Process and methods
3 The Guidance Development Group
Convening an effective Guidance Development Group (GDG) is one of the most important stages in producing NICE social care guidance. The GDG agrees the questions to be addressed by the evidence reviews, considers the evidence, develops the recommendations and advises on adoption support. Membership of the GDG therefore needs to be multidisciplinary and comprise:
social care practitioners and other professionals (both specialists in the topic and generalists)
social care providers or commissioners
service users or carers.
The exact composition of the GDG should be tailored to the topic covered by the social care guidance. It should reflect the range of stakeholders and groups whose activities, services or care will be covered by the guidance, and should include at least 2 members who have experience or knowledge of service users and carer issues.
During guidance development, people who are not members of the GDG but who have relevant expertise may be asked to attend meetings to take part in specific discussions (see section 3.1.7).
Members of the GDG are not permitted to submit comments as stakeholders during the consultation on the draft guidance (see section 11). If a GDG member is involved with a registered stakeholder organisation, they should not submit comments during the consultation on behalf of that organisation – someone else in the organisation should draft and submit the comments.
This section describes the core elements of forming and running a GDG, including the appointment and role of the chair and members.
The chair and members of the GDG are appointed for the duration of the development of a particular piece of guidance. The chair is appointed before the guidance scoping stage and is a member of the scoping group. If appropriate, a social care topic adviser for the guidance is also appointed before scoping (see section 3.1.3). Other GDG members are appointed after discussion about GDG membership at the stakeholder scoping workshop (see section 2.4.1).
The chair and GDG members are recruited and appointed in accordance with NICE's policy on Appointments to guidance producing bodies advisory to NICE (November 2006).
The composition of each GDG is agreed between the NICE Collaborating Centre for Social Care (NCCSC) and NICE during the scoping phase. A workable size for a GDG is between 13 and 15 people. This balances the opportunity for people to contribute effectively with the need for a broad range of experience and knowledge. Members of the GDG should have sufficient credibility to command the respect of people within their field. The GDG has 3 key constituents:
the social care topic adviser
members from the social care professions, providers and commissioners, and from other professions if relevant
service user and carer members.
The GDG will be supported by technical and project management staff from the NCCSC.
For some guidance topics, it may be important for the GDG to include an epidemiologist with knowledge of the subject. The GDG may also be supported by expert witnesses who are invited for specific areas only (see section 3.1.7).
As far as possible, the GDG will have an appropriate balance with regard to the principles of NICE's equality scheme.
Ideally, GDG members should represent a geographical spread across England, but this will be influenced by the expertise available.
All GDG members should be committed to developing the social care guidance according to the processes set out in this manual, and to working within NICE's equality scheme (see section 3.2.3). They are expected to attend all GDG meetings (usually between 7 and 12).
New members should not usually be added to the GDG after the first GDG meeting has taken place, because this may disturb the group dynamic. If a GDG member is unable to fulfil their duties (for example, because of illness), another recruitment process may be considered to replace that person. If GDG members are unable to attend a GDG meeting, deputies are not permitted.
People are GDG members in their own right and do not represent any particular organisation or group.
If service guidance is being developed (see section 1.4.1), or if the social care guidance contains a service guidance component, additional members should be appointed to the GDG to reflect this. This might include input from:
commissioning bodies in England
relevant practitioner networks
a chief executive or local authority representative, such as a director of adult social services, with an interest in the topic.
Additional GDG members recruited for service guidance are subject to the same recruitment process as other GDG members (see below).
At any time, the GDG can invite expert witnesses to meetings, particularly where specific expertise is needed on an important issue related to the guidance.
The following sections outline the roles of GDG members and describe how the members should be appointed.
Vacancies for GDG positions are posted on the NICE website. Other means are also used to alert people to GDG vacancies. These include circulating the information to all registered stakeholder organisations, liaising with any relevant professional, practitioner, community or voluntary organisation or group, and using local networks.
To work well, a GDG needs an effective chair. The GDG chair is a member of the scoping group (see section 2.2) and should therefore be recruited before work starts on the scope.
The chair guides the GDG in terms of task (developing the guidance) and process (how the group works). The chair also helps the GDG to work collaboratively, ensuring a balanced contribution from all members (see box 4).
The chair need not be an expert in the guidance topic because specialist knowledge is provided by other GDG members. The chair is appointed for their expertise and skill in chairing small groups, and although they may have some knowledge of the topic, this is not their primary role in the group.
The chair attends an induction session (see section 3.3.1).
The chair needs a detailed understanding of NICE's social care guidance development process, and may have some background or basic understanding of the guidance topic.
The chair should also have a good overall understanding of social care and the context in which the guidance will apply.
To help the working of the group, the chair:
In GDG meetings, the chair:
The chair approves the draft guidance, before sign-off by NICE, and advises the NCCSC on responses to stakeholder comments.
In accordance with NICE's policy on Appointments to guidance producing bodies advisory to NICE (November 2006), the position of GDG chair is advertised on the NICE website. It may also be advertised on the NCCSC web pages of the organisation that hosts the NCCSC, and in other appropriate places identified by the NCCSC. The NCCSC tells the stakeholder organisations about the advertisement.
If appropriate, a social care topic adviser with specialist topic knowledge may be appointed. The social care topic adviser is a member of the GDG, but also works closely with the NCCSC team to provide topic-specific support.
The social care topic adviser is a member of the scoping group (see section 2.2) and is therefore appointed before work starts on the scope.
The social care topic adviser's exact responsibilities will differ depending on the guidance and the expert input needed. It may include, for example, working with the systematic reviewer on the evidence reviews (if expert topic-specific knowledge is needed), or checking the guidance to ensure the terminology and language is correct.
If a social care topic adviser is to be appointed, the position is advertised on the NICE website. It may also be advertised on the NCCSC web pages of the organisation that hosts the NCCSC, and in other appropriate places identified by the NCCSC. NICE tells the stakeholder organisations about the advertisement.
Social care practitioner members of the GDG should be recruited shortly after the stakeholder scoping workshop (see section 2.4.1). They should represent the perspectives of the social care practitioners (and other professionals if relevant), providers and commissioners involved in the care or services covered by the guidance topic.
Social care practitioner members are on the GDG as members with appropriate knowledge and skills; detailed research expertise is not necessary, although an understanding of evidence-based practice is essential. They are not expected to represent the views of their professional organisations.
A GDG has, on average, between 6 and 8 practitioner members; the list of professions represented is agreed between the NCCSC and NICE as part of the work plan.
The roles and responsibilities of the practitioner members of the GDG are shown in box 5.
GDG practitioner members are expected to:
They are not routinely expected to:
Vacancies for practitioner members of the GDG are advertised on the NICE website. They may also appear on the website of the NCCSC or the professional body that hosts the NCCSC, and in other appropriate places identified by the NCCSC. NICE tells registered stakeholder organisations about the advertisement.
At least 2 members of each GDG should have experience or knowledge of issues that are important to service users and carers (the 'service user' and 'carer members'). This is to ensure their views, as well as the views of practitioners, are taken into account in the guidance development process.
In general, service user and carer members will have direct experience of the condition or services being covered – as a service user, carer or family member, or as an officer or member of a service user or carer organisation or support group. They should be willing to reflect the experiences of a wide network of service users, rather than basing their views only on their own experience. However, they do not represent the views of any particular organisation.
Professional and practitioner groups are well represented on GDGs, so service users and carer members do not usually have a social care practitioner background.
Service user and carer members have equal status with other members of the GDG. Their specific roles are shown in box 6.
Service user and carer members carry out the same functions as other GDG members (see box 5), but they are often able to offer specific expertise in:
a Grey literature is defined as reports that are not formally published or have limited distribution, such as institutional reports, and that may not be identified through the common bibliographic retrieval systems
Service users, carers and other members of the public can apply to become GDG members by responding to advertisements posted on the NICE website. NICE's Public Involvement Programme and the NCCSC contacts registered service user and carer stakeholder organisations to alert them to these advertisements. However, a person does not need to be a member of a registered stakeholder organisation to apply. For further details, see information on service user and public involvement.
A core team from the NCCSC supports the GDG. This team usually includes the NCCSC director, an information specialist, a lead systematic reviewer, an economist and a project manager (the lead systematic reviewer may also act as project manager).
NCCSC staff who act as members of a GDG are voting members. However, to ensure that the NCCSC does not have too much influence in a vote, no more than 3 NCCSC members are allowed to vote on any one issue. For each vote, the NCCSC should decide which of its staff are the most appropriate to vote; these would normally be staff with particular knowledge of the issue.
The information specialist identifies relevant literature to answer the review questions developed by the GDG and the NCCSC team (see sections 4, 5 and 6). The role of the information specialist involves:
contributing to the setting of review questions and review protocols
designing and testing search strategies (see section 5.2.2)
contributing to discussions among the NCCSC team and in GDG meetings as needed, including deciding whether a search is needed and gathering key terms and synonyms
identifying which databases should be searched
drafting, refining and executing search strategies
creating databases of the search results using reference management software (including removing duplicates), in preparation for sifting by a systematic reviewer (see section 6.1)
maintaining audit trails, including keeping a log of search results, rationales and strategies
keeping track of which papers are ordered for which review question in the document delivery process.
In addition, the information specialist advises on issues such as copyright and licences, metadata, archiving and record management.
The role of the systematic reviewer is to provide summarised tables of the evidence for other GDG members. The role involves:
contributing to the setting of review questions and review protocols
assessing and selecting published abstracts
critical and quality appraisal of evidence using a validated system
distilling evidence into tables
synthesising evidence into statements
maintaining comprehensive audit trails.
The systematic reviewer attends the GDG and is crucial to the dissemination, presentation and debate of the evidence within the GDG.
The role of the economist is to identify potential economic issues for consideration within the guidance and to perform economic analyses. The economist is a core member of the GDG, and their role is described in more detail in section 7.1.
People who are not members of the GDG may also attend GDG meetings as either expert witnesses or observers. They may be social care practitioners or other professionals, service users or carers, other experts, or NICE or NCCSC staff. They are expected to follow the code of conduct of the GDG and to sign the confidentiality agreement form (see section 3.2.2).
If the GDG does not have sufficient knowledge or expertise to make recommendations in a particular area, it may call on expert witnesses – external experts who can provide additional evidence from their experience and specific expertise – to help the GDG make decisions. These can include people with a service user and carer perspective.
Expert witnesses attend a GDG meeting because of their knowledge in a particular area. However, they are not full members of the GDG; they do not have voting rights, and they should not be involved in the final decisions or influence the wording of recommendations. They should submit a declaration of interests form before attending the GDG meeting.
An observer at a GDG meeting may be asked to sit apart from the group, and should enter into discussions only if invited to do so by the GDG chair.
Observers at GDG meetings may include members of NICE staff (for example, social care fellows, the programme manager, the technical adviser, the NICE public involvement lead, the lead editor and members of NICE's implementation team). They may also include members of the NCCSC (for example, members of other guidance project teams). Observers who are not members of NICE staff or members of the NCCSC are required to sign a declaration of interests form, and need the permission of the group to attend.
From April 2014, NICE social care guidance meetings will be open to members of the public and press. This supports NICE's commitment to openness and transparency and will enable stakeholders and the public to understand how social care guidance is developed and consultation comments taken into account.
To promote public attendance at social care guidance meetings, NICE will publish a notice with a draft agenda alongside a registration form on its website at least 20 working days before the meeting. Members of the public who wish to attend the meeting should return the completed registration form 10 working days before the meeting. Up to 20 places are available, depending on the size of the venue. To allow wide public access, NICE reserves the right to limit attendees to 1 representative per organisation. The final meeting agenda will be published on the website 5 working days before the meeting. For further details, see information for people attending a NICE committee meeting.
If an item on the agenda includes commercial- or academic-in-confidence information, it is discussed at a separate session of the meeting, from which the public is excluded. The decision to hold a separate session is made by the GDG chair and the responsible NICE director.
All GDG members and anyone who has direct input into the guidance (including NCCSC and NICE staff, expert witnesses and expert peer reviewers) must complete declaration of interests forms at various points in guidance development, including at the application stage for GDG membership. Declarations of interests are published in the final guidance.
NICE has developed a code of conduct (see appendix A) for GDG members and other people who attend GDG meetings.
This code sets out the responsibilities of NICE and the GDG, and the principles of transparency and confidentiality.
All people who see documents or who are party to discussions relating to guidance before public consultation are required to sign the confidentiality agreement form before becoming involved.
All GDG members should be provided with a copy of NICE's most recent report on social value judgements: Social value judgements: principles for the development of NICE guidance (second edition, 2008) and be made aware of NICE's equality scheme and action plan. (The social value judgements document is currently being updated to incorporate NICE's new remit for social care.)
The person selected to perform the crucial role of GDG chair may need support and training so that they can carry out their role effectively. The chair needs in-depth knowledge of the NICE social care guidance development process and an understanding of group processes. Anyone appointed as a GDG chair is required to attend an induction session (see box 7), which covers the key tasks that the chair is expected to perform.
To work effectively, GDG social care practitioners, professional members and service user and carer members may need training and support in some technical areas of guidance development, such as systematic reviewing and economics. Training should be provided for all GDG members and include components similar to those outlined in box 7.
All service user and carer members of the GDG are offered training by the Public Involvement Programme at NICE. This is over and above any training they may receive alongside other members of the GDG and covers topics such as:
an introduction to economics in guidance
developing recommendations from evidence.
In addition, the training gives service user and carer members support to participate and the opportunity to learn from people who have been on previous GDGs.
A summary of the minutes of each GDG meeting is made available on the NICE website; this includes:
where the meeting took place
apologies for absence
declarations of interests of those in attendance, including actions and decisions made about any conflict of interest
a list of the subjects discussed
date, time and venue of next meeting.
Minutes of GDG meetings are posted on the NICE website during guidance development, before guidance is published.
The GDG is multidisciplinary and its members bring with them different beliefs, values and experience. All these perspectives should be valued and considered. Each member should have an equal opportunity to contribute to the guidance development process.
It is important to check that the terminology GDG members use is understood by all and clarified if needed. The chair should ensure there is sufficient discussion to allow a range of possible approaches to be considered, while keeping the group focused on the guidance scope and the timescale of the project.
The quorum of the GDG is 50% of appointed members. No business relating to the formulation of guidance recommendations may be conducted unless the meeting is quorate. If a member is excluded because of a conflict of interest and this causes membership to fall below the quorum, no business may be transacted.
Expert witnesses (see section 3.1.7) are not appointed members of the GDG and do not count towards the quorum.
There are likely to be 12–13 GDG meetings for most guidance topics, but this will depend on the size and scope of the topic. Most are 1-day meetings, but some may take place over 2 days.
Specific aspects of the social care guidance development process are covered in the first and second GDG meetings.
The first meeting should focus on providing information for GDG members on the following subjects:
process of social care guidance development
how systematic reviews are performed
role of economics in decision-making
how service user and carer members contribute
role of the GDG
role of individual members of the NCCSC team.
GDG members should also be made aware of, and operate within, the principles contained in Social value judgements: principles for the development of NICE guidance (second edition, 2008) and NICE's equality scheme (see section 3.2.3). (The social value judgements document is currently being updated to incorporate NICE's new remit for social care.)
Staff from NICE will give presentations to explain how the elements of the social care guidance development process fit together, and the relationship to quality standards.
Mapping the service user's 'journey'
At this first meeting, the GDG should consider the 'pathway' or service user 'journey' and draft a flowchart of this process. This should include any areas of care or services that are integrated (or overlap) with healthcare provision or services.
The flowchart should be revised and updated throughout guidance development and may form the basis for any associated NICE pathway.
The second meeting should focus on agreeing the review questions, based on the scope. It may be helpful to establish an explicit framework that clarifies the objectives of the work, the specific tasks that need to be carried out and the timetable. This enables the group to focus and to develop a structured and well-defined working relationship.
Section 4 describes the process of developing review questions.
At subsequent GDG meetings, the NICE lead editor for the guidance and leads from the NICE implementation team may give presentations or provide information to explain their roles. The NICE leads will also ask for nominations for GDG members to work with them on the following aspects:
The roles of the various GDG nominees are described in more detail in the sections of this manual indicated above.
GDG members need to make collective decisions throughout the development of social care guidance. For example, they need to agree review questions (section 4), interpret the evidence to answer these questions (section 6) and develop recommendations (section 9).
The role of the chair is to ensure:
everyone on the GDG is able to present their views
assumptions can be debated
discussions are open and constructive.
The GDG chair needs to allow sufficient time for all members to express their views without feeling intimidated or threatened, and should check that all of them agree to endorse any recommendations. If the group cannot come to consensus in a particular area, this should be reflected in the wording of the recommendation.
There are many different approaches to making group decisions and there is no blueprint about which approach should be used in which circumstances. Because GDGs function in different ways to reflect their individual members, it is difficult to be prescriptive about the approach. In the vast majority of cases, the GDG reaches decisions through a process of informal consensus. Some GDGs may choose to use more formal voting procedures for certain decisions, but it is beyond the scope of this manual to offer guidance on when these should be used, or which of the many variants might be used.
Exceptionally, if the literature search has found no evidence that addresses the review question, the GDG may identify best practice by using formal consensus methods (for example, the Delphi technique or the nominal-group technique). If these techniques are used, the methods should be described in the guidance. The use of these methods should be discussed on a case-by-case basis with NICE. The final decision on whether these methods are warranted will be made by NICE. If it is decided that such methods may be used, the planning and methods will be clearly documented and the methods described.
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National Institute for Health and Clinical Excellence (2006) Appointments to guidance producing bodies advisory to NICE. London: National Institute for Health and Clinical Excellence.
National Institute for Health and Clinical Excellence (2008) Social value judgements: principles for the development of NICE guidance, 2nd edition. London: National Institute for Health and Clinical Excellence.