Professor Gordon Lowe, Chairman, SIGN

As the new chair of the Scottish Intercollegiate Guidelines Network (SIGN) succeeding the late Professor Jim Petrie, I, with the SIGN team, look forward to improving the effectiveness of patient care. We aim to achieve this not only through continued development of SIGN guidelines, but also through increasing interactions with key partners not just in Scotland, but throughout the UK and worldwide.

The SIGN team has been a pioneer in the development of national guideline methodology. SIGN's current methodology is published in SIGN 50: A guideline developer's handbook.1 In brief, its principles include: involvement of all relevant healthcare professionals and patients; systematic collation and critical evaluation of evidence; considered judgment of the evidence, based on professional and patient experience; and explicit linking of the recommendations to evidence and judgment.2

SIGN is actively working with partners in guideline development worldwide.3 First, by cooperating in the methodology of guideline appraisal, using the AGREE instrument,4 which contains 23 validated criteria for assessment of clinical guideline quality. Second, by discussing possible sharing of appropriate elements of the development process – such as literature searches and evaluation – to minimise duplication of effort.

We have regular constructive discussions with our partner guideline developer the National Institute for Clinical Excellence (NICE) as it develops its own guideline methodology and programme.

SIGN has also developed links with other UK guideline developers, including its sister Royal Colleges, and specialist societies such as the British Thoracic Society (BTS). The joint SIGN/BTS guideline on asthma, developed using SIGN methodology, is due to be published this summer.

While we in SIGN are therefore collaborating actively with other clinical guideline developers, we are also active in promoting implementation of our guidelines across Scotland, in several ways. First, by SIGN Council members networking with their professional colleagues, for example through specialist societies or their Scottish branches, including primary care.5 Second, by involving and informing patients and the public,5 in accordance with the Scottish Executive's Health Plan.6 Third, by further developing SIGN's links with other clinical effectiveness bodies in Scotland.

A good topical example of 'joined-up' clinical effectiveness in Scotland is the simultaneous development of the SIGN guideline on management of diabetes* (updating seven previous SIGN guidelines), together with Clinical Standards for Diabetes Care in Scotland,7 developed by the Scottish Royal Colleges of Physicians and the Clinical Standards Board for Scotland, and the Scottish Diabetes Framework.8

Such integrated developments will play a key role in the clinical effectiveness cycle of scientific evidence (judged by professional and patient experience), setting of standards for clinical audit and service accreditation, and development of both the clinical audit and the clinical research loops.

As always, the success of such developments will depend not only on guidelines and education, but also on adequate numbers of healthcare professionals with adequate time and support (including IT access) for both patient care and continued professional development.

* Copies of all SIGN guidelines can be downloaded free of charge from the SIGN website,


  1. Scottish Intercollegiate Guidelines Network. SIGN 50: A Guideline Developers' Handbook. Edinburgh, 2001. SIGN 50 is available on the SIGN website at
  2. Harbour R, Miller J. A new system for grading recommendations in evidence based guidelines. Br Med J 2001; 323: 334-6.
  3. Miller J. The Scottish Intercollegiate Guidelines Network (SIGN). Br J Diabetes Vasc Dis 2002; 2: 47-9.
  4. Details of the International Appraisal of Guidelines Research and Evaluation (AGREE) collaboration can be found on the AGREE website at
  5. Donald T. Patient-friendly guidelines are the next challenge. Guidelines in Practice 2001; 4 (1): 13.
  6. Scottish Executive Health Department. Our National Health: A plan for action, a plan for change. Edinburgh, 2000.
  7. Matthews DM, McKnight J, Warner J. Clinical Standards for diabetes care in Scotland. Br J Diabetes Vasc Dis 2002; 2: 32-7.
  8. Small M, Morris A, Cline D. The Scottish Diabetes Framework 2001. Br J Diabetes Vasc Dis 2002; 2: 38-9.

Guidelines in Practice, March 2002, Volume 5(3)
© 2002 MGP Ltd
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