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Developing NICE guidelines: the manual – appendices A to P

Appendix P: Updating guideline recommendations

Appendix P: Updating guideline recommendations

Types of update

NICE updates guideline recommendations in different ways depending on the specifics of the topic area, evidence base, and health and care system need. The drivers for and types of updates include:

  • amending recommendation(s) based on new evidence, including health economic evidence

  • amending recommendation(s) based on safety signals (for example, from the Medicines and Healthcare products Regulatory Agency or the Healthcare Safety Investigation Body

  • amending or adding recommendation(s) for clarification

  • aligning or amending recommendations across related topic areas to ensure consistency

  • aligning, cross-referencing, incorporating or integrating recommendations across different NICE products

  • amending existing cross-reference recommendation(s)

  • adapting or cross-referencing to external guideline recommendation(s)

  • amalgamating recommendations across related topic areas (consolidation work)

  • standing down recommendation(s), including consolidation work

  • correcting errors that are found after publication of the guideline.

Identification of topics for updating

NICE is prioritising the topics that are being actively monitored and updated. For further details on this process, see the appendix on interim principles for methods and processes for supporting digital living guideline recommendations.

Updates of recommendations from topic areas

Updates of recommendations

NICE monitors existing recommendations as outlined in the chapter on ensuring that published guidelines are current and accurate and the appendix on surveillance – interim principles for monitoring approaches of guideline recommendations.

When recommendation(s) from a topic area have been identified for update, an assessment will be conducted to decide suitable methods and processes of update. This assessment is based on a multi-criteria decision framework (see the appendix on the surveillance decision framework and multi-criteria decision framework for deciding whether to develop or update recommendations and which methods to use) and aims to be proportionate and efficient.

Where suitable, updates of topic areas or recommendations will use the review questions and review protocols already defined by the existing guideline. These may be updated or adapted to reflect the change of evidence or practice identified through monitoring. Some topic areas for updates will need new review questions and new review protocols, for example to address gaps identified in the existing guidelines portfolio. Topic expertise will be sought during the development of the update. This expertise may come from a guideline committee, or through engagement with members of the faculties and Public Involvement Programme expert panel. For the roles of faculties and guideline committees, see the chapter on decision-making committees and the appendix on interim principles for methods and processes for supporting digital living guideline recommendations. For options on the types of topic expertise, see the multi-criteria decision framework (in the appendix on the surveillance decision framework and multi-criteria decision framework for deciding whether to develop or update recommendations and which methods to use).

Updates of all topic areas or recommendations are subject to the same principles of transparency of process and methodological rigour as new guidelines.

Proportionate external validation with stakeholder organisations will be sought for updates of recommendations. For further details on proportionate external validation, see the chapter on the validation process for draft guidelines, and dealing with stakeholder comments, and the table on the multi-criteria decision framework in the appendix on surveillance decision framework and multi-criteria decision framework for deciding whether to develop or update recommendations and which methods to use. Information on updated recommendations will be available on the NICE website. This may include evidence reviews, rationale and impact sections, committee discussion sections, and other relevant documentation.

Full update of a guideline

With the strategic ambition to focus on topic areas that have the potential for the biggest impact on improving health and care outcomes, it is likely that there will be fewer full updates of guidelines than in the past.

If a full update of a guideline is needed:

  • a new scope is prepared, following the process described in the chapter on the scope, or

  • the scope of the published guideline is used and registered stakeholders are informed.

Recruitment of committee members follows the usual process. Where possible, the developer informs all members who were involved in the current published guideline that a new committee is being recruited. The composition of the committee should be tailored to new requirements if a new scope has been developed.

A guideline that has been fully updated replaces an existing guideline. The update has a new set of recommendations, a new set of rationale and impact sections, new evidence reviews and new sections detailing the committee's discussion of the evidence. When a full update is published, the old guideline is withdrawn.

Full guideline updates are always subject to public consultation. Stakeholder views are sought only on recommendations that have changed as a result of new or updated evidence reviews. Only comments in these areas will be responded to individually. Where there are multiple comments in the same sections of the guideline, theming of the comments for responses may be considered.

Routine editorial maintenance

Routine maintenance changes may also be made after publication or update of guideline recommendations. These include minor editorial amendments, such as updating or fixing broken links or changing standard texts in line with agreed template changes or NICE style.

Routine editorial maintenance of guideline recommendations allows us to improve the usability of recommendations without changing the intent, and therefore without the need for an evidence review or input from committee or topic experts.

Routine editorial maintenance can be conducted at any time, including during surveillance, or during the development of recommendations.

It can be undertaken alongside the consolidation of portfolio content. For further information on consolidation, see the appendix on interim principles for methods and processes for supporting digital living guideline recommendations.

Routine editorial maintenance might involve:

  • adding or amending text to reflect changes to a medicine's marketing authorisation, to reflect changes in service configuration (for example, the setting up of integrated care systems) or a change to an organisation's name

  • changes to reflect the latest government policy or statutes (for example, on alcohol consumption)

  • amending recommendations to reflect the current practice context (for example, removing references to tools or resources that no longer exist)

  • bringing recommendations in line with NICE's current policy on wording without changing the meaning of the recommendation.

As routine editorial maintenance does not change the meaning of the content of a recommendation, it does not require external validation.

ISBN: 978-1-4731-5693-7


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