The Royal College of Physicians (London) has a Clinical Effectiveness Forum constituted of representatives of the 36 specialist societies within the College.

The Clinical Effectiveness and Evaluation Unit (CEEU) administers the Forum. The aim of the Forum is to support and facilitate clinical effectiveness within the specialist societies and its current work is progressing down 3 lines:

Database of Guidelines
The Forum has established a database of guidelines developed by specialist societies or relevant to the work of the specialist societies. The database can be accessed via the Royal College website at http://tinyurl.com/ftms
(Alternatively go to www.rcplondon.ac.uk and use the phrase “clinical guidelines database” in its “SEARCH” facility).

Currently the Forum is going through a process of “kite marking” the guidelines using the “AGREE” methodology (Appraisal of Guidelines, Research and Evaluation). See www.agreecollaboration.org for details. This process assesses various aspects of the guideline production, including: the rigour of the literature search, the appropriate representation of the guideline development group, the impartiality of the guideline and the presentation.

Database of Audits
The Forum is now developing a database of audits. The aim is to provide a reference source for departments wishing to audit aspects of practice so that they can identify what standards others have used in carrying out similar audit, compare their results with other departments and identify how others have endeavoured to change practice.

Currently the only criterion for the audits is that they should be multi-centred. The recent audit by the BGS, of the use of bisphosphonates to prevent steroid induced osteoporosis is one example of such a multi-centre audit. This project is at an early stage. The BGS has been asked to be one of 3 pilot societies to test the system for collecting details of such multi-centre audits. It would be very much appreciated if anyone who has details of a multi-centre audit, would contact Annette at the BGS (Annette-guerda-fischer@bgs.org.uk) so the required details can be obtained and entered onto the database

Dr Jonathan Potter

.Proposals for NICE Guidelines/Appraisals
Recent efforts within the Forum have been aimed at raising awareness, within specialist societies, of the opportunity to influence the work programme of NICE with regard to Guidelines and Appraisals. At the last meeting Gillian Leng (NICE senior executive responsible for Guidelines) spoke to the Forum about the submission of proposals.

The process for submitting is now the same for both appraisals and guidelines. In general, appraisals relate to one specific drug or intervention whereas guidelines relate to the management of a condition. The work of NICE is relevant only to England and Wales. Scotland and Northern Ireland have their own arrangements.

Guidelines once developed by NICE will have an important bearing on clinical practice and the resources that are directed towards practice. It is particularly important that the needs of older people are appropriately considered in the guideline programme. Current examples of guidelines under development include:

• Cardiac Failure
  
• Chronic Obstructive Pulmonary Disease
  
• Type 1 Diabetes
  
• Falls
  
• Epilepsy
  
• Parkinson’s Disease

NICE guidelines are developed with great rigour over two years, and at a cost of approximately £250,000. In England and Wales it is hard to match this in any other way because of the constraints on funds and time. There is a considerable incentive therefore, if any specialist group feels that there is an area of clinical importance for which a guideline should be developed, for trying to get it adopted by NICE.

Details of the system for submitting proposals can be found on the DoH website at: www.doh.gov.uk/nice/consultation2002

There are some points to bear in mind in making a proposal:

• The Department of Health receives a large number of proposals for NICE guidelines/appraisals from all clinical areas. It pays to prioritise submissions from any one clinical area to increase the chance of acceptance.
  
• To obtain and maximise the Society’s support for proposals, they should be routed through the Academic and Research Committee before submission to the Department of Health.
  Please contact Annette (Annette-Guerda-Fischer@bgs.org.uk)
  
• Support from different sources – professional and non-professional – is helpful.
  
• Consider carefully the criteria by which any proposals will be judged (see DoH web site)
  
• The Committee assessing proposals is largely non-clinical (see DoH web site). It is important to bear this in mind in the constructing of the proposal.

Although not as glamorous as research, the processes of clinical effectiveness in general, and of NICE in particular, are beginning to have a significant impact on clinical practice and resources. It will pay the Society to be involved in these processes. I would be interested to hear from any members of the Society who would like to be actively involved in this area of activity, either within the Society’s Clinical Practice Evaluation Group (CPEG) or the Royal College Clinical Effectiveness Forum.

Jonathan Potter
BGS Representative,
RCP Clinical Effectiveness Forum.
jonathan.potter@ekht.nhs.uk/ jonathan.potter@rcplondon.ac.uk