Developing NICE guidelines: the manual
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12 Support for putting the guideline recommendations into practice
12.1 Introduction
The NICE strategy for 2021 to 2026 outlines the importance for our guidance to provide useful and useable advice and for it to purposefully influence the health and care system to adopt the best possible care. We have agreed 4 strategic aims to support the implementation of NICE guidance:
embedding implementation support during guidance development, making sure that recommendations are useful and useable
strengthening external collaboration and partnerships
developing implementation campaigns for health and care system priorities
increasing data used to measure uptake and impact of NICE guidance.
Implementation is considered from the guideline monitoring and scoping stages and throughout the guideline development process for topics aligned with system priorities.
We work with committees, organisations and stakeholders from all relevant sectors to identify potential challenges for implementation and to consider actions to address these. For some topics, we work with organisations to develop resources to support implementation, or to embed recommendations in policy documents or raise awareness with key stakeholders (see the section on promoting awareness in the chapter on finalising and publishing the guideline). The rest of this chapter outlines some of the resources and support available to help organisations and individuals use NICE guidance.
12.2 Tools for planning and resource impact assessment
We provide a baseline assessment tool for each guideline at the time of publication. Organisations can use the tool to identify whether they are in line with NICE guideline recommendations, and to help them plan and record activity to implement them.
We have developed a resource planner to help users plan for and implement our guidance by listing forthcoming guidance, and summarising the resource impact of published guidance and when available those in development.
NICE resource impact assessment tools help organisations assess the potential costs, savings and capacity impacts associated with implementing the guideline. For guidelines that will have a significant resource impact, a resource impact report and resource impact template are produced, where data allows. A guideline's resource impact is significant if the national cost is more than £1 million per year for a single recommendation or £5 million per year for the whole guideline. When costs and savings cannot be quantified but the resource impact may be significant, a resource impact summary report is produced. If the guideline's resource impact is not significant, a 1-page resource impact statement is produced.
12.3 Into practice resources
Visual summaries
For some guidelines, a visual summary of part of the guideline is produced for health or care practitioners. This might happen if practice needs to change, a practitioner needs to make quick decisions, or a specific audience needs support in implementing the recommendations. Examples include a summary showing how the technology appraisals on lung cancer drugs fit together, treatments for more severe depression in adults and antimicrobial prescribing for Clostridioides difficile infection.
Quick guides
For some social care topics, a quick guide is produced to help practitioners with putting recommendations into practice (for example, in a care home), or to support people using services to understand what to expect and make decisions about their care.
Patient decision aids
If a guideline contains a highly preference-sensitive decision point, we include information in the guideline to make it easier for professionals and practitioners to discuss options with the person making a decision on care (see the section on supporting shared decision making in the chapter on writing the guideline). Occasionally we develop a separate patient decision aid to support shared decision making by the person and their health or care practitioner. See our web page on making decisions about your care for the process guide and a list of our patient decision aids.
Into practice guide
Our into practice guide shows how to use evidence to improve care and services. It sets out the most common steps taken when putting evidence-based guidance into practice.
12.4 Assessing and measuring the use of NICE guidance
Several tools are available which aim to address variation in care:
Our quality standard service improvement template helps providers do an initial assessment of how their service compares with a range of quality statements.
The innovation scorecard reports on the use of medicines and medical technologies in the NHS in England that we have positively appraised.
We use a range of data to measure the uptake and impact of NICE guidance. Examples include NHS England's Secure Data Environment (SDE), other national data collections, clinical audit, and data from journals. Intelligence and feedback from users of our guidance and strategic partners also provides insights on the use of our guidance.
12.5 Working with organisations to support implementation
We are strengthening external collaboration so that opportunities for implementation are maximised, for example, by aligning with organisational regulation, monitoring and improvement frameworks.
If other organisations produce resources to support guideline implementation we work with them to ensure that the NICE guidance is correctly referenced and embedded within the resource.
Implementation campaigns are prioritised to reflect the priorities and needs of the health and care system.
Organisations from all sectors and individuals, both lay and practitioner, play a key role in supporting guidance implementation. NICE works with external organisations in the following ways to help to put all NICE guidance and standards into practice:
The adoption and implementation team work with guidance development teams and national organisations to support implementation of specific pieces of guidance, often by seeking alignment to national initiatives. The team also collects information from the health and care system to feed into NICE to help ensure we deliver useful and useable guidance.
The field team supports regional and local health and care systems to implement NICE guidance and use quality standards. The team works with some national partners and provides feedback and intelligence to NICE on the views of stakeholders.
The medicines optimisation team supports the implementation of NICE products and provides feedback and intelligence to NICE from the NHS and other stakeholders, with a specific focus on medicines optimisation. It does this through national, regional and local networks, such as the NICE medicines and prescribing associates.
An implementation strategy group comprising external academics provides expertise and feedback on our implementation activities and keeps the organisation up-to-date on new and ongoing developments in implementation science.
The public involvement programme team works with national and local voluntary and community sector organisations and members of the public to raise awareness of guidance, promote the use of our guidance and standards, and support implementation.
We also seek feedback from people who use our guidelines to improve guidelines and implementation resources. We welcome system intelligence and information about any of our guidelines and use this to inform our monitoring and topic intelligence work. This enables us to prioritise our guideline updates and implementation support work.
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