NICE advice to GPs 'not primary care based'

Researchers have questioned the relevance of NICE guidance to general practice after a study found wide variations in the amount of evidence based on primary care.

A team led by Nottingham GP Dr Nadeem Qureshi, a member of the NICE Primary Care QOF Indicator Advisory Committee, found some GP-focused guidelines used very few primary care-relevant studies as evidence.

Researchers examined NICE guidelines for respiratory tract infection (RTI), COPD and hypertension written for primary care.

They noted that ‘the validity of a guideline depends on the data that are available and chosen for inclusion’. Evidence drawn from selected populations, such as a secondary care clinic, may be less relevant to primary care, they added.

Researchers identified 160 studies that were used to inform 115 recommendations for primary care.

They found that 80% of evidence for the RTI guideline was derived from primary care evidence. But the hypertension guideline used just 67% and the COPD guideline just 26% from this setting.

NICE guidelines influence GP pay through the QOF and will be used to develop quality standards against which GP performance will be judged.

Researchers said the use of these standards ‘may become controversial’ unless targets arise from evidence based on primary care.

A NICE spokesman said its guidance is based on the best available evidence of clinical and cost effectiveness.

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