STAGE 1. Consultation

What approaches have been used to identify potential equality and health inequalities issues during indicator development?
Equality and health inequality issues have been identified through the existing EHIA on NICE's guideline on sore throat (2018).

What potential equality and health inequalities issues have been identified during indicator development?
The use of FeverPAIN and Centor scores in sore throat diagnosis may raise some equality and health inequalities concerns: Socioeconomic and geographic disparities, for example digital exclusion may limit access to remote consultations, where scoring might be used inconsistently. Health literacy and understanding, for example older adults or those with cognitive impairments may experience communication challenges (such as, hearing loss or difficulty articulating symptoms), which may result in healthcare providers skipping the scoring process or relying on clinical judgment rather than standardised tools. Prescribing variability and systemic bias, for example clinician discretion in applying FeverPAIN or Centor scores may lead to inconsistent antibiotic prescribing. Also, implicit bias could result in certain demographic groups being less likely to receive a recorded score. Data accuracy and indicator reliability, for example incomplete or inconsistent recording of scores may lead to underrepresentation of certain populations in the indicator. Variability in coding practices across healthcare settings could affect data quality and interpretation.

What potential equality and health inequalities issues have been identified during indicator development?

The use of FeverPAIN and Centor scores in sore throat diagnosis may raise some equality and health inequalities concerns:

Socioeconomic and geographic disparities, for example digital exclusion may limit access to remote consultations, where scoring might be used inconsistently.
Health literacy and understanding, for example older adults or those with cognitive impairments may experience communication challenges (such as, hearing loss or difficulty articulating symptoms), which may result in healthcare providers skipping the scoring process or relying on clinical judgment rather than standardised tools.
Prescribing variability and systemic bias, for example clinician discretion in applying FeverPAIN or Centor scores may lead to inconsistent antibiotic prescribing. Also, implicit bias could result in certain demographic groups being less likely to receive a recorded score.
Data accuracy and indicator reliability, for example incomplete or inconsistent recording of scores may lead to underrepresentation of certain populations in the indicator. Variability in coding practices across healthcare settings could affect data quality and interpretation.

How have the committee's considerations of equality and health inequalities issues identified in 1.2 been reflected in the indicator?
The committee discussed that using diagnostic tools for certain patients might lead to increased antibiotic prescribing but agreed that their use is in line with recommendations. They also recognised the potential risk of reduced sore throat coding but considered this comparable to the challenges inherent in any indicator relying on recorded diagnosis codes.

How have the committee's considerations of equality and health inequalities issues identified in 1.2 been reflected in the indicator?

The committee discussed that using diagnostic tools for certain patients might lead to increased antibiotic prescribing but agreed that their use is in line with recommendations. They also recognised the potential risk of reduced sore throat coding but considered this comparable to the challenges inherent in any indicator relying on recorded diagnosis codes.

Could any indicators potentially increase inequalities?
It is unlikely that the indicator will increase inequalities.

Based on the equality and health inequalities issues identified in 1.2 do you have representation from relevant stakeholder groups for the indicator consultation process, including groups who are known to be affected by these issues? If not, what plans are in place to ensure relevant stakeholders are represented and included?
Registered national stakeholders include Age UK, British Infection Association, British Medical Association, Carers UK, Office for Health Improvement and Disparities and Royal College of General Practitioners.

Based on the equality and health inequalities issues identified in 1.2 do you have representation from relevant stakeholder groups for the indicator consultation process, including groups who are known to be affected by these issues? If not, what plans are in place to ensure relevant stakeholders are represented and included?

Registered national stakeholders include Age UK, British Infection Association, British Medical Association, Carers UK, Office for Health Improvement and Disparities and Royal College of General Practitioners.

Has it been proposed to exclude any population groups from coverage by the indicator? If yes, could these exclusions further impact on people affected by any equality and health inequalities issues identified?
It is proposed that the following populations will be excluded from the indicator: People who are immunosuppressed (all ages) People who are immunosuppressed are excluded due to their higher risk of severe infections and complications. This is unlikely to increase health inequalities.

Has it been proposed to exclude any population groups from coverage by the indicator? If yes, could these exclusions further impact on people affected by any equality and health inequalities issues identified?

It is proposed that the following populations will be excluded from the indicator:

People who are immunosuppressed (all ages)

People who are immunosuppressed are excluded due to their higher risk of severe infections and complications. This is unlikely to increase health inequalities.

What questions will you ask at the stakeholder consultation about the impact of the indicator on equality and health inequalities?
Are there barriers to recording these scores consistently in primary care? Do you think there is potential for differential impact (in respect of age, disability, gender and gender reassignment, pregnancy and maternity, race, religion or belief, and sexual orientation)? If so, please state whether this is adverse or positive and for which group. If you think any of these indicators may have an adverse impact in different groups in the community, can you suggest how the indicator might be delivered differently to different groups to reduce health inequalities?

What questions will you ask at the stakeholder consultation about the impact of the indicator on equality and health inequalities?

Are there barriers to recording these scores consistently in primary care?

Do you think there is potential for differential impact (in respect of age, disability, gender and gender reassignment, pregnancy and maternity, race, religion or belief, and sexual orientation)? If so, please state whether this is adverse or positive and for which group.

If you think any of these indicators may have an adverse impact in different groups in the community, can you suggest how the indicator might be delivered differently to different groups to reduce health inequalities?

Completed by lead analyst: Shalmali Deshpande

Date: 19/06/2025

Approved by NICE quality assurance lead: Craig Grime

Date: 19/06/2025

How are you taking part in this consultation?

Equality and health inequalities assessment (EHIA): GID-IND10331: Infections: scoring tools for sore throat

STAGE 1. Consultation