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 |