Process and methods
Clinical guidelines developed by NICE are published with the expectation that they will be regularly reviewed and updated as necessary. Any decision to update a guideline must balance the need to reflect changes in the evidence against the need for stability, because frequent changes to guideline recommendations would make implementation difficult. However, even though a guideline may not need a substantive update, there are often small discrete areas that could be updated to make sure that NICE guidance reflects the latest evidence.
Evaluation of the outcomes of the previous process for reviewing the need to update a clinical guideline (used until August 2013) highlighted that although only about 1 in 7 guidelines needed a substantive update 3 years after publication, a further proportion had some areas of the guideline that would have benefited from updating. This usually involved small and defined areas of the guideline – perhaps 2 or 3 recommendations, 2 or 3 review questions or a single distinct section of the guideline.
NICE's ability to undertake clinical guideline updates using standing committees has been greatly limited by our standard processes and the way we commission guideline development slots with the National Collaborating Centres. A significant amount of time is needed to prepare for updating a guideline, including recruiting members of the Guideline Development Group (GDG) and scoping the update. This is in addition to the development time and the quality assurance process for the guideline itself. In the 2 or 3 instances where we have undertaken a rapid update, it has been limited to areas where patient safety may have been compromised by the existing guidance.
This pilot programme for clinical guideline updates using standing committees aims to address these capacity and efficiency issues, by creating a standing committee (the Clinical Guidelines Updates Committee) and using processes that significantly reduce the time taken to prepare for the update and to develop recommendations.
The methods and processes described here do not replace those described in chapter 14 of the NICE guidelines manual 2012 for substantive updates of clinical guidelines. They allow small, discrete sections of a guideline to be updated more efficiently.