NATIONAL INSTITUTE FOR CLINICAL EXCELLENCE

430 views

Published on

0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
430
On SlideShare
0
From Embeds
0
Number of Embeds
3
Actions
Shares
0
Downloads
2
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

NATIONAL INSTITUTE FOR CLINICAL EXCELLENCE

  1. 1. Guidance producer subject to accreditation: Royal College of Radiologists (RCR) for the referral guidelines Date: 6 April 2010 Draft Accreditation Report – for consultation
  2. 2. Contents Introduction ..................................................................................................................... 3 Accreditation recommendation........................................................................................ 3 Implementation................................................................................................................ 4 Reapplication for accreditation ........................................................................................ 5 Appendix A: NHS Evidence accreditation analysis ......................................................... 7 Appendix B: Bibliography .............................................................................................. 15 Appendix C: Advisory Committee members, external advisers and NHS Evidence accreditation team......................................................................................................... 16
  3. 3. Introduction The NHS Evidence Accreditation Scheme recognises organisations that demonstrate high standards in producing health or social care guidance. Evidence users can therefore have high confidence in the quality of the information. Organisations can publicly display a seal of approval called an Accreditation Mark for three years after their processes have been accredited. The process for accrediting producers of guidance and recommendations for practice is described in the process manual1 . Accreditation recommendation It is proposed that the process to produce referral guidelines by the Royal College of Radiologists (RCR) is recommended for NHS Evidence accreditation. This draft decision is subject to public consultation before a final decision is made. Background to the guidance producer The Royal College of Radiologists aims to advance the practice of radiology and oncology, improve public education, and promote study and research through setting professional standards of practice. To help achieve these aims, faculty publications are produced to provide members and Fellows with professional standards and guidance. The RCR has produced the referral guidelines, „Making the best use of clinical radiology services‟, for clinicians, radiologists, radiographers and other healthcare professionals to determine the most appropriate imaging investigations for a wide range of clinical problems. They provide practical guidance based on the evidence, together with expert opinion where evidence is lacking or conflicting. 1 http://www.nice.org.uk/nhsevidence/aboutaccreditation/aboutaccreditation.jsp?domedia=1&mid= 27C232A0-19B9-E0B5-D4A11FA899F4C219
  4. 4. Summary The Advisory Committee considered that the Royal College of Radiologists referral guidelines demonstrated compliance with 23 of the 25 criteria for accreditation. The processes used by the Royal College of Radiologists to produce the referral guidelines are clearly documented and robust. Processes are described in the Royal College of Radiologists „Making the best use of clinical radiology services: the process for the sixth edition 2003 – 2007‟ manual. The Royal College of Radiologists referral guidelines are clearly presented and up to date. A range of Stakeholders, including patients, are involved in developing guidance and there is a comprehensive peer review process. Systematic methods are used to identify evidence for developing guidance. Suggestions to further strengthen the Royal College of Radiologists‟ development processes for the referral guidelines are: showing how the organisational barriers to guidance implementation have been considered adding estimated costs for each investigative technique to the guidance making evidence demonstrating the self funding model for the guidance available on request. This draft decision is now going out for consultation, and the decision will be reviewed by the committee in the light of any feedback received before making a final recommendation. David Haslam Chair, Advisory Committee March 2010
  5. 5. Implementation If accreditation is awarded, guidance from the accredited producer will be identified on NHS Evidence by the Accreditation Mark. The accredited guidance producer is also granted a royalty-free, worldwide licence to use the NHS Evidence Accreditation Mark in accordance with the Conditions and Terms of Use2 . Providing these conditions are met, a guidance producer's accreditation will last for three years from publication of approval on the NHS Evidence website. Accredited guidance producers must take reasonable steps to ensure the accredited processes are followed when generating the type of evidence for which they are accredited. Accredited guidance producers should have quality assurance mechanisms in place and must inform NHS Evidence of any significant change to a process within 30 days. Figure: The NHS Evidence Accreditation Mark 2 http://www.nice.org.uk/nhsevidence/?domedia=1&mid=5AE1D938-19B9-E0B5- D471CA81220F57DA
  6. 6. Reapplication for accreditation If accreditation is not granted, guidance from the non-accredited producer will still be available on the NHS Evidence site but will not be identified by the accreditation mark graphic. Guidance producers that are not accredited following the accreditation process have the opportunity to reapply from one year after the previous assessment. It is assumed that the organisation will have addressed any concerns highlighted in the original assessment before reapplying. The NHS Evidence team will provide detailed feedback and advice on areas where improvement is required to meet the criteria in a future application.
  7. 7. Appendix A: NHS Evidence accreditation analysis The Advisory Committee considered the following analysis of the guidance producer‟s compliance with NHS Evidence accreditation criteria, which covers six discrete domains. The full analysis leading to the accreditation decision is shown below. Domain Criterion Evidence for meeting the criterion Accreditation decision Scope and purpose Does the guidance producer have a policy in place and adhered to that requires them to explicitly detail: 1.1 Overall objective The overall objective is clearly defined and implemented in the referral guideline b as described in the process manual a . In the referral guideline b section 1 „Introduction‟ states the overall objective. Criterion met 1.2 The clinical, healthcare or social questions covered The clinical questions are clearly defined and implemented in the referral guideline b as described in the process manual a . In each of the 12 sections of the referral guideline b a number of clinical / diagnostic problems are indicated. Criterion met 1.3 Population and/or target audience to whom the guidance applies The population and target audience is clearly defined and implemented in the referral guideline b as described in the process manual a . The patient populations for each clinical problem are indicated within the body of the guideline itself and the target audience is indicated in the Introduction section. Criterion met
  8. 8. Domain Criterion Evidence for meeting the criterion Accreditation decision 1.4 Guidance includes clear recommendations in reference to specific clinical, healthcare or social circumstances The recommendations are clearly linked to specific clinical circumstances in the referral guideline b as described in the process manual a . Criterion met Stakeholder involvement Does the guidance producer have a policy in place and adhered to that means it includes: 2.1 Individuals from all relevant stakeholder groups, including patient groups, in developing guidance The production of the referral guideline b includes individuals from relevant stakeholder groups including patients as described in the process manual a . In the guideline there is an „Acknowledgements‟ section which names both individuals and consultation groups involved in the guideline production process. Criterion met 2.2 Patient and service user representatives and seeks patients views and preferences in developing guidance The production of the referral guideline b includes patient‟s views as described in the process manual a . The guidance producer provided evidence that the opinions of lay representatives were sought during the production of its guidance. Criterion met 2.3 Representative intended users in developing guidance. Intended users are involved in the development of the referral guideline b described in the process manual a . Criterion met Rigour of Does the guidance producer have a clear policy in place that:
  9. 9. Domain Criterion Evidence for meeting the criterion Accreditation decision development 3.1 Requires the guidance producer to use systematic methods to search for evidence and provide details of the search strategy Systematic methods were used to search for evidence on which the referral guideline b is based and the search strategy detailed as described in the process manual a . Further information regarding the dates of searches can be found in the evidence tables of the e-guideline. Criterion met 3.2 Requires the guidance producers to state the criteria and reasons for inclusion or exclusion of evidence identified by the evidence review The inclusion and exclusion criteria are defined in the production of the referral guideline b as described in the process manual a . The information for this process is found in section 6.2 of the process manual a . Criterion met 3.3 Describes the strengths and limitations of the body of evidence and acknowledges any areas of uncertainty The strength and limitations of the evidence are defined in the production of the referral guideline b as described in the process manual a . The guidance producer‟s response is documented in section 6.2 of the process manual a . In addition the evidence grading system documented by the guidance producer in its response to criterion 3.2 shows that this criterion is met. Criterion met 3.4 Describes the method used to arrive at recommendations (for example, a voting system or formal consensus techniques like Delphi consensus) The method used to arrive at recommendations in the referral guideline b are explained as described in the process manual a . The guidance producer‟s chosen methodology is the Delphi technique. Criterion met
  10. 10. Domain Criterion Evidence for meeting the criterion Accreditation decision 3.5 Requires the guidance producers to consider the health benefits against the side effects and risks in formulating recommendations The risks versus health benefits are considered in the production of the referral guideline b as described in the process manual a . All of the directives noted in this submission effectively state that given the choice of two or more dose levels of radiation the lowest practicable should always be used. Criterion met 3.6 Describes the processes of external peer review The peer review process used in the production of the referral guideline b is clearly defined as described in the process manual a . The peer review process is documented in section 6.5 of the process manual a . Criterion met 3.7 Describes the process of updating guidance and maintaining and improving guidance quality The process of updating and maintaining guidance quality is observed in the referral guideline b as described in the process manual a section 6.6. Criterion met Clarity and presentation Does the guidance producer ensure that: 4.1 Recommendations are specific, unambiguous and clearly identifiable All recommendations in the referral guideline b are specific, unambiguous and clearly identifiable as described in the process manual a . The recommendation grading system is documented in section 2 of the process manual a . Criterion met
  11. 11. Domain Criterion Evidence for meeting the criterion Accreditation decision 4.2 Different options for the management of the condition or options for intervention are clearly presented Different options for the management of radiological conditions are clearly presented in the referral guideline b as described in the process manual a . Each specific condition has a number of different treatment options indicated where these treatments are available. Criterion met 4.3 The date of search, the date of publication or last update and the proposed date for review are clearly stated All dates of search, update and proposed date for review are documented as described in the process manual a . Criterion met 4.4 The content of the guidance is suitable for the specified target audience. If patients or service users are part of this audience, the language should be appropriate. The content of the referral guideline b is suitable for its target audience as described in the process manual a . Some of the language within the guidelines is technical particularly in the „Comments‟ section. However the intended audience for these referral guidelines is clinicians, radiology practitioners and healthcare organisations so the technical language within the guidelines is acceptable. Criterion met Applicability Does the guidance producer routinely consider: 5.1 Publishing support tools to aid implementation of guidance Support tools are published to aid implementation of the referral guideline b by the Royal College of Physicians. The e-guideline and format of the print version assist in implementation because of their ease of use. Criterion met
  12. 12. Domain Criterion Evidence for meeting the criterion Accreditation decision 5.2 Discussion of potential organisational and financial barriers in applying its recommendations The guidance producer provided an overarching discussion of potential barriers in applying its recommendations. It also stated that the inclusion of information regarding the cost effectiveness of each investigation for each diagnostic or imaging problem is not thought to be helpful. It is acknowledged that due to the wide range of clinical problems investigated this criterion would be difficult to meet on a case by case basis. However, a generalisable comparison of costs for different types of investigation technique may be helpful in the choice of investigation. In its feedback, the guidance producer provided further explanation as to why costs were not included in its guidance. This shows that the financial aspects of using the referral guideline b have at least been considered. However, it did not address the potential organisational barriers to implementation of its guidelines. This therefore remains an area of uncertainty. Some uncertainty 5.3 That their guidance is current, with review criteria for monitoring and/or audit purposes within each product. The referral guideline b is current and audit of the uptake and use of this guideline is undertaken. Examples were supplied that demonstrate the RCR encourages local level audits and engages with users of the guidance to monitor uptake and outcomes from these local level audits. Criterion met Editorial Does the guidance producer:
  13. 13. Domain Criterion Evidence for meeting the criterion Accreditation decision independence 6.1 Ensure editorial independence from the funding body The referral guideline b is editorially independent from the funding body. All groups involved in the guideline production are independent of the College and all work carried out by the Delphi panels, the guidelines working party and the Editorial Group is done on a voluntary basis. Criterion met 6.2 Demonstrate transparency about the funding mechanisms for its guidance The process document and example guidance do not provide details of how the funding is achieved. In its response to criterion 6.1 the guidance producer stated that “all editions of „Making best use of clinical radiology services‟ have been produced solely by the RCR under a funding model through which the sales from one version fund the development of the next edition”. In its feedback the guidance producer reiterated that the funding model followed was one in which the sales income from the current version of the guideline funds the development and production of the next version. No further information was provided to confirm this. Therefore this criterion is still assessed as uncertain. Some uncertainty 6.3 Record and state any potential conflicts of interest of individuals involved in developing the recommendations Conflicts of interest are stated and recorded as described in the process manual a . There is a conflicts of interest policy in place which can be found on the website. Criterion met
  14. 14. Domain Criterion Evidence for meeting the criterion Accreditation decision 6.4 Take account of any potential for bias in the conclusions or recommendations of the guidance The referral guideline b production minimises bias via a combination of the composition of the GDG, declaration of interests, stakeholder consultation and review, as described in the process manual a . Criterion met a Making the best use of clinical radiology services: the process for the sixth edition 2003 – 2007‟ (process manual). b Making best use of clinical radiology services, sixth edition. Referral guidelines.
  15. 15. Appendix B: Bibliography Appendix B lists the additional information taken into account in the analysis and considered by the Committee. Document name Description Location Making the best use of clinical radiology services: the process for the sixth edition 2003- 2007 Process manual Not publicly available. Making the best use of clinical radiology services: referral guidelines (Sixth edition, 2007) Guideline assessed as evidence Not publicly available.
  16. 16. Royal College of Physicians Stroke guideline: Draft Accreditation Report Page 16 of 18 Appendix C: Advisory Committee members, external advisers and NHS Evidence accreditation team NHS Evidence Advisory Committee Members The NHS Evidence Advisory Committee operates as a standing advisory committee of the Board of the National Institute for Health and Clinical Excellence (NICE). The Committee provides advice to the Institute on a framework for accrediting sources of evidence that should be recognised as trusted sources of information for the NHS. The Chair of the Committee is appointed by the Institute‟s Board and the meetings are conducted by the Chair or in his/her absence the vice chair. The current Chair is David Haslam. A full list of the Advisory Committee membership is available on the NICE website3 . The members have been appointed for a period of 18 months. This may be extended by mutual agreement to a further term of 3 years and up to a maximum term of office of 10 years. The decisions of the Committee are arrived at by a consensus of those members present. The quorum is set at 50% of committee membership. The Committee submits its recommendations to the Institute‟s Guidance executive which acts under delegated powers of the Institute‟s Board in considering and approving its recommendations. Committee members are asked to declare any interests in the guidance producer to be accredited. If it is considered that there is a conflict of interest, the member(s) is excluded from participating further in the discussions. A list of the committee members who took part in the discussions for this accreditation decision appears below. 3 http://www.nice.org.uk/nhsevidence/nhseac.jsp
  17. 17. Royal College of Physicians Stroke guideline: Draft Accreditation Report Page 17 of 18 Title Name Surname Role Organisation Mr Richard Brownhill Clinical Development & Nurse Practitioner Calderdale & Huddersfield NHS Trust & Kirklees PCT Dr Brian Fisher General Practitioner NHS Alliance (GP and national patient/public lead) Professor David Haslam National Clinical Advisor Care Quality Commission Dr Monica Lakhanpaul Senior Lecturer in Child Health / Consultant Paediatrician Health Education , Research and Development Unit (HERADU), University of Leicester Professor Stuart Logan Professor of Paediatric Epidemiology The Peninsula College of Medicine Professor Jon Nicholl Professor of Health Services Research School of Health and Related Research (ScHARR) Dr Carl Parker PEC Chair Stockton on Tees Teaching PCT Advisory Committee Deputies Title Name Surname Role Organisation Deputising for Ms Lynda Cox Head of Knowledge Sharing and Learning North East Strategic Health Authority Stephen Singleton Ms Parul Desai Director of Population Health NHS Information Centre Mark Davies Ms Julie Robinson Project Information Officer Social Care Institute for Excellence (SCIE) Amanda Edwards External Advisers for Royal College of Radiologists referral guidelines accreditation application Cheryl Harding-Trestrail, Locality Commissioning Manager (West), NHS Southampton City, Southampton, UK Dr Frances Burnett, Associate Medical Director-Practice Governance, Consultant Adult Psychiatrist (Community), Hertfordshire Partnership Foundation Trust, Hertfordshire, UK
  18. 18. Royal College of Physicians Stroke guideline: Draft Accreditation Report Page 18 of 18 NHS Evidence accreditation team for Royal College of Radiologists referral guidelines accreditation application Stephanie Birtles, Accreditation Technical Analyst, NHS Evidence, National Institute for Health and Clinical Excellence, Manchester, UK Dr Paul Chrisp, Associate Director Accreditation, NHS Evidence, National Institute for Health and Clinical Excellence, Manchester, UK

×