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Do guidelines have legal implications?
  1. J H Tingle
  1. Centre for Health Law, Nottingham Law School, The Nottingham Trent University, UK
  1. Correspondence to:
    Mr J H Tingle, Director of the Centre for Health Law, Nottingham Law School, The Nottingham Trent University, NG1 4BU, UK

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Clinical guideline use is increasing

Clinical guidelines are becoming an increasingly common feature of the health care environment in the UK, with health organisations such as the National Institute of Clinical Excellence (NICE), Royal medical colleges, and the universities regularly developing clinical guidelines. The development rate of clinical guidelines has even been termed a “flood” in the area of general medical practice.1

Health quality enhancement activity by clinical guidelines has been given a clear boost by government calls for an end to unacceptable regional variations of care and the concept of evidence based care. Clinical guidelines also sit well with other government health care quality enhancement activities such as clinical governance and clinical risk management. The central argument that can be advanced is that, as a matter of sound common sense, if best, reflective, evidence based practice is put into effect, the incidence of untoward incidents must be reduced. Risks can also be more effectively managed and the quality of health improved. Littlejohn and Humphris argue that specific guidelines do improve clinical practice, when introduced in the context of rigorous evaluations.2


It is important to remember that clinical guideline development is taking place in a much more health litigation orientated health care environment. More patients are suing then ever before.3 The National Audit Office announced3:

  • The rate of new claims per thousand finished consultant episodes rose by 72% between 1990 and 1998. In 1999–2000 the NHS received some 10 000 new claims and cleared 9600. At the end of March 2000 there were an estimated 23 000 claims outstanding, with an estimated net present value of £2.6 billion (up from £1.3 billion in 1996–97). In addition, there is an estimated liability of a further £1.3 billion where negligent episodes are likely to have occurred but …

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