Clinical Guidelines - evidence based recommendations for health

NICE clinical guidelines recommend how healthcare professionals should care for people with specific conditions.

Our evidence-based guidelines can cover any aspect of a condition. They include recommendations about providing information and advice, prevention, diagnosis, treatment and longer-term management.

This year we produced guidelines on gold standards of practice in a number of important different health areas.

Help with diagnosing cancer earlier

In June 2015, we published updated guidance to help healthcare professionals in the NHS diagnose cancer earlier.

One in 2 people will be diagnosed with cancer in their lifetime. The disease is responsible for more than a quarter of all deaths in the UK; for many terminal cancer cases this will be due to a late diagnosis.

Often patients present at primary care with symptoms that are non-specific.  Signs of cancer may also not be clear or obvious and GPs see, on average, only around eight new cases a year.

Our updated and redesigned guideline aims to support GPs to recognise the signs and symptoms of 37 different cancers and refer people for the right tests faster.

The guideline focuses on the symptoms that a patient might experience and go to their doctor with, making it easier for GPs to use. It sets out clear tables linking signs and symptoms to possible cancers and includes simple recommendations about which tests to perform and the type of referral to specialist services that should be made.

Saving more lives from cancer: NICE guidance

Dr Steve Hajioff, a director of public health, who chaired the independent group of experts which developed the guidance for NICE, commented:

“No GP wants to miss a cancer diagnosis. This guideline will support them by encouraging them to think about the possibility of cancer sooner. Not only will it speed up the process of referral, enabling faster diagnosis, but its recommendations to monitor people with less severe signs and symptoms will mean fewer cancers are missed.”

Sara Hiom, Cancer Research UK’s director of early diagnosis, added:

“These new guidelines for suspected cancers will give GPs more freedom to quickly refer patients with worrying symptoms – crucial for a disease that can be hard for GPs to spot in primary care. This will mean diagnosing more cancers earlier, at a stage when treatment is most likely to be effective, better for patients and ultimately increasing survival.”

Preventing antibiotic prescribing

In August 2015 we published new guidelines to help curb inappropriate antibiotic prescribing in the NHS. The guidelines call for healthcare professionals to use antibiotics sensibly and to cut back on unnecessary prescribing of the drugs to help tackle the rise in antibiotic resistance.

The first NICE guideline to address this issue recommends that GPs, nurses, pharmacists and dentists promote and monitor the sensible use of antimicrobials – a group of medicines that includes antibiotics.

If successfully implemented, NICE’s guidance could help to reduce inappropriate antibiotic prescribing by 22 per cent – accounting for 10 million prescriptions.

Dr Tessa Lewis, GP and Medical Advisor to All Wales Therapeutics and Toxicology Centre and Vice Chair of the Guideline Development Group, said
“Resistance to antibiotics is increasing and there have been very few new antibiotics developed in recent years, so we need to make sure that, as well as searching for new antimicrobial medicines we use the ones we currently have in the most effective way.
“This NICE guideline considers the whole area of antimicrobial prescribing. It looks at the evidence and makes recommendations for health and social care practitioners and organisations on the best ways to minimise antimicrobial resistance.”

Ensuring women with menopause do not suffer in silence

We published our first guidelines on menopause in November 2015. The guideline says that women whose lives are being affected by the symptoms of menopause should not feel they have to suffer in silence. It recommends that help and information is available and that a range of treatment options such as HRT can help.

The Royal College of Obstetrics and Gynaecology also supported the guidelines, describing them as a “milestone”. And the British Menopause Society backed the guidelines, saying they were long-awaited.

Christine Carson, Programme Director at the NICE Centre for Clinical Practice, said: “Women don’t always get the help they need from their GP, practice nurse or hospital specialist to manage their symptoms but this guideline recommends effective treatments which can help.
“The message to women is clear – talk about the menopause with your clinician if you need advice on your symptoms – it’s very important to discuss the options to find what might help you.”

Professor Mary Ann Lumsden discuss the guideline's aims and potential impact.

New guidelines to improve care at end of life

We published our first guidelines on improving care at end of life in December 2015. The guidelines aim to put the dying person at the heart of decisions about their care, so that they can be supported in their final days in accordance with their wishes.

Until recently, the Liverpool Care Pathway (LCP) was used to provide good end of life care. It was withdrawn however, following widespread criticism and a subsequent government review that found failings in several areas. Among the criticisms were:

• There were no ways of reliably determining whether a person was in the last days of life
• Drinking water and essential medicines may have been withheld or withdrawn
• Examples of changes to treatment were carried out without forewarning

As a result, NICE was asked to develop evidence-based guidelines on care of the dying adult. The new guideline aims to tackle these and other issues by providing recommendations for the care of a person who is nearing death no matter where they are.

Professor Sam Ahmedzai, Emeritus Professor of palliative medicine and chair of the guideline development group, said: “Until now we have never had guidelines in this country on how to look after people at the end of life. This evidence-based guideline provides a good overview of how to give good end of life care in any setting in the NHS.“

“The main way this guideline differs to the LCP is that it stresses an individualised approach rather than a ‘blanket’ method of using the LCP in an unthinking way. The guideline also stresses that the patient should be reviewed daily, and the person should always be taken as an individual.”