Legal Considerations of Clinical Guidelines: Will NICE make a Difference?

The Next Step in Guideline Development

“…Clinical practice guidelines are becoming more widely used as a method for standardizing clinical practice and building pay-forperformance programs. 15 By not getting guidelines right for patients, perverse incentives may be introduced for clinicians to advocate treatments that are counter to what patients want and value; physicians may also be incentivized to deselect patients with low literacy or ethnic backgrounds whose health preferences are at odds with guidelines. Getting guidelines right means not only rolling out science but also taking seriously what matters to patients, in finding evidence, making recommendations, and integrating these recommendations into clinical decisions.…”

How does evidence based guidance influence determinations of medical negligence?

“…The creation of NICE, with its dual role of developing authoritative guidelines and of disseminating them through official NHS channels, means that its guidelines are likely to be credited with a distinctive authority medically and therefore legally 24 25. The current situation has been encapsulated in this way: “Guidelines are no substitute for expert evidence about acceptable practice.…”

Implementing clinical guidelines for self harm – highlighting key issues arising from the NICE guideline for self‐harm

“…Ignorance of clinical guidelines is a poor defence and clinical records should indicate clearly how a reasoned decision has been made to follow alternative management plans on a case‐by‐case basis. The Bolam Test is invoked to demonstrate that a doctor acted in keeping with the expected practice of ‘a responsible body of medical practitioners’, and following the Bolitho judgment a court may deem existing clinical guidelines to represent expected practice, provided they are judged to be ‘reasonable’, ‘responsible’, or ‘respectable’ (Samanta, Samanta, & Gunn, 2003). The implication is that not all guidelines are guaranteed to be the expected practice of ‘a responsible body of medical practitioners’.…”