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Developing NICE guidelines: the manual – appendices A to P

Appendix M: Interim principles for methods and processes for supporting digital living guideline recommendations

Appendix M: Interim principles for methods and processes for supporting digital living guideline recommendations

This statement sets out the interim principles for methods and processes that are used to develop NICE's digital living guideline recommendations. It is a living document that is reviewed on a quarterly basis.

To help meet NICE's strategic aims, the NICE guidelines programme is transforming to a more flexible and proportionate approach to allow us to focus on what matters most and to provide useful and useable advice. This flexible and proportionate approach will support the timely development or update of guideline recommendations, ensuring a sustainable living approach. We are testing this approach on selected topics within our guideline portfolio.

The key differences compared with the standard NICE guideline programme are:

  • The update unit is changing from a guideline to a key priority area. To find out how we are prioritising our guideline portfolio, see the webpage on maintaining and updating our guideline portfolio.

  • Engagement with stakeholders to find out what matters most to the health and care system.

  • Moving to flexible approaches to surveillance that identify key changes in evidence and system feedback.

  • Different approaches to how we update guideline recommendations in response to a change in evidence or health and care system priorities.

Proportionate, agile and responsive approaches

There are 6 key ways in which we are developing more proportionate, agile and responsive approaches to the development or updating of guideline recommendations. Decisions on updates are available on the NICE website.

1. Prioritisation of key priority areas

This includes categorising guidelines into topic suites, independent guidelines, and foundational guidelines. The NICE guideline portfolio is undergoing a prioritisation process to identify key priority areas where an update of recommendations is appropriate, initially in guideline suite content. This is an ongoing process that will include re-prioritisation to ensure that we focus on what matters most.

2. Multiple approaches to surveillance

Moving from fixed, planned surveillance to more responsive approaches enables timely updating of recommendations. This includes evidence monitoring alongside the consideration of current health and care system priorities and contextual feedback.

3. Use of the surveillance decision framework, followed by the multi-criteria decision framework, to assess if an update is needed, and the method and process to use

Following a signal from the evidence or the health and care system, a topic area for possible update is assessed using the surveillance decision framework. This enables a clear and systematic assessment of key domains to decide whether recommendations in this topic area should be updated.

If the decision is to update recommendations, there is a further assessment, using the multi-criteria decision framework, of the possible methods and processes for updating guideline recommendations.

For details of the areas assessed in this process, see the appendix on surveillance decision framework and multi-criteria decision framework for deciding whether to develop or update recommendations and the methods used for developing or updating.

4. Use of suite faculties to help us update or develop recommendations

Members of suite faculties are practitioners with experience in the topic covered by the suite. A suite faculty member could be involved in a range of activities relating to recommendation development and updating, including:

  • supporting surveillance and monitoring activities

  • validation of prioritisation of key priority areas within a suite

  • assisting with content consolidation (see below)

  • helping to agree committee constituencies for development work

  • reviewing evidence and developing recommendations as part of a committee

  • supporting dissemination of recommendations in the suite

  • providing feedback on implementation

  • providing informal advice and topic expertise as well as other activities involved in the guideline recommendation lifecycle.

Lay people are recruited to take part in these activities via the public involvement programme's expert panel.

5. Content consolidation

Our guideline portfolio currently contains over 20,000 recommendations. To achieve our strategic ambition of ensuring that we provide recommendations that are useful, useable, and focus on what matters most, we need to consolidate and streamline our content by:

  • standing down recommendations that are not essential (as defined using the principles below), and

  • amalgamating recommendations that overlap in content.

Consolidation of the extensive portfolio is an ongoing process. It may be done at any time, not necessarily when there is an update in progress.

Consolidated content will be published with a statement explaining what has been streamlined and that no changes to practice are intended.

Principles for consolidation

a. Stand down recommendations:

  • that are covered in other NICE guidelines (agree a single source guideline for the recommendations and link from all other guidelines)

  • that reflect good practice or general principles of care or that add contextual information not directly related to review questions or evidence (retain if there is evidence of poor practice or variation in practice)

  • on prescribing information that is already covered by the BNF, BNFc or SPC

  • that repeat legislation or statutory guidance (retain if there is evidence that guidance is needed on how to follow the law or statutory guidance)

  • on service delivery or service configuration that are not directly based on evidence, are no longer relevant to current health or care systems, or are not in line with national policy (retain if there is a strong rationale to keep them)

  • on training or competency for health and care professionals or practitioners that are the responsibility of professional bodies

  • on information provision and communication that are not based directly on evidence or that are already covered by other NICE products.

b. Amalgamate recommendations within a NICE guideline or topic suite that have similar, or overlapping content, unless there is a strong rationale for not doing so. The decision should be based on the most appropriate evidence or topic expertise that has underpinned the recommendations. Consider amalgamating recommendations that are taken from another NICE guideline and contextualised or adapted for the topic.

6. Options for validation

Validation of guideline recommendations and related outputs developed using the standard NICE guideline programme is by open stakeholder consultation. For digital living guideline recommendations, a proportionate approach to validation will be used. This will reflect the complexity of the update and a flexible range of approaches will be considered.

Review process

After review, these interim principles will be updated and, following the usual consultation process for manual updates, they will become part of the main methods and processes in developing NICE guidelines: the manual.

We welcome comments on the content of this statement. These should be addressed to GuidelinesManualUpdate@nice.org.uk.


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