The National Institute for Health and Care Excellence (NICE) exists to bring robust evidence-based guidance to the NHS and local authorities in order to provide a clinical and cost-effective basis of care. There is no point in developing guidance for the NHS if it does not have a significant impact on patient care and outcomes. Therefore, in 2004, NICE launched a programme to support the implementation of its guidance. This programme is designed to have an impact at national, organisational, and individual levels and aims to ensure that mechanisms for implementing guidance recommendations are embedded within quality improvement systems throughout the NHS. The strategy has three elements. These are:
- working with other organisations/mechanisms within the NHS to encourage change
- providing practical support
- monitoring the uptake of recommendations to inform future work.
As part of the practical support element, NICE produces a variety of implementation support tools. These include topic-specific tools such as:
- cost impact reports and cost templates
- slide sets
- implementation advice.
There are also generic tools, such as:
- the guide on ‘How to put NICE guidance into practice’1
- a shared learning database
- a database for the evaluation and review of NICE implementation evidence (ERNIE) (see www.nice.org.uk/usingguidance).
In 2006, NICE recruited a team of implementation consultants (see Figure 1) to provide a regional focus for implementation support and to act as the local face of NICE. The field-based team are supported by two coordinators based in NICE’s Manchester office.
The implementation consultant offers several sources of support, including:
- updates and advice to help senior management teams in NHS organisations implement NICE guidance
- help with problem solving, by sharing examples of how organisations have worked together to implement guidance
- advice on how to use the NICE implementation support tools
- a chance for clinicians and managers to provide feedback to NICE on local issues, ideas for new topics and suggestions for improvement
- regular feedback to the NICE board, centres, and directorates arising from fieldwork.
An initial programme of visits to NHS organisations started in late August 2006. Meetings were held with all NHS trusts, primary care trusts (PCTs), and strategic health authorities (SHAs). Follow-up support visits have been made where requested (e.g. requests to speak to GP clinical governance leads, or to take part in NICE implementation groups or clinical effectiveness forums), in addition to telephone and email support and an annual meeting. Initial field visits have focused on meetings with chief executives and senior managers. The focus for second and subsequent visits will be on providing support for senior individuals and groups involved in implementing NICE guidance across a locality.
Since February 2007, the priority has been engagement with local authorities who are key partners in the implementation of NICE public health guidance. The team of implementation consultants has focused initial visits on local authorities providing education and social services, that is unitary authorities and county councils. Some of these visits have been held jointly with PCT staff (e.g. joint Directors of Public Health, health improvement team members). In addition, the team is now making contact with cancer and cardiac clinical networks, regional specialised commissioning groups, and local government offices.
Figure 1: NICE implementation consultants by region
Support to primary care trusts
Visits to PCTs have been varied. Implementation consultants have met with chief executives and executive directors with a clinical effectiveness brief (often directors of public health), and sometimes with clinical effectiveness/clinical governance leads and managers, and directors of commissioning. Discussions have covered numerous issues. These include:
- how far organisations have progressed in setting up processes for NICE implementation and monitoring
- local challenges for implementing NICE guidance and possible solutions
- support tools available from NICE
- differences in NICE issues related to PCT provider and commissioner functions
- specific queries related to individual pieces of NICE guidance
- the new NICE commissioning guides and their potential use for supporting evidence-based commissioning
- feedback to NICE on its processes and individual pieces of guidance.
In addition to discussions held during visits, the implementation consultants encourage trusts to share examples of their learning relating to NICE implementation (either generic processes or specific pieces of guidance) through the NICE shared learning database (see www.nice.org.uk/sharedlearning), as well as through personal contacts. Two examples of input into PCTs are detailed below.
1) Walsall Teaching PCT
Chris Connell (Implementation Consultant for the West of England) met with the Director of Public Health and members of the Clinical Effectiveness Department at Walsall Teaching PCT.
Following this meeting, the PCT invited Chris back to give a presentation to members of the local Clinical Effectiveness Committee and to discuss local arrangements for the implementation of NICE guidance in more detail.
Chris discussed options for developing local strategies for implementation, audit and evaluation with members of the Clinical Effectiveness Team, and demonstrated the obesity costing tool.
The Walsall Clinical Effectiveness Team was able to provide Chris with valuable feedback on local views about NICE. They also demonstrated the PCT’s impressive computerised system for recording and tracking the implementation of NICE guidance. Chris suggested that the team consider submitting this to the NICE shared learning database, which they have successfully done.
The Clinical Effectiveness Manager said, ‘It certainly was a worthwhile visit. Chris was able to brief us on the latest news from NICE and we were able to provide NICE with feedback. We were delighted that Chris thought that our approach to NICE implementation might be of interest and help to other organisations.’
|NICE implementation consultants (from left to right): Gill Mathews, Jenny Lewis, Chris Connell, Val Moore, Steve Sparks, Jayne Chidgey-Clark|
2) Wiltshire PCT
One of the challenges during the recent restructuring of PCTs has been merging NICE structures from previous organisations. One example of my input as the Implementation Consultant for the South West, was to attend a workshop with representation from the reconfigured PCT areas to allow an opportunity to explore strengths and weaknesses of previous systems. I was able to facilitate discussions about what is required to develop integration and set up of future systems within the new PCT.
This was also an opportunity to provide expertise and shared learning in the principles underpinning NICE implementation systems. One issue raised at this meeting was the challenge of engaging primary care clinicians in the implementation process and I was invited back to give a presentation and take part in a GP clinical leads meeting. This was an opportunity to discuss issues and support available relative to NICE implementation, such as NICE implementation support tools and commissioning guides, and to share approaches to enhancing clinical engagement from other PCTs.
‘Jayne’s input encouraged us GPs to pay more attention to NICE guidance. Jayne also gave us a great deal of information about the NICE website and what they can provide for commissioning purposes,’ said a GP.
The NICE/National Service Framework manager said, ‘Jayne is always accessible and ever since our first contact with her last November, she has always been extremely helpful. We struggled to take NICE implementation forward during the time of reorganisation in our Trust. Jayne’s expertise, network and in-depth knowledge is an invaluable support for us, for which we are extremely grateful.’
We are here to provide support
As well as providing advice and support to organisations implementing NICE guidance, NICE wants to receive feedback on the quality and usefulness of its guidance and support tools, and on what new topics NICE should be promoting. These contacts with people at the forefront of care provide a unique opportunity to discuss the way NICE continues to develop and respond to the needs of the NHS.
If you would like to understand more about the role of the implementation consultant and their input into your PCT, please contact your local PCT NICE lead or your local implementation consultant, and we will work with you to help get evidence into practice and improve the care you give.
- National Institute for Health and Care Excellence. How to put NICE guidance into practice. A guide to implementation for organisations. London: NICE, 2005G