We expect you to take our guidance into account, but people also have the right to be involved in discussions and make informed decisions about their care, as described in your care.

Using recommendations

Recommendations are based on:

  • the trade-off between the benefits and harms of an intervention
  • the quality of the underpinning evidence.

Some recommendations are made with more certainty than others. We word our recommendations to reflect this. For example we use 'offer' to reflect a strong recommendation, usually where there is clear evidence of benefit. We use 'consider' to reflect a recommendation for which the evidence of benefit is less certain.

Developing NICE guidelines: the manual has detailed information on this.

Shared decision making

We are working with other leading health organisations to encourage discussions between the people receiving and delivering care.

Find out more

Prescribing medicines

You should use a medicine's summary of product characteristics when making decisions with patients.

Sometimes a medicine doesn’t have a UK marketing authorisation for a particular condition but we still recommend it. We only do this when there is good evidence for it. If we do recommend this ‘off-label’ use, we mark it with a footnote.

You should follow relevant professional guidance and take full responsibility for the decision.

The patient - or those with authority to give consent on their behalf - should also give informed consent. Make sure you document this.

For more information, see the General Medical Council's prescribing guidance: prescribing unlicensed medicines.

Professional guidelines, standards and laws


When using guidance remember that child maltreatment:

  • is common
  • can present anywhere
  • may co-exist with other health problems.

See the NICE guideline on child maltreatment for clinical features that may be associated with maltreatment.

When using guidance remember that maltreatment of adults at risk of abuse or neglect:

  • is common
  • can present anywhere, including in emergency departments and primary care.

Consider or suspect abuse as a contributory factor or cause of an injury in adults at risk. Abuse may co-exist with an injury.