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Reducing variation in care: NIC projects

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Non-ST-elevation acute
coronary syndromes
Reducing alcohol consumption in people with alcohol dependence

Welcome to the Guidelines in Practice resource centre: Reducing variation in care: NIC projects

This resource centre host reports and related information on NICE Implementation Collaborative projects that examine variation in best practice with respect to:

  • the management of people with non-ST-elevation acute coronary syndromes—click on the red tab at the top to find out more.

What is NIC?

The NICE Implementation Collaborative (NIC) was established in 2012 as a partnership between the NHS, the life sciences industry, healthcare professional bodies, and key health organisations, including NICE and the Association of the British Pharmaceutical Industry, which have committed to work together to understand, analyse, and overcome the challenges and tensions to implementation and widespread adoption of NICE recommendations.

Click here to find out more about the NIC and its work.

Why is it important to reduce variation in care?

Reducing unwarranted variation can help to improve patient experience and outcomes, improve efficiencies, and reduce costs.

The Five Year Forward View and From evidence into action highlight that unless new models of care are introduced and unwarranted variation are addressed:

  • it will not be possible to meet the changing needs of the population nor those of individual patients
  • people will be harmed who should have been treated
  • unwarranted variation will continue thereby resulting in the waste of valuable healthcare resources.

 Click here to access the NHS Atlas of Variation in Healthcare.

NSTEACS: aiming to improve patient outcomes and experiences

The NICE Implementation Collaborative (NIC) clinical and commissioning and service provision consensus documents on NSTEACS have been developed by the NHS and are for use by the NHS. It is hoped that these documents will support clinicians and commissioners involved in the provision of care for patients with NSTEACS, and stimulate changes to reduce variation and improve outcomes.

The NIC would like to express its thanks to AstraZeneca (AZ) for sponsorship of this project. The bi-partisan support provided by AZ to initiate and oversee the project has been central to the project’s aim of improving NSTEACS patient outcomes (please refer to the individual documents for the full disclaimers).

Clinical consensus 

The clinical consensus document on NSTEACS:

  • covers pre-hospital care, in-hospital management, and post-discharge follow up
  • includes an algorithm on the NSTEACS pathway 
  • focuses on practical recommendations for implementing best clinical practice
  • aligns the Kotter eight-step change model with a real-life case study on achieving a target of getting 80% of patients to the catheterisation lab within 60 hours of admission

Commissioning and service provision consensus 

The commissioning and service provision consensus document on NSTEACS:

  • highlights that many patients with non-ST-segment-elevation myocardial infarction do not receive guideline-recommended interventions
  • outlines the rationale for commissioners to take action
  • includes case studies from Middlesbrough, Sheffield, and Wessex, where changes to care have led to a better patient experience and improved efficiencies 
  • includes factors to consider when planning a change and where to go for support and resources.

Case studies

Related information and resources

Supporting local implementation of NICE Technology Appraisal 325: Reducing alcohol consumption in people with alcohol dependence 

The report has been developed by Oxford Academic Health Science Network (AHSN), Innovation Agency North West Coast AHSN, and MGP and initiated on behalf of NIC, which is a collaborative including the membership, among others, of NICE, NHS England, AHSNs, and the Association of the British Pharmaceutical Industry. Innovation Agency North West Coast AHSN and Oxford AHSN have provided strategic project leadership, and Lundbeck Ltd has contributed funding support for this project. Lundbeck Ltd has had no editorial input into the content of the report but was able to review it for technical accuracy.


Despite the high negative impact of alcohol on health and wider society, alcohol dependence is still poorly recognised and managed within the NHS, and primary care in particular. Although there a number of therapies available for maintaining abstinence, nalmefene is the first pharmacological drug licensed for the reduction of alcohol consumption in people with alcohol dependence.

The NIC report on implementation of NICE Technology Appraisal (TA) 325 was based on primary and secondary research, involving clinicians and clinical commissioning group medicines management leads, conducted in selected localities across England. This work identified and explored three key barriers to implementation of NICE TA325 and the issues contributing to these barriers:

  • commissioning
  • adapting and developing services
  • delivery and patient access.

Related information and resources