Content under review
We're updating this page following the publication of our new methods, processes and topic selection manuals. Our previous manuals still apply to evaluations that started before 1 February 2022. The new manuals apply to evaluations that began after this date.
We make 4 types of recommendations:
This is our most positive recommendation. It means that there is enough evidence for doctors to consider this procedure as an option.
Doctors do not have to offer this procedure to patients. They should always discuss the available options with the patient before making a decision. You can find out more on our making decisions about your care page.
Hospitals will have their own policies about getting permission to perform operations and monitoring the results.
This means that there are uncertainties about whether a procedure is safe and effective. We also recommend special arrangements if risks of serious harm are known. These will need to be carefully explained to a patient before they make a decision.
A special arrangements recommendation places emphasis on the need for informed consent. This includes both the patient (or carer) and senior medical staff, such as the clinical governance lead in their trust.
Clinicians using these procedures should collect data, either by audit or research. If there's no method of data collection already available, we'll publish an audit tool along with the guidance.
Only in research
Clinicians should only carry out these procedures in the context of formal research studies. A research ethics committee needs to have approved their use.
We make this recommendation if a procedure is still considered to be experimental, or because of unresolved uncertainties.
Do not use
We make this recommendation if evidence suggests that a procedure does not work well, or if there are unacceptable safety risks.
Are our recommendations mandatory?
There's no legal requirement to follow the recommendations we make. But it's considered best clinical practice for the NHS to do so. This does mean that even if we've issued guidance recommending an interventional procedure, the NHS is not obliged to provide it.
Our guidance does not consider how much the procedures would cost the NHS, or whether the NHS should allocate funding for them. These decisions are made at a local NHS level and usually on a case-by-case basis.
You can find out more in the summary of requirements for the NHS and clinicians (PDF).
Why we publish this guidance
Unlike medicines, there's no licensing system in the UK for operations or other interventional procedures.
This means that it can be difficult for healthcare professionals to be fully informed about the possible risks and benefits of new procedures as they become available within UK clinical practice.
Our guidance encourages doctors to consider newer procedures that they might not have otherwise used. It also protects patients by giving advice on risks and benefits.