In December 2001, the National Institute for Clinical Excellence (NICE) launched six national centres which will develop guidelines. NICE's guideline programme is believed to be the largest systematic guideline development programme in the world.
The Royal College of General Practitioners is hosting the National Collaborating Centre for Primary Care (NCC-PC).
Nearly 300 million consultations take place in general practice every year, and primary healthcare teams deal with 90% of clinical problems. Primary care trusts will soon control 70% of the NHS budget. Most, if not all, guidelines will have an impact on primary healthcare.
Individual GPs and GP organisations have an opportunity to influence the development of guidelines. The task of implementing guidance will fall to primary healthcare teams within the consultation, and it is therefore vitally important that GPs engage actively in NICE's programme of development.
The days of secondary care specialists producing guidelines for use by GPs without effective GP input must come to an end. GPs and their organisations will want to have their say. GPs will have a key role in asking pertinent questions on clinical and commissioning issues related to guideline topics.
GPs can become involved in three ways – at strategic level, with guideline development groups, and through'the national stakeholder consultation process. Strategic involvement means board level membership of collaborating centres and of NICE business committees. Most guideline development groups would wish to include a GP representative.
In particular, GPs can contribute perspectives about applying evidence in the consultation, using information technology, commissioning and prescribing, referrals and implementation. Small group work skills, which many GPs possess, will be invaluable.
It is important to acknowledge that GPs and practices are at saturation point and that becoming involved in the national NHS guideline development programme will be challenging. We must find ways to release GP time, to support practices and to develop different methods of working.
Part of my role as Chairman of the NCC-PC Board and Vice-Chairman of Council, RCGP, is to ensure that there are links between the NICE guideline development programme and professional organisations, and to develop appropriate processes for collaboration and communication.
The NHS guideline development programme will take time to mature. However, it is an initiative to be welcomed, particularly as it follows a set methodology and will go some way towards dealing with the problem of too many guidelines of variable quality in primary healthcare.
In due course, one could envisage a network of GPs involved in guideline development work. A crucial role could be in the dissemination and implementation of clinical guidelines.
In return, the NHS must recognise that to ensure sustainable and effective input from GPs, there is a need for investment in resources to provide support for GPs.
- See also 'The National Collaborating Centre for Primary Care' in this issue.