Thank you for correcting me, Neal. But in practice, if a technology appraisal states that drug A should be prescribed under conditions X, the health care organisation will end up doing that rather than the alternatives. I cannot provide a reference but in a newspaper interview the chair (not the director, as I erroneously stated) did state that organisations would be forced to follow NICE guidance if necessary.
My sincere apologies to all and especially those at NICE for the lack of precision in my previous email.

On 9 Sep 2009, at 09:24, Maskrey Neal wrote:

HI
 
Just to clarify, and I know you know this Kev, the ONLY binding bit of NICE technology appraisals in the UK is for the financial resources to be made available within 3 months of the appraisal in line with the technology appraisal’s recommendations. And sometimes there’s dispensation for a longer time for even that if development of the resource – e.g. more memory clinics for the assessment of people with ?Alzheimers.
 
NICE guidelines are simply guidelines.
 
I’d love to see the reference for the director of NICE threatened that legal action would be taken against those who did not use approved technologies. 
 
The only quote I can remember was Mike Rawlins (the Chair of NICE) musing on where a clinician would stand legally if he/she deviated in his/her clinical practice from the evidence-based guideline even if he/she could produce a body of expert opinion to support the non-evidence-based practice. That seems a reasonable question.
 
Bw
 
Neal
 
Neal Maskrey
National Prescribing Centre
Liverpool Uk
From: Evidence based health (EBH) [mailto:[log in to unmask]] On Behalf Of k.hopayian
Sent: 09 September 2009 07:27
To: [log in to unmask]
Subject: Re: Guidelines again
 
Definitions of guidelines usually contain a phrase that they do not replace practitioners' judgement, for example, the NICE definition "They are based on the best available evidence. Guidelines help healthcare professionals in their work, but they do not replace their knowledge and skills"
Sounds good but I have always wondered how this fits in with NICE guidance on specific treatments  (technology appraisals) which ARE binding on health care organisations. In the past, the director of NICE threatened that legal action would be taken against those who did not use approved technologies. 
Does anyone on this list see a difference between guidelines that tell you in which conditions a treatment should be used and guidelines that tell you which treatments to use in certain conditions? 
 
Kev Hopayian
 
On 9 Sep 2009, at 04:41, Alejandro Piscoya wrote:


Guidelines are quite interesting tools but they need to be used
thoughtfully. This is why they just guide
and are flexible, there is always room for individual cases where
physicians need to think and take decissions taking into account their
patient´s opinion. As EBM, guidelines are not cookbook recipes, this
example shows that bluntly.

The issue here is, assuming the news is not too biased, why this
guideline is followed so rigidly and what to do to avoid this...

Alejandro




On Tue, Sep 8, 2009 at 12:08 PM, Ted
Harding<[log in to unmask]> wrote:

I know it's a Press story, but ...
 
 
If the main points in the stgory are accurate, then this is surely
a disastrous example of adherence to guidelines.
 
Ted.
 
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