Shared learning database

Type and Title of Submission


Using a NICE Implementation Steering Group to link the commissioning role of the PCT with the education and training strategy for General Practice teams


This submission describes the process of how a PCT can both commission and help facilitate PHCTs to implement NICE guidelines in a timely, locally owned framework that incorporates some core quality improvement processes derived from principles of adult learning. The example of one GP team demonstrates, dissemination and adoption of guidelines done in a way that focuses on the key issues that may reinforce or change current clinical practice by all members of the practice team,within the local resources and structure, who can then be confident to relate this appropriately to patients Key steps include using a NICE Implementation Steering Group which has particular reference to the Commissioning and Education and Training strategies, local interpretation and dissemination to practice teams, protected learning time for practice teams and care pathway review system within a practice team to ensure dissemination to the point of patient self management



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Description of submission


The NICE Implementation Steering Group (NISG) exists to provide timely access to appropriate resources that supports capability for primary healthcare clinicians to cope with complexity and change associated with new NICE guidelines. The aim is to help clinicians deliver best clinical practice- in particular reference can be made to areas where there may be contradictions or lack of harmony with existing local health economy rules and regulations so that there is a clear expression of where ongoing developments are needed as opposed to simple changes in clinical practice that can be made immediately. Teams need to have time to review their quality control processes and use adult learning techniques to agree and make change. To provide as many forms of dissemination or opportunities to interpret NICE guidelines as possible made available locally and direct to individuals. The practice team to have a method by which the care pathway can be checked and updated appropriately Practices teams to feel confident that they can inform patients they are complying with NICE guidelines within local resources and frameworks and be able to understand and explain any areas of discrepancy or ongoing development. Patients can be guided to NICE patient resources where appropriate.


Objectives 1.Objectives of NICE Implementation Steering Group (NISG) NISG to meet monthly and prepare concise summary of monthly guidelines relevant to General Practice teams with particular reference to local commissioning and prescribing issues. NISG to liaise and inform relevant PCT committees of any areas of conflict or need for development with existing services/ policy. NISG to offer 'NICE BITES' education meetings NISG to email GPS in all practices with the summaries NISG to post monthly summaries on PCT extranet with links to NICE website 2. Objectives of PCT Education and Training Strategy PCT to provide Protected Learning Time sessions for teams to discuss implementation PCT to provide Quality Improvement tools for practices to develop their capability 3. Objectives of the General Practice Team The Practice to forward the summary to all clinicians. The nominated clinical leads to review the existing care pathway and to amend to be consistent with NICE guidelines where possible. The proposed changes to be discussed and agreed with the team at a clinical meeting. Patient care is compatible with NICE guidelines where possible and staff aware of any barriers and how they are being dealt with.


When the PCT first set up the NISG it only provided presentational meetings which were poorly attended. In turn General Practices had, if any, various degrees of multi professional learning to discuss NICE guidelines and the importance of implementation. The NISG considered the definition of 'reasonable steps' and agreed full implementation by every General Practice team on every guideline was unrealistic in the foreseeable future but that robust multifaceted dissemination, support for education and incentives to audit together with an element of compulsion would be desirable. The NISG is needed to try to help flag issues relevant to those involved in commissioning and prescribing and to help draw together areas of complexity for GP teams. It was felt this could only be done by linking with the PCT Education and Training Strategy.


1. All objectives are being undertaken and in the case of the GP team described in this submission any monthly NICE guidance relevant to practice is circulated to all clinicians. 2. A practice representative may attend a NICE BITES meeting to discuss the issues with colleagues 3. Leads within the practice team study the summary and the formal NICE guideline document and assess the existing patient care pathway. the general practice team developed a 'WRIGGLER' pathway review method. W - Website - the practice website is reviewed to ensure NICE is referenced and appropriate links are available for patients R - Reception - reception guidelines reviewed especially telephone triage I - Intrasite - the practice intrasite contains policies/procedures and these are reviewed and updated. G - Guideline on the practice computer clinical consultation template developed or edited (with a hyperlink to NICE website where helpful) G - Guideline for computer prescribing formulary checked / updated LE - Learning for the patient - patient information for self management is referenced and available R - Refer - appropriate referral criteria take place 4.The practice team meets to discuss NICE implementation for the month. 5.This fits with quality improvement processes such as The Improvement Foundation in their QUISP programme. The PCT has helped facilitate the practice to undertake process mapping by helping with Protected Learning Time and Quality Improvement courses. 6. By using multifaceted dissemination there is material to cater for 4 basic adult learning styles known as 'VARK' Learners have opportunity to learn in particular with Visual, Auditory and Reading styles (Kinesthetic style being the hardest to facilitate although workbased protected learning time does help here) 7. The General Practice team can be confident that all those with patient contact are aware of and implementing new NICE guidelines within their local framework.

Results and evaluation

The process is monitored and evaluated through 1.Monthly reporting to NISG 2.QOF 3.Quality Monitoring meetings 4. Audit element of PBC LES 5 Non Compliance Policy will be audited annually 6 Attendees at NICE BITES workshops complete evaluation forms and results reported to NISG 7 Practice Protected Learning feedback reports

Key learning points

Maximise the modes of dissemination to try to cater for all styles of adult learning Have local ownership of the issues Communication both within the PCT and with 'providers' is essential A strategy to support the capability of general practice teams is essential - change and complexity needs support from all parties

This submission was shortlisted for the 2008 Shared Learning Award.

Contact Details

Name:Mrs Andrea O'Connell
Job Title:Deputy Director of Patient Safety
Organisation:NHS Bournemouth and Poole
Address:Canford House, Discovery Court, Wallisdown Road
Postcode:BH12 5AG
Phone:01202 541497


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This page was last updated: 30 September 2008

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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.