for topics selected for the main clinical guidelines programme, with an additional judgement about the urgency of the advice.
Clinical guideline development methods: The guidelines manual 2012
The guidelines manual explains how NICE develops clinical guidelines and provides advice on the technical aspects of guideline development.
The manual is updated every 3 years. The 2012 edition is the latest version and describes the process and methods used for all clinical guidelines that began development after 1 December 2012.
- The guidelines manual 2012 - All chapters
- The guidelines manual 2012: appendix A - Agreements and advice for Guideline Development Group members
- The guidelines manual 2012: appendices B-I - Methodology checklists
- The guidelines manual 2012: appendices J-K - Evidence tables and GRADE profiles
- The guidelines manual 2012: appendix L - Abbreviations and glossary
- The guidelines manual 2012: appendix M - Guide to the short clinical guideline process
- The guidelines manual 2012: appendix N - How NICE clinical guidelines are developed: an overview for stakeholders, the public and the NHS (fifth edition)
Previous versions of the guideline manual
Guidelines that were published or in development between 2009 and 2012 will have followed the process and methods from the 2009 manual for some or all stages of their development. The methods sections of draft and published full guidelines will specify which version of the manual was used
Positively Equal: a guide to addressing equality issues in developing clinical guidelines
This guide to addressing equality issues in developing clinical guidelines is used by NICE's Centre for Clinical Practice, the National Collaborating Centres, chairs and members of guideline development groups (GDGs).
Interim methods for developing service guidance
NICE has developed interim methods for developing service guidance and published these in February 2013.
- Interim methods guide for developing service guidance 2013 (including appendix 1)
- Appendix 2: Service delivery operational research methods reference
Interim process and methods for clinical guideline surveillance
NICE has developed an interim clinical guideline surveillance process and methods guide. This replaces sections 14.1 and 14.2 of the guidelines manual for guidelines being considered for updating from August 2013 onwards. This interim process will be evaluated over a 12-month period, and will then be subject to formal consultation.
Reviewing and updating published guidelines
Published guidelines undergo surveillance reviews every 2 years after publication to decide if an update is needed at that time. This surveillance review decision is informed by a number of stages of intelligence gathering, including searches for evidence, related guidance and qualitative feedback from other NICE departments, the National Collaborating Centre (NCC) that developed the original guideline and the Guideline Development Group (GDG).
Stakeholders register interest
National organisations representing patients and carers, and also healthcare professionals involved in their care, can register as stakeholders.
Surveillance process begins
Searches take place for new evidence that may have emerged after publication of the guideline that will inform surveillance review proposals for updating.
Surveillance review proposal prepared
The surveillance review proposal will outline a summary of the key factors that have influenced the decision behind the proposal.
Consultation on the surveillance review proposal (only for proposals to not update the guideline at 4 and 8 years after publication)
This is a period for registered stakeholders to comment on any surveillance review proposal to not update the guideline in whole or in part.
Surveillance review proposals about guidelines undergoing surveillance at 2, 6 and 10 years after publication will not be consulted on.
Final surveillance review decision produced and published
NICE Guidance Executive makes a final decision on whether NICE will update the guideline, and the review decision is published on the website.
This interim process and methodology is described in more detail here.
Clinical guideline updates using a standing committee
NICE uses a standing committee, rather than an ad hoc guideline development committee, to update discrete parts of published clinical guidelines when a full update is not needed. A pilot programme began in October 2013. The principal role of the committee is to update clinical guideline recommendations across a range of clinical guidelines as requested by NICE's Guidance Executive. The Committee develops recommendations for the NHS in accordance with NICE's published methods, but the process takes less time than a full update. This process was formerly known as 'rapid updates'.
Guidelines eligible for update by the standing committee are those where the update focuses on small and very defined areas of the guideline.
The process for substantially updating clinical guidelines has not changed and is explained in the guidelines manual.
The committee consists of 12-15 core healthcare professional, patient and carer members. They are supplemented by 2-5 topic-specific members primarily drawn from the original Guideline Development Group for each guideline. Additional expert witnesses may be invited to attend.
The initial topics identified for update using a standard committee are:
- Advanced breast cancer
- Irritable bowel syndrome
- Long acting reversible contraception
- Post natal care
- Colorectal cancer
The draft recommendations will be consulted upon. To take part in the consultation process your organisation will need to register as a stakeholder
- Terms of Reference and Standing Orders of the updates standing committee
- Interim process and methods guide for the clinical guideline standing committee updates pilot programme 2013
Clinical guideline static list
Some clinical guidelines are not updated as often as the rest of NICE's clinical guidelines. They are placed on a 'static list' and undergo surveillance less often
NICE's collaborating centres (NCCs)
NICE’s collaborating centres (NCCs) help develop clinical and social care guidelines by harnessing the expertise of the royal medical colleges, professional bodies and patient/carer organisations.
- The National Clinical Guideline Centre (NCGC) is hosted by the Royal College of Physicians and overseen by a governance partnership between the Royal College of General Practitioners, Royal College of Nursing, Royal College of Physicians and Royal College of Surgeons of England.
- The National Collaborating Centre for Cancer (NCC-C) is hosted by Velindre NHS Trust in Cardiff and operates in partnership with Cardiff University and other organisations.
- The National Collaborating Centre for Women´s and Children's Health (NCC-WCH) is supported by a partnership led by the Royal College of Obstetricians and Gynaecologists, which includes the Royal College of Paediatrics and Child Health, Royal College of Midwives, Royal College of Nursing and a range of stakeholder and consumer partners including general practitioners.
- The National Collaborating Centre for Mental Health (NCCMH) is a partnership between the Royal College of Psychiatrists and the British Psychological Society.
- The NICE Collaborating Centre for Social Care is a consortium led by the Social Care Institute for Excellence, with Research in Practice, Research in Practice for Adults,the Evidence for Policy and Practice Information and Co-ordinating Centre and the Personal Social Services Research Unit.