Interim methods guide for developing service guidance 2014

4.1 Policy context and constraints

Service guidance is likely to have considerable overlap with policy considerations, and a review of existing and planned policies is needed. There should be discussions with relevant policy/domain leads at NHS England, through NICE, to identify any existing policy initiatives. This may also include a review of existing government policy and other guidance, for example from the Royal Colleges.

4.2 Understanding the current service and variations

Information on current service configuration and provision is needed to inform the development of service guidance and to identify important variations in the provision and quality of services. This can usually be obtained from published sources such as reports and audits. Sources that could be considered include:

See appendix 1 for a list of possible sources.

Any relevant recommendations from published NICE guidance should be identified. These may include service recommendations, such as when interventions and services should be provided. NICE guidance will also include recommendations on interventions that the service(s) under consideration will be providing.

It is important that contacts within relevant national organisations, such as NHS England and the Health and Social Care Information Centre, are identified and engaged with as early as possible, because getting access to data sources may be time consuming.

4.3 Clinical and NHS engagement

There will need to be engagement with the service commissioning community to put the information gathered into clinical context. Stakeholders may also be aware of other useful data sources.

The process of identifying key areas for improvement and guidance should be informed by a combination of stakeholder input and the earlier intelligence gathering, especially if there are policy targets. For example, key areas could include addressing variation in practice or ensuring timely access to treatments.

A meeting with stakeholders could be arranged with the aims of producing an initial list of potential areas to be covered and/or developing potential hypotheses about the service. The feedback obtained could be combined with information already gathered to develop a list of priorities and initial searches to be conducted.

The areas identified should be assessed for the type of evidence that would be needed in order to develop recommendations and whether this is likely to be available: for example, a systematic review of when an intervention should be delivered, or a qualitative review to inform recommendations about behaviour change. These can then be confirmed with focused scoping searches if needed.

A key objective of this process is to develop a list of key stakeholder organisations who would be willing to provide information to support guidance development. This group of stakeholders can then be approached throughout development and asked to provide particular types of information as needed.

4.4 Involving patients, service users and carers

The views of patients, service users and carers should be actively sought. This is particularly useful for identifying the key outcomes of the service that are important to them and the relative importance of outcomes. Patient and carer organisations may also have valuable information about patients' experiences of services.

4.5 Approach to scoping

Because a number of topics will cut across clinical areas, it may be difficult to identify key areas for the guidance to focus on. Therefore various approaches to scoping may be used. In particular, consideration should be given to recruiting not only a Committee chair and topic adviser to help in developing the scope, but also additional members of the scoping group who will become Committee members. When several relevant clinical guidelines are being developed simultaneously with service guidance, there should be representation from each guideline scoping group (or Committee if established) on the service guidance scoping group.

Various methods can be used to run the stakeholder scoping workshop. It is likely that more stakeholders will need to be engaged, so the workshop may have more participants than for a clinical guideline. The workshop could be split over 2 days; for example:

However, when service delivery forms part of a clinical guideline, the stakeholder scoping workshop for the clinical aspects, as described in stage 5 in section 2.3 of 'The guidelines manual', could include service delivery considerations. In this case, specific time should be set aside to discuss the service delivery sections and identify the key issues to be addressed in the guideline.

4.6 The scoping search

A scoping search is undertaken by the Developer and is important to identify:

The search should not aim to be exhaustive. It should be based on the need to inform the development of the draft scope and the issues to be discussed at the scoping workshop. See appendix 1 for a list of suggested sources.