37 The primary output of the appraisal will be advice from NICE on the circumstances in which the intervention is recommended for routine clinical use in the NHS. If the advice is to succeed in improving the use of resources and in reducing the disparities over the uptake of the intervention (para 4 above), the recommendations will need to be as clear and precise as the evidence will allow. The recommendation should be expressed in terms of a limited number of categories; this will be familiar to many health authorities and clinicians from the methods developed by the South Western Development Evaluation Committee (DEC) and elsewhere. These categories are likely to be:
     
  A recommended as clinically cost-effective for routine use in the NHS (either for all licensed indications or for specific indications and/or only for particular patient subgroups)
  B recommended only for use in the context of clinical trials to help answer specific questions about cost-effectiveness/targetting
  C not recommended for routine use.
   
38 Category A might be further qualified as follows
     
  i recommended for use by all GPs and specialists
  ii recommended for use in hospitals and for GPs with particular expertise, underpinned by joint formulary or agreed shared care arrangements
  iii recommended for use only by hospital specialists (of named specialty)
  iv recommended for use only in specialist (tertiary referral) centres.
   
39 In addition to the primary recommendation, NICE's advice might consist of
     
  i clinical guidance on the appropriate use of the intervention, covering issues such as indications for use, training, issues to raise with patients in seeking informed consent, monitoring and evaluation, and indications for stopping treatment;
  ii a brief summary of the evidence on which the appraisal group had based its conclusions.
     
The outputs will be widely disseminated, and the documentation considered by the appraisal group will be made available on request under normal open government rules.