Steve Sparks and Sanjay Tanday (left) outline the range of NICE features that are available to help clinical commissioning groups implement guidance clinically and cost effectively
- The NICE quality standards and the COF will provide CCGs with powerful tools to improve care and patient outcomes
- The ‘support for commissioners’ tool can help CCGs to consider the cost impact of guidance implementation and will help to ensure that recommendations are embedded into day-to-day practice
- The NICE website features a ‘forward planner’ that shows forthcoming guidance. Individuals can also sign up for the monthly e-newsletter Update for primary care
- The databases on ‘do not do’ and ‘referral advice’ recommendations will be helpful to commissioners when reviewing services
- The QIPP collection hosts quality assured case studies evaluated on quality improvements, savings, evidence of change, and implementation
- ‘NICE pathways’ brings together all related NICE guidance and associated products in a set of interactive topic-based flowcharts
- NICE Implementation Consultants are keen to build links with CCGs, can assist them in several ways, and can be contacted at: firstname.lastname@example.org
COF=commissioning outcomes framework; CCG=clinical commissioning groups; QIPP=quality, innovation, productivity, and prevention
It has been a busy time of late for clinical commissioning groups (CCGs) as they embark upon the first wave of the authorisation process required to transform them into statutory bodies. They are also working hard to ensure they are ready to meet the clinical challenges that lie ahead from 1 April 2013 (the date on which CCGs take over responsibility for planning and commissioning local healthcare services), and are drawing up detailed plans and agreements between commissioners and trusts.
Quality standards and the commissioning outcomes framework
The 2012 Health and Social Care Act set out a new role for NICE in producing quality standards for healthcare and social care.1 While a clinical guideline provides a comprehensive description of an entire care pathway, a NICE quality standard provides a number of sentinel statements that act as markers of high-quality care and services for a particular clinical setting.2 The distinctive feature of NICE quality standards is that they provide commissioners with measures to compare how a service matches up to the standard.
So far, NICE has published 22 quality standards, which include a number of primary care topics such as diabetes, dementia, chronic kidney disease, and chronic obstructive pulmonary disease. Over the next 5 years, NICE will develop a library of 180 standards, which will touch on most aspects of care provided by the NHS.3 It is hoped that the quality standards will help people to design and commission high-quality, evidence-based services for their patients and population. The intention is that the quality standards of today will become the essential standards of tomorrow.
The NICE quality standards will be used by the NHS Commissioning Board to develop the commissioning outcomes framework (COF).4 The COF aims to drive local improvements in quality care and outcomes for patients. It will hold CCGs to account for their progress in delivering these outcomes, and provide clear and publicly available information on the quality of healthcare services commissioned by CCGs.4
A NICE COF Advisory Committee has been established to develop indicators for the COF, based on the quality standards, and to quality assure COF indicators from other sources.4 The NHS Commissioning Board is currently considering which indicators to include in the COF 2013/14 after NICE put forward 44 draft indicators.5
Together, quality standards and the COF will provide CCGs with powerful tools to improve quality and outcomes for their populations.
For some time, NICE has been working on how its guidance, advice, and standards can be aligned so that they can be used to help CCGs deliver both clinical- and cost-effective services successfully for the patients that they serve. The results of the Guidelines in Practice 2012 readership survey revealed that 56% of GPs are unaware of the support that NICE can offer CCGs and so now is a good time to outline what we can offer in terms of help.
‘Support for commissioners’ tool
To help CCGs get the most from the NICE quality standards, a ‘support for commissioners’ tool is developed alongside every published standard.2 This tool can help CCGs to:
- consider the cost impact of making the changes needed to achieve the quality standard at a local level
- identify where cost savings can be made
- highlight the areas within the quality standard that have the biggest implications for commissioners.
The ‘support for commissioners’ tool will be useful to CCGs not only by putting together an effective process for handling guidance from NICE, but also as a way of ensuring that the evidence-based recommendations are embedded into day-to-day practice. On top of the support provided by NICE for the quality standards, a suite of other resources is available to help CCGs make the most out of NICE guidance and drug recommendations and these are discussed below.
One of the most important aspects of working with guidelines is awareness of forthcoming guidance. Being able to look at draft versions of guidelines and anticipating their release allows CCGs to get ahead of the game so that they can start making preparations to put the recommendations into practice. The online NICE ‘forward planner’ displays future guidance in development and provides an estimate of their likely resource implications.6 It is available as an Excel spreadsheet and fields can therefore be sorted and filtered to enable users to focus on the areas that are important to them. Financial planning is an essential aspect of preparing for guideline implementation, and the ‘forward planner’ can make a big difference in this process.
Another way of keeping up to date with the latest primary care developments from NICE is to sign up for the free monthly e-newsletter—Update for primary care (email email@example.com). 7
Obtaining the best value from spending is a focus for all within the NHS, and NICE is contributing to this process in a number of ways. Understanding the resource implications of new guidance is particularly important and this is why when NICE publishes guidance, it also develops an analysis of the likely cost impact, the costing report, accompanied by a costing template that can be used to work out the implications for local populations.8 NICE is also working to make sure that these tools are up to date and based on the new CCG populations.
‘Do not do’ and ‘referral advice’ databases
The NICE guidance that has been produced over the past few years has been reviewed to identify interventions with a weak or non-existent evidence base. The recommendations that no longer need to be implemented have been highlighted and included in an easily searchable ‘do not do’ database.9
The NICE ‘referral advice’ database contains current primary-to-secondary referral advice from NICE clinical guidelines, cancer service guidance, and public health guidance.10 Each record in the database includes additional information, such as the health topic, the guidance it comes from (with a link to the relevant paragraph in the guidance) and other ‘referral advice’ recommendations from the same guidance.
Use of the two databases will help commissioners to identify ‘easy wins’ when reviewing services.
Quality, innovation, productivity, and prevention
When it comes to writing a clear and credible quality, innovation, productivity, and prevention (QIPP) plan, the QIPP collection on NHS Evidence may be a useful tool.11 This is a growing database of case studies, including ones on medicines management, that show how healthcare professionals are improving quality and productivity across the NHS.11 The QIPP collection is unique in that the case studies it hosts have all been quality assured. The examples are peer reviewed and evaluated on quality improvements, savings, evidence of change, and implementation;11 each case study includes an evidence summary that provides at-a-glance details on how each of these elements has been rated.
Continuing professional development
But it’s not all about cash and making savings! NICE guidance plays an important role in ensuring that healthcare professionals are keeping their own professional practice up to date. NICE has collaborated with BMJ Learning to develop some popular web-based education tools that lets individuals work through a series of learning exercises and complete a test to demonstrate how they have improved their knowledge.12 A certificate can then be printed out for the professional portfolio. In effect, this is free continuing professional development, which is ideal when training budgets are tight.
Individuals may be completely overwhelmed by all the different pieces of guidance, standards, and products that NICE produces, and this can make it difficult when searching for a particular recommendation or support tool. To address this, ‘NICE pathways’ brings together—for the first time—all related NICE guidance and associated products in a set of interactive topic-based flowcharts.13 ‘NICE pathways’ provides a visual and interactive format to view and navigate NICE guidance quickly on a given topic, including quality standards, and other tools. Previously, there has been no easy way to see at a glance everything that NICE has said on a specific condition across all of its separate published guidance.
‘NICE pathways’ covers the entire range of NICE guidance, including health technology appraisals, clinical guidelines, public health and social care advice, quality standards, and implementation tools. Users do not need to understand how NICE classifies different types of guidance to view recommendations on a particular topic—’NICE pathways’ will synthesise all of this guidance together in one place. The pathways can be printed out and saved for future reference, and viewed on smartphones and on iPads, allowing easy access while on the move. This new resource will improve access to NICE guidance greatly for commissioners who need to commission care across a whole pathway.
Share your views
Being able to access these web-based resources is great, but sometimes it is useful to be able to talk to someone about how the CCG is handling NICE guideline implementation. NICE has a team of eight Implementation Consultants based regionally in England and Northern Ireland. The team is keen to build links with CCGs and to assist commissioners in using NICE guidance, advice, and standards to improve services for the local population and patients. The field team can help to:
- develop a process for working with NICE quality standards
- share examples of good practice from other CCGs
- run workshops for CCGs, introducing all the support available from NICE.
If there is something that you think the NICE field team can help you with, please contact them at: firstname.lastname@example.org
- Legislation.gov.uk website. Health and Social Care Act 2012. www.legislation.gov.uk/ukpga/2012/7/contents/enacted (accessed 12 November 2012).
- National Institute for Health and Care Excellence website. NICE quality standards. www.nice.org.uk/aboutnice/qualitystandards/qualitystandards.jsp (accessed 12 November 2012).
- National Institute for Health and Care Excellence website. More information about NICE quality standards. www.nice.org.uk/guidance/qualitystandards/moreinfoaboutnicequalitystandards.jsp (accessed 12 November 2012).
- National Institute for Health and Care Excellence website. About the commissioning outcomes framework. www.nice.org.uk/aboutnice/cof/cof.jsp (accessed 12 November 2012).
- National Institute for Health and Care Excellence website. First commissioning outcomes framework indicators revealed. www.nice.org.uk/newsroom/news/FirstCommissioningOutcomesFramework
IndicatorsRevealed.jsp (accessed 12 November 2012)
- National Institute for Health and Care Excellence website. Forward planner. www.nice.org.uk/usingguidance/implementationtools/forwardplanner/forward_planner.jsp (accessed 12 November 2012).
- National Institute for Health and Care Excellence website. Update for primary care. www.nice.org.uk/newsroom/nicenewslettersandalerts/updateforprimarycare/update_for_primary_care.jsp (accessed 12 November 2012).
- National Institute for Health and Care Excellence website. Costing tools. www.nice.org.uk/usingguidance/implementationtools/costingtools.jsp
- National Institute for Health and Care Excellence website. NICE ‘do not do’ recommendations. www.nice.org.uk/usingguidance/donotdorecommendations/index.jsp (accessed 12 November 2012).
- National Institute for Health and Care Excellence website. NICE referral advice. www.nice.org.uk/usingguidance/referraladvice/index.jsp (accessed 12 November 2012).
- NHS Evidence website. Quality, Innovation, Productivity and Prevention (QIPP).
www.evidence.nhs.uk/qipp (accessed 12 November 2012).
- National Institute for Health and Care Excellence website. Online education tools. www.nice.org.uk/usingguidance/education/educational_tools.jsp (accessed 15 November 2012).
- National Institute for Health and Care Excellence website. NICE pathways. pathways.nice.org.uk (accessed 15 November 2012).
- National Institute for Health and Care Excellence website. NICE Annual Conference 2013. www.nice.org.uk/newsroom/niceannualconference/nice_conference.jsp (accessed 15 November 2012). G