Developing NICE guidelines: the manual

Commenting on the draft guideline

The draft version of the guideline (recommendations, rationales, committee discussions, evidence reviews and methods) is posted on the NICE website for consultation with registered stakeholders. Stakeholders can register at any point during guideline development. NICE informs registered stakeholders that the draft is available, via email and through its promotional channels, and invites them to comment by the deadline. Questions for stakeholders are posted with the draft guideline. The purpose of these questions is to seek stakeholder views on factors such as the potential equality impact. NICE also asks stakeholders to comment on recommendations identified as likely to substantially increase costs, and their justification, and to consider whether any other draft recommendations are expected to add substantial costs. Questions related to implementation may also be included to identify practitioners or services who are already implementing the draft recommendations, or resources that may support implementation.

The length of time for consultation depends on the size of the guideline and the number of review questions. Consultation on a new guideline or full update consisting of 15 to 20 review questions usually lasts for 6 weeks. A 4‑week consultation may be used for partial updates of guidelines with less than 15 review questions, while small updates with 1 or 2 review questions will normally have a 2-week consultation. NICE staff with responsibility for quality assurance will decide how long the consultation will last, and stakeholders will be told well in advance.

NICE is unable to accept:

In these cases, NICE will invite a registered stakeholder to resubmit a single set of comments with no attachments before the consultation deadline. NICE is unable to accept any comments received after the deadline.

Comments should be constructed as reasoned argument and be submitted for the purpose of improving the draft guideline. NICE reserves the right not to respond to comments that are hostile or inappropriate.

Stakeholders should make sure that any confidential information or information that the owner would not wish to be made public is clearly underlined and highlighted. Confidential information should be kept to a minimum. Stakeholders should explain why the information is confidential and if and when it will become publicly available.

Where views on the guideline are shared by more than 1 stakeholder organisation, NICE encourages these organisations to work together to produce a joint response. This should be submitted by 1 registered stakeholder; other stakeholders supporting the joint response should respond to the consultation noting their endorsement.

When registering, and when commenting on the draft scope and draft guideline, stakeholders are asked to disclose whether their organisation has any direct or indirect links to, or receives or has ever received funding from, the tobacco industry. Disclosures will be included with the published consultation responses. Tobacco companies and those who speak for them or are funded by them (collectively referred to as 'tobacco organisations') cannot register as stakeholders. This is in line with NICE's obligation under Article 5.3 of the WHO Framework Convention on Tobacco Control (FCTC) to protect public health policies from the commercial and other vested interests of the tobacco industry. Tobacco organisations are simply referred to as 'respondents' and any comments received during consultation are reviewed for factual inaccuracy claims and are made public along with any responses.

Approaches to additional consultation and commissioned primary research

Additional consultation is a targeted engagement exercise to obtain a range of views, experiences and expertise, independent from the committee. An additional consultation for a guideline is considered only on an exceptional basis and is additional to the routine stakeholder consultations.

Commissioned primary research can occasionally be useful for addressing topic areas where there is limited or no evidence. Commissioned primary research should start during the development of the guideline, and the findings should be used by the committee as part of the evidence base for developing recommendations.

For more information, see the appendix on approaches to additional consultation and commissioned primary research.

External expert peer review

Although NICE does not routinely commission peer review from external experts, members of NICE staff with responsibility for quality assurance, or the developer, may occasionally consider arranging additional external expert peer review of part or all of a guideline, or an evidence review, executable model or economic analysis. For example, review by external experts may be valuable if novel methods have been used in developing an evidence review.

External expert peer reviewers may include practitioners, those commissioning care, academics (for example, with expertise in economic or meta-analysis), or people with a lay perspective. Experts are selected on the basis of their experience in the particular issue under review.

External expert peer review may take place during guideline development or during consultation on the draft guideline. If it occurs during development the comments are not published, but the reviewers should be named in the guideline. Comments from external expert peer reviewers during the development of the guideline should be discussed by the committee, and their decisions fully documented in the committee discussion section of the relevant evidence review. If the reviewers also comment during consultation, their comments are responded to in the same way as comments from registered stakeholders and are published in the guideline consultation table on the NICE website under 'external expert peer reviewers'. All external expert peer reviewers are required to complete a declaration of interests form (see the section on code of conduct and declaration of interests in the chapter on decision-making committees).