13 Research methods, statistics, critical review and evidence-based practice13.12 Guidelines and reporting
13.12.2 NICE and SIGN guideline development
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Written by Resident Doctor Committee · Published
The two bodies
NICE is the independent UK body that develops national evidence-based and consensus guidance for health and care.
NICE does not set reporting standards, synthesise evidence or regulate medicines; other bodies do those jobs.
Feature | NICE | SIGN |
|---|---|---|
Jurisdiction | England | Scotland |
Position | Accountable to the Department of Health and Social Care | Part of Healthcare Improvement Scotland |
Legal force | Funding duty for positive technology appraisals | Advisory; NHS boards implement |
Recommendation strength | Conveyed through wording | Strong or conditional |
Review | Proportionate surveillance | Considered for review about three years after publication |
A positive technology appraisal normally obliges commissioners to fund the treatment within three months, but it does not oblige clinicians to prescribe it to every eligible patient.
Ordinary guideline recommendations carry no automatic funding mandate.
The Scottish Medicines Consortium, not SIGN, appraises medicines in Scotland.
Reaching consensus: the Delphi method
The Delphi method is an iterative survey of experts who stay anonymous and answer remotely.
Experts rate statements, receive controlled feedback of the group result, then re-rate them over repeated rounds.
Rounds stop once a predefined consensus threshold is reached.
The Delphi method differs from the nominal group technique, whose experts meet face to face.
From topic to recommendation
The scope sets populations, settings and questions, and stakeholders comment on it.
Review protocols fix questions, eligibility criteria and outcomes before anyone searches.
A committee of clinical, methodological, economic and lay members weighs the evidence; members declare interests, and declaring an interest does not resolve it.
Draft recommendations go out to consultation, and published responses explain any changes.
GRADE rates certainty for each outcome as high, moderate, low or very low.
Certainty of evidence and strength of recommendation are separate judgements.
NICE wording | Signals |
|---|---|
Offer, do not offer | A stronger recommendation |
Consider | A conditional, preference-sensitive recommendation |
Must, must not | Usually a legal requirement or a very serious consequence |