NICE process and methods

9 Links to other NICE centres and guidance programmes

This chapter describes how the work of other guidance development centres, directorates and teams at NICE links to the development of public health guidance. It also outlines the approaches to be taken if:

  • NICE asks a Public Health Advisory Committee (PHAC) to incorporate or update existing published guidance during the course of its work

  • NICE is asked by the Department of Health to develop combined guidance on the prevention and treatment of a particular condition

  • related guidance is being developed concurrently by another centre at NICE.

9.1 Coordinating with technology appraisal guidance

Independent technology appraisal committees advise NICE on what the guidance should say. The appraisal committees are stakeholders for public health guidance (see about technology appraisals on the NICE website).

9.1.1 Dealing with overlaps

If a referral for a new public health guidance topic covers an area in which there is existing technology appraisal guidance, there are 2 options:

  • The technology appraisal guidance is incorporated into the public health guidance unchanged, and is acknowledged in the public health guidance. For example, the technology appraisal guidance on varenicline is incorporated into the public health guidance on smoking cessation services.

  • The technology appraisal guidance is updated (either in full or in part) through the public health guidance development process (see section 10.2.1).

If a public health guidance topic is being developed simultaneously with a related technology appraisal, timing is coordinated to ensure that the recommendations are consistent (see section 10.2).

A decision on whether published technology appraisal guidance is to be incorporated or updated in public health guidance is taken by the NICE Guidance Executive while the draft scope for the guidance is being developed.

9.1.2 Updating technology appraisal guidance in public health guidance

Any proposed update to the recommendations in technology appraisal guidance is discussed with the NICE technology appraisals team and agreed by the Guidance Executive (see chapter 10). There should be an update only if a technology appraisal recommendation extends into the setting or circumstances for the use of the public health guidance, or if the marketing authorisation for the product has been extended to different population groups and the appraisal recommendation is being superseded by a systematic review of the effectiveness and cost effectiveness of that aspect in the public health guidance. The reasons for any change should be documented clearly in the full version of the public health guidance.

Superseded recommendations are withdrawn from the technology appraisal guidance when the public health guidance is published; this withdrawal is indicated on the NICE website. Once technology appraisal recommendations have been updated in public health guidance, the funding direction that related to the original recommendations no longer applies. (The funding direction requires local NHS organisations to fund medicines and treatments recommended by NICE technology appraisal guidance, normally within 3 months of publication of the guidance).

9.1.3 Simultaneous development of public health guidance and technology appraisal guidance

If technology appraisal guidance is being developed around the same time as related public health guidance, the final recommendations in both should be complementary and consistent. The timetables for the development of the technology appraisal and the public health guidance should be coordinated so that the published technology appraisal recommendations can be incorporated into the consultation draft of the public health guidance. If the public health guidance is issued for consultation before the technology appraisal has been published, the guidance should cross refer to the technology appraisal consultation document.

9.2 Interventional procedures

Interventional procedures guidance is concerned with the safety and efficacy of surgical and clinical interventions, but not with their clinical and cost effectiveness (for more details see about interventional procedures guidance on the NICE website).

If published interventional procedures guidance is identified as relevant to a public health guidance topic (for example, interventional procedures guidance on division of ankyloglossia for breastfeeding and public health guidance on infant nutrition), it is referred to in the 'Related NICE guidance' section of the public health guidance scope and the final published guidance. Because the interventional procedures programme does not examine cost effectiveness, an economic appraisal may be needed in these circumstances.

9.3 Medical technologies guidance

Medical technologies guidance is designed to help the NHS adopt efficient and cost-effective medical devices and diagnostics more rapidly and consistently. It covers medical devices that deliver treatment such as those implanted during surgical procedures, technologies that give greater independence to patients, and diagnostic devices or tests used to detect or monitor medical conditions (for more details see Medical technologies evaluation programme on the NICE website).

If published medical technologies guidance is identified as relevant to a public health guidance topic, it is referred to in the 'Related NICE guidance' section of the public health guidance scope and the final published guidance.

9.4 Clinical guidelines

Clinical guidelines are concerned with the appropriate treatment and care of people with a particular disease or condition (for more details see about clinical guidelines on the NICE website).

If a published clinical guideline is relevant to a public health guidance topic (for example, the clinical guideline on the management of depression in children and young people and the public health guidance on the social and emotional wellbeing of children in primary education), the clinical guideline is referred to in the 'Related NICE guidance' section of the public health guidance scope and the final published guidance.

NICE clinical guidelines are developed by independent national collaborating centres. National collaborating centres for relevant clinical guidelines are stakeholders for public health guidance.

9.4.1 Combined clinical guideline and public health guidance

The Department of Health may ask NICE to develop combined guidance on both the prevention and clinical management of a particular condition.

The NICE Centre for Clinical Practice and the Centre for Public Health Excellence (CPHE) manage referrals for combined guidance jointly (for example, the prevention and management of obesity, or the prevention, early identification and management of alcohol use disorders in adults and adolescents). When a joint referral is received, the Centre directors consult with senior staff and relevant committee Chairs, before deciding how to develop the guidance. Joint or combined processes may be implemented over varying periods of time, as appropriate.

A joint referral may be developed in 1 of 3 ways:

  • both clinical and public health aspects of the guidance are developed by 1 combined committee, with 1 Chair, using either the clinical or public health guidance development processes, or

  • both clinical and public health aspects of the guidance are developed by 1 combined committee, with 1 Chair, using both sets of processes, or

  • clinical and public health aspects of the guidance are developed by 2 separate committees, which may have some shared membership, using separate processes.

In general, where joint guidance is developed through a single process, the methods and quality assurance for clinical and public health aspects of the guidance will be managed by the relevant guidance development centre team. In these circumstances, there will usually be one combined scope and guidance document, with clinical and public health areas clearly defined and described. Where joint guidance is produced through two processes, with 1 or 2 committees, then it may be more appropriate to produce separate scopes and guidance documents.

Where PHAC and guideline development group meetings are held separately, it can be helpful to have at least 1 joint meeting to ensure consistency and to avoid overlaps or gaps.

To help ensure consistency, where PHAC and GDG meetings are held separately an internal steering group will be set up, composed of senior staff from both centres. Combined guidance usually involves the PHAC developing public health guidance on the prevention, early identification or protection aspects of a condition, and a guideline development group producing a clinical guideline on clinical management, treatment and care. A joint Chair for both the development groups may be appointed. The joint Chairs should have a good understanding of both public health and clinical issues. If it is not possible to appoint a joint Chair, the steering group is responsible for communication between the 2 Chairs and the 2 development groups.

Where the guidance is developed through 1 process, then it may be appropriate to develop a combined scope. Where 2 processes are used, 2 scopes may be more appropriate: 1 for the public health guidance and 1 for the clinical guideline. The draft scopes are issued for consultation simultaneously, and the final scopes for the public health guidance and the clinical guideline are agreed through discussion between guidance centre directors, topic leads (associate or programme directors) and relevant Chairs.

Where the guidance is developed through more than 1 process, the draft clinical guideline and public health guidance are usually issued for consultation at the same time. The CPHE project team (see chapter 7) is responsible for responding to stakeholder comments on the draft public health scope and guidance. The collaborating centre for the clinical guideline deals with responses to stakeholder comments on the draft clinical scope and guideline. The guidance centre directors and topic leads ensure consistency between responses.

The steering group also decides whether the prevention and management aspects will be published as integrated joint guidance, or as separate public health guidance and a clinical guideline to be published at the same time.

Once both areas of the guidance are complete, a NICE Pathway will be produced linking the two.

9.5 Working with other NICE teams

The CPHE and the other guidance-producing centres work with the following directorates and teams:

  • Implementation Directorate

  • Communications Directorate

  • Evidence Resources Directorate, including information services

  • Patient and Public Involvement Programme (PPIP)

  • Health and Social Care Directorate, including the quality systems team.

9.5.1 Implementation

The Implementation Directorate supports the guidance development process by providing implementation tools and resources. It continues to support implementation of NICE guidance once it is published, for example through follow-up visits by regional implementation consultants. The implementation adviser assigned to the CPHE project team (see chapter 7) is known as the implementation lead. In addition, a costing lead and an audit lead produce costing and audit support tools.

For each set of guidance, the implementation lead undertakes an implementation needs assessment and works with the CPHE project team, members of the PHAC and other key stakeholders to develop an implementation support plan. The needs assessment and development of the implementation tools usually start during consultation and continue through to publication of the guidance.

The implementation support plan summarises the education and learning needs and other levers and barriers identified through needs assessment derived from intelligence gathered during development (for example, there may be a quality standard available). The plan sets out the proposed action to address any barriers and specifies what tools and resources will be developed to support implementation of the guidance. Tailored solutions are then developed according to need.

The implementation lead, costing lead and audit lead work with members of the PHAC and key stakeholders to develop the tools. The guidance-related support tools provided by NICE are designed to support each of the key steps to implementation. These are outlined in How to put NICE guidance into practice: a guide to implementation and How to put NICE guidance into practice and improve the health and wellbeing of communities: practical steps for local authorities, and may include:

  • Tailored education and learning tools which focus on topic-related education and learning for individuals and organisations, for example online resources developed with BMJ Learning, or support for scrutiny committees developed with the Centre for Public Scrutiny. See Into Practice on the NICE website for examples of the types of tailored tools that are produced.

  • Audit support and a data collection tool. These help organisations to carry out audits based on some of the measurable recommendations in the guidance. They consist of audit standards, data collection tools and action plans. Some will also be produced as Excel electronic audit tools that provide a basic data analysis and clinical audit report.

  • Costing tools to help organisations assess the cost of implementing the guidance. The costing analyst assesses the recommendations to identify those with the greatest resource impact (see Assessing cost impact: methods guide [2011] on the NICE website). NICE usually provides two types of costing tools to accompany each public health guidance:

    • a costing report, which summarises the estimated national costs and savings associated with implementing the guidance and discusses the assumptions made in reaching this figure

    • a costing template, which allows users to estimate the local impact of implementing the guidance based on their population and to change the assumptions and variables to reflect local circumstances.

    • Occasionally, implementing the recommendations in the guidance may not be estimated to result in significant additional costs or savings. No costing report or costing template is produced in these cases. Instead, a costing statement is produced that explains why the cost impact is not considered to be significant.

  • A commissioning guide.

Draft versions of tools and other resources are consulted on with the CPHE project team, volunteers from the PHAC and other key stakeholders before they are finalised for publication.

9.5.2 Communications Directorate

Three teams in the Communications Directorate are involved in the guidance development process.

  • The publishing team provides editorial support to the CPHE project team (see chapter 7), including the development of editorial processes for key documents. It edits documents during guidance scoping, development and validation stages, develops the NICE Pathway and coordinates publication of the guidance and the Pathway.

  • The website team is responsible for publishing all information relating to the project on the website, including consultation documents and final guidance.

  • The press team is responsible for managing all media matters relating to the guidance, writing and coordinating press and journal articles and advising on issues arising during guidance development, dissemination and following publication.

9.5.3 Evidence Resources Directorate

The information services team is part of the Evidence Resources Directorate. It contributes to the search strategy involved in developing the scope. This specialist team helps to assure the quality of the search strategies that the evidence providers use for the evidence reviews. In addition, staff may help to identify links to NICE guidelines or technology appraisals on similar topics – either in development or already published – and the implications for topic selection and public health guidance in development. From time to time, the information services team may develop and implement search strategies in-house, in collaboration with the CPHE project team (see chapter 7).

9.5.4 Patient and Public Involvement Programme

The PPIP supports community involvement in the development of public health guidance. This includes:

  • identifying and supporting contributions to guidance development from stakeholder organisations that promote the interests of specific population groups or service users, or the wider public (usually national voluntary or non-governmental organisations)

  • commenting on the community focus of the draft scope for the guidance, and giving a presentation at the stakeholder meeting about the opportunities for community involvement in guidance development

  • supporting the identification and recruitment of community members and co-opted community members to the PHACs

  • providing induction and training to community members and additional briefing and support to community members and co-opted community members, when needed

  • commenting on the draft guidance.

9.5.5 Health and Social Care Directorate

NICE quality standards are produced by the quality systems team, which is based in the Health and Social Care Directorate. NICE quality standards are a concise set of statements designed to drive and measure priority quality improvements within a particular area of care. They are derived from the best available evidence such as NICE guidance and other evidence sources accredited by NICE (such as NHS Evidence). Where a quality standard is to be produced based on NICE public health guidance, the CPHE project team (see chapter 7) link with the quality systems team and provide information and support on the evidence and guidance. For more details see NICE quality standards on the NICE website.