HOW USEFUL ARE THE NATIONAL INSTITUTE FOR CLINICAL EXCELLENCE GUIDELINES FOR TOTAL HIP REPLACEMENT?

Abstract

The National Institute for Clinical Excellence (NICE) was set up to provide patients, health professionals and the public with authoritative, robust and reliable guidance on current “best practice”.

To determine how useful for NICE guidelines for Selection of Prostheses for Primary Total Hip Replacement were to patients who were undergoing total hip replacement (THR) and the health professionals who were looking after them. We surveyed 100 patients, 50 Orthopaedic Surgeons, 40 Orthopaedic nurses and posted a questionnaire to GPs, to which 79 replied (56% response rate).

19% of patients had heard of NICE but only 2% were aware of the existence of NICE guidelines on THR and 1% found them useful. Almost all orthopaedic surgeons had heard of NICE and their guidelines for THR, with 74% knowing what the guidelines actually stated but only 14% finding them useful. 78% of surgeons believed that their preferred hip replacement conformed to NICE guidelines, 2% knew that they did not conform and 20% did not know. 27% of general practitioners knew of the guidelines, but only 5% knew what they actually stated and 1% found them useful in their practice. Most nursing staff working in orthopaedic areas had heard of NICE (83%). 43% knew of the NICE guidelines but only 13% knew the actual guidelines and % found them useful.

NICE has failed to communicate its guidelines to both patients and the public. None of the groups found the guidelines useful. NICE has failed to fulfil its mission statement and may instead have other motives, such as empowering centralised regulation of healthcare in the NHS.