IMPLEMENTACIÓN DE GUÍAS DE PRÁCTICA CLÍNICA. LA EXPERIENCIA DEL NICE (Reino Unido, videoconferencia). Ponente: Steve Sparks. Director Asociado del Equipo de Trabajo y Especialista en Implementación del Suoreste de Inglaterra en el NICE (National Institute for Health and Care Excellence).

1. Implementing clinical guidelines – a view from the field
Steve Sparks
Associate Director NICE Field Team

2. The role of NICE
• To identify good clinical, public
health and social care practice using the
best available evidence
• To help resolve uncertainty for
the public, service users,
professionals and practitioners
• To reduce variation in the availability and
quality of practice and care

3. Core principles of all NICE guidance
• Comprehensive evidence base
• Expert input
• Patient and carer involvement
• Independent advisory
committees
• Genuine consultation
• Regular review
• Open and transparent
process.

4. Guidance from NICE

5. “… an expanded role for NICE
extending its remit into social care”
• April 2013
• Adults and children
• Still NICE but…….. ‘care excellence’
• Non NHS body and set in legislation
• New Chair

6. The NICE Implementation Strategy
• Developing a supportive
environment
– Key partners
– Education initiatives
• Practical tools
• Evaluation

7. Main barriers to implementation
• Lack of trust in
guidance
• Lack of organisational
support - structures
and processes
• Resources (or lack of
them)
• Poor knowledge of
support from NICE

8. Principles of implementation
Evidence and experience shows that there are six key
components to a successful implementation process:
– board support and clear leadership
– provision of a dedicated resource (a NICE manager)
– support from a multidisciplinary team
– a systematic approach to financial planning
– a systematic approach to implementing guidance
– a process to evaluate uptake and feedback.
The organisation’s approach to meeting these
components should be clearly stated in an
implementation policy. This should be agreed across the
organisation or health community and approved by the
boards of the organisations involved.

9. NICE Field Team
• Implementation Consultants
• Team of 7 aligned to NHS CB
regions
• 1 in Northern Ireland
• Responsible for a
geographical territory
• Field based
• Provide local connectivity

10. What we offer……
• Support organisations to use/ implement NICE
guidance, advice and standards
• Strategic advice on implementation and context
advice for senior management teams
• Promote awareness and understanding of the
entire range of NICE outputs
• Problem solving, by sharing learning across
organisations
• Advice on how to use and access NICE
implementation support resources, NICE
pathways, NICE Evidence etc
• Opportunity to feed back to NICE on local issues,
ideas and suggestions for improvement
• Facilitate stakeholder engagement with NICE

11. NICE to know …
• We facilitate and support good practice – we don’t judge
• We will meet with anyone from providers and commissioners
of NHS and social care services at their request
• National, regional and local speaker for NICE
• Lead on specific projects that deliver benefit to NICE and our
partners - often national focus
• Provide regular feedback to NICE on our findings in the field,
with recommendations for action
• Unable to work with individual pharma/medtech companies:
conversations are via ABPI/ABHI
• Evolving our support offer to meet needs in the changing
environment.

12. Who we will engage with 2013/14
April May June July August September October November December January February March
Primary Care Provision
Community Trusts and Ambulance services
AHSN Areas for collaboration
Social Care: Adults
Acute and Mental Health Trusts
Local Authorities and Directors of Public Health
Health & Wellbeing Boards
Clinical Commissioning Groups
Local Area Teams
Strategic Clinical Networks
and Clinical Senates
Social Care: Children
Academic Health Science
Networks
Public Health England
April May June July August September October November December January February March
Primary Care Provision
Community Trusts and Ambulance services
AHSN Areas for collaboration
Social Care: Adults
Acute and Mental Health Trusts
Local Authorities and Directors of Public Health
Health & Wellbeing Boards
Clinical Commissioning Groups
Local Area Teams
Strategic Clinical Networks
and Clinical Senates
Social Care: Children
Academic Health Science
Networks
Public Health England

13. • Horizon scanning
– Forward planner
• A systematic approach
– Into practice guides
– How to guides
• Measuring progress and achievements
– Baseline assessment, audit tools
– Quality standards indicators and measures
• Building a business case
– Costing tools
– Commissioning tools
Practical support

14. • Sharing success
– Shared learning database and awards
– QIPP database
• Learning support
– Slide sets and clinical case scenarios
– BMJ online learning modules
– Podcasts
• Field Team!
Practical support

16. Feedback
• Monthly report for implementation
programme director
• Quarterly reports to each centre and
directorate
• Quarterly report to Senior Management
Team
• Annual report to board

17. Evaluation
• Ad hoc surveys of specific campaigns
• Full review 2010 and 2013
• 2013 survey
– 18 telephone interviews
– 10 internal interviews
– 500 email surveys

18. Success criteria 2013-14

19. Challenges and opportunities
• Managing internal expectations
• Managing external expectations
• Managing a remote work force
• Balancing workload
• Demonstrating impact

20. Staying in touch
• Sign up for the NICE News
• Log on to the website and register
your details at www.nice.org.uk
• Email steve.sparks@nice.org.uk