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Table 1 Barriers to mandatory implementation of NICE clinical guidelines for bipolar disorder and their mitigation

From: Mandatory implementation of NICE Guidelines for the care of bipolar disorder and other conditions in England and Wales

Type of barrier

Nature of barrier

Mitigation against barrier

Policy

a) Lack of political, managerial, and professional leadership in mandating their implementation versus contest and ignorance of clinical guidelines

Affirmation of importance of implementation of NICE clinical guidelines unless there is a compelling reason not to by leaders

 

b) Complexity of policy directed towards health and social care including mental health

Consider rationalisation of policy; obligation by NHS England, NICE, and professional bodies to ensure compatibility of existing policy with NICE clinical guidelines

Organisation of care

a) Multitude of NHS professional and social care bodies with overlapping roles, responsibilities, and differing or unclear lines of accountability

Consider rationalisation of organisation of care; require all agencies to focus on implementation of NICE guidelines with other agencies to improve effectiveness and efficiency of clinical pathways in line with NICE clinical guidelines

 

b) Concern over professional and personal conflict of interest in development of NICE clinical guidelines, lack of psychiatric involvement because of pharmaceutical industry conflict of interest, and insufficient professional and NHS organisational engagement

Improve processes of developing clinical guidelines in line with Institute of Medicine’s recommendations to obtain full multidisciplinary professional, service user, and NHS input into NICE clinical guidelines, and manage any conflict of interest

Education

NICE clinical guidelines are low priority for training, licensing, continuing professional development, appraisal, and revalidation by professional and NHS workforce organisations

Affirm that principles, e.g. recovery and content of NICE clinical guideline care, are of central importance and design systems to ensure they are mandatory for training, examination, licensing, appraisal, continuing professional development, and revalidation

Economic

a) Some high cost items recommended in NICE clinical guidelines or innovation, e.g. technology; service redesign to improve care requiring investment with later cost offset

NHS England with other bodies, e.g. Academic Health Science Networks (AHSN), work with NICE to set timetable for implementation with non-recurrent funding for set up costs

 

b) Guideline may discourage innovation and research by setting out specific recommendations for care

Guideline highlights areas of uncertainty for innovation and research

 

c) Overall uncertainty about costs, benefits, unintended consequences, and harms with mandatory implementation of NICE clinical guidelines

Overall research and monitoring study commissioned with review dates to consider results and mitigating action

Treatment

Professionals will over rigidly apply or not conform to NICE clinical guidelines

Monitoring of NICE quality standards and service user experience as routine requirement of commissioning, inspection of providers, professional appraisal, and revalidation

Service user

Lack of knowledge of public about NICE guidance

Requirement of all NHS providers and AHSN to work with NICE to disseminate patient versions of NICE clinical guidelines and how to use them