Barriers and how to overcome them

Putting NICE guidance into practice can be challenging. Here is some advice about how to overcome the most common barriers.

Funding issues

A lack of funding is often seen as a barrier to the implementation of NICE guidance.

The recent financial pressures, coupled with the drive to make efficiency savings within the NHS, may be making organisations even more reluctant to fund NICE guidance.

There is also a tension within primary care between promoting our guidance and guarding against overspend of budgets, especially on prescribing.

This can result in a half-hearted endorsement of NICE guidelines, with an agreement that it is the right direction to head in, but little desire to promote putting the guidance into practice.

Far from using up resources, following NICE guidance can actually help practices make significant savings in some areas.

Following our guidance can provide a way for you to ensure that your patients receive treatment that is proven to be both clinically and cost effective.

It can also free up resources and capacity that can then be channelled into other services.

We have identified 19 sets of recommendations that, if fully implemented across the pathway, could help to save millions of pounds.

Following NICE recommendations on the prescribing of drugs to control hypertension, for example, can deliver considerable savings by reducing the number of patients who go on to suffer a heart attack or a stroke that requires treatment or hospital care.

NICE estimates that £446,627 can be saved for every 100,000 patients that are treated in line with the hypertension guidance, resulting in an overall saving of over £200 million.

Encouraging women to use long-acting reversible contraceptives (LARCs) instead of the pill is another good way to produce significant savings.

Switching just 7 per cent of women from the pill to LARCs could save the NHS £100 million by reducing 73,000 unwanted pregnancies each year.

Guidance from a range of sources

You may be concerned that a recommendation in our clinical guidelines conflicts with what is being said in other guidelines, leaving you unsure about which one to follow.

Some guidelines are based on American or European recommendations, but NICE guidance is developed specifically for the NHS in England, Wales and Northern Ireland.

All of our guidance is developed using the latest clinical evidence and in consultation with independent committees and experts. These include industry and health experts, academics, patients and other members of the public with a background or interest in the area.

GPs are involved in the development of every piece of NICE guidance to ensure that the recommendations are relevant, workable and achievable within primary care.

We also work in collaboration with The Royal College of General Practitioners (RCGP), allowing us to feed in their expertise into the development of our guidance.

For our technology appraisals, trusts have a legal requirement to fund the treatments within three months of their publication.

Where NICE guidance doesn't exist, you can access other sources of accredited guidance by searching NCES Evidence Services.

Results from accredited sources feature at the top of the list of search results, with the Accreditation Mark clearly displayed. NHS Evidence Accreditation Mark

The NICE Evidence Services accreditation team uses standardised criteria and assessment processes, based on the recognised quality standard Appraisal of Guidelines Research & Evaluation (AGREE). Supporting information supplied by the guidance producer is rigorously assessed and analysed to produce a qualitative assessment of compliance with the criteria.

Does it change current practice?

Some pieces of NICE guidance require a change in current practice. This can result in the need for new equipment, additional training, or possibly more staff.

Although this could mean that your practice has to spend money to implement the guidance, you will soon see the benefits of offering optimised care. It can cut down the number of patient visits, as patients who receive the best possible care are less likely to return with complaints.

Use our guidance, particularly the patient friendly versions, during a consultation to involve and empower patients so that they take an active role in the management of their problems.

NICE provides a range of tools to help you to put guidance into practice. Many of these focus on helping you to identify what needs to be changed, and provide access to information and resources to help you to change practice.

Again, this will help to reduce the number of unnecessary visits from patients, improve patient compliance, and ensure your practice scores well for patient satisfaction.

Too much to handle

Some GPs have said that there is too much NICE guidance for them to keep track of, making it difficult to work out which pieces of guidance they need to implement in their practice.

Assigning a NICE lead in your practice and discussing the guidance at your practice meeting will help you decide which pieces of guidance are relevant and need implementing.

Read our Update for Primary Care e-newsletter every month for a breakdown of the latest NICE guidance and what it means for general practice.

The ´Is my practice up to date?´ section of this site also provides a summary of the guidance from NICE that is particularly relevant to general practice, from the past 12 months.

This page was last updated: 22 November 2013

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Accessibility | Cymraeg | Freedom of information | Vision Impaired | Contact Us | Glossary | Data protection | Copyright | Disclaimer | Terms and conditions

Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.