Glasgow GP Dr Margaret McCartney, chairwoman of the RCGP overdiagnosis group, suggested in a debate at the RCGP annual conference on Thursday that NICE should run a jury-style service for GPs to sit on NICE guideline committees.
Several GPs at the event warned that NICE’s reliance on GP ‘experts’ to write up guidelines was leading to unrealistic targets being written into official guidelines.
Having a system where ‘normal’ GPs can give real-world feedback on proposed guidelines would allow for better representation from the profession, Dr McCartney said.
The debate comes in the wake of a GP backlash against NICE after it issued several high-profile and controversial pieces of guidance over the last year.
At the launch of its antibiotic stewardship guidance, one NICE expert suggested that GPs should face sanctions for overprescribing. Another set of guidance lowered the prescribing threshold for statins from a 20% cardiovascular risk to 10%.
NICE jury service
NICE chairman David Haslam said he could not promise that a ‘jury service’ was the way forward, but he understood that something must be done to improve GP contribution to guidelines.
Axminster GP Dr Phil Taylor said: ‘The problem from my point of view is that NICE comes out with a suggestion that’s fine, such as lowering the statin threshold, but it’s a value judgment and that isn’t something that should be in the mouth of an authoritative body.
‘And I think there’s a reason why these sorts of things happen. The people spending the time doing the work developing the guidance tend to be experts and enthusiasts. And the problem is that if you have a set of guidance written by experts and enthusiasts, it contains a lot of good ideas but it all comes from the same mindset.
‘I think what you really need is a panel of cynics and the experts should put forward the evidence, but they shouldn’t be the ones actually writing the guidance.’
Dr McCartney said: ‘I wonder whether, to stop too many experts becoming involved, there should be a jury service of normal GPs, where you're asked to go and sit on a NICE guideline committee.
GP guidelines
‘So you're a normal GP and therefore probably better to represent what needs to happen more than any expert. So we need to look at a completely different way and fund it properly to make it possible for normal general practice to be represented.’
Professor Haslam said NICE was ‘exploring better ways of engaging GPs’. He added: ‘This GP jury suggestion – I'm not promising that would necessarily be the way forward, but I get the issue. We use patients, service users, carers on all our committees, we use GPs on as many committees we can as well as specialists. I’d really encourage people to get engaged.’
In a lively debate on whether NICE was now a friend or foe to GPs, Dr McCartney also argued that although GPs ‘need somebody like NICE’, the relationship with GPs was ‘not working out’.
A vote after the debate showed GPs were split on the issue. The majority decided that NICE was ‘a bit of both’ friend and foe. A substantial number said NICE was a ‘friend’ and the lowest number said it was a ‘foe’.
