42 Normally, the advice from the appraisal group will be disseminated directly to the NHS (and to patient/carer groups) on the authority of NICE, and there will be no NHS Executive or Welsh Office involvement. Exceptionally, the appraisal group may advise that although a particular intervention is clinically cost-effective, its effective uptake by the NHS is likely to cause particular management or other challenges, for instance for workforce planning. The NHS Executive or Welsh Office would then need to consider whether to issue complementary management guidance on how introduction of the intervention should best be handled.
   
  Are there any particular circumstances in which management guidance from the NHS Executive or Welsh Office would be helpful, to supplement the clinical guidance from NICE?