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Setting standards in antenatal care. Jane Thomas Director NCC-WCH Hon consultant Obstetrics and gynaecology, Oxford 30.April 2003. Overview. NCC-WCH National Standards ANC Children’s National Service Framework National screening committee NICE Technology appraisals

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Setting standards in antenatal care

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Setting standards in antenatal care l.jpg

Setting standards in antenatal care

Jane Thomas

Director NCC-WCH

Hon consultant Obstetrics and gynaecology, Oxford

30.April 2003


Overview l.jpg

Overview

  • NCC-WCH

  • National Standards ANC

    • Children’s National Service Framework

    • National screening committee

    • NICE

      • Technology appraisals

      • Clinical guidelines

  • Clinical Guidelines

  • ANC guidelines


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NCC-WCH

Funded to produce

guidelines and audit for the NHS by NICE

RCOG Evidence Based Clinical Guidelines

RCOG Manchester Audit Unit

RCOG CESU

Consumer

RCOG, RCM, RCPCH, FFPRHC, AGUM, MSSVD

2002

HSR


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NCC-WCH guidelines

Publication

  • Antenatal CareOct ‘03

  • InfertilityNov ‘03

  • Caesarean sectionMar ’04

  • Type 1 Diabetes in childrenFeb ‘04

  • Long acting reversible contraceptionDec 04


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National standards for ANC

  • National screening committee

  • National Service Framework

  • NICE

    • Technology appraisals

    • Clinical guidelines National Service Framework


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National standards for ANC

  • National screening committee

  • National Service Framework

  • NICE

    • Technology appraisals

    • Clinical guidelines National Service Framework


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Continued Professional Development

Clinical Governance

Lifelong Learning

First Class Service 1998

National service frame works

National Standards

NICE

Local

CHI

National Monitoring

National Collaborating Centre for

Women’s and Children’s Health


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National standards for ANC

  • National Service Framework

  • National screening committee

  • NICE

    • Technology appraisals

    • Clinical guidelines


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NICE TA and guidelines

  • NHS clinical guidance based on

    • Clinical effectiveness

    • Cost effectiveness

  • Products

    • Clinical guideline (⇒Collaborating Centres)

    • Technology appraisals


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Clinical guidelines


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What are clinical guidelines?

“systematically developed statements to assist practitioner and patient decision about appropriate health care

for specific clinical circumstances’

National Institute of Medicine 1992


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improve quality + consistency + outcome of care

promote effective interventions + discourage ineffective interventions

make efficient use of resources

highlight clinical need/service provision

highlight gaps in research

reassure clinicians and patients

Aim of guidelines


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Key components for guideline validity

1. multi-disciplinary working groups

2. systematic review

3. explicit link of evidence to recommendations

4. explicit methods


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Antenatal care guideline


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NICE guideline development process

Time

months

DH remit

Scope

6

Submit

Evidence

GDG

Develop questions

4. Apply evidence

NCC-WCH

  • Systematic review

  • Evidence appraisal

12-18

1st Draft

Final Draft

6

Stakeholder comment

GUIDELINE


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DH remit ANC

  • " …NHS in England and Wales

  • routine antenatal care for all women including the number and timing of antenatal visits required and evidence based justification for the scope and content of each.

  • draw upon the evidence based recommendations of the antenatal subgroup of the National Screening Committee".


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ANC scope

  • Populations

    • baseline care of all pregnancies.

    • Comprehensive advice on the antenatal care of the healthy woman with an uncomplicated singleton pregnancy

  • Settings- all NHS


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ANC scope

  • guidance on antenatal visits

  • antenatal screening

  • educational aspects of antenatal care that are relevant to the antenatal health of the woman.

  • communication issues that influence the ability of women to make informed decisions


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ANC scope-what’s excluded

  • The investigation and management of complications arising in pregnancy

  • Any aspect of intrapartum and postpartum care


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ANC guideline group

GDG:

Group leader: Peter Brocklehurst

2 midwives

2 GP’s

2 obstetricians

a paediatrian

a radiolographer

2 consumer representatives

NCC-WCH methodological support

1st GDG meeting June 02

1st Draft consultation: Apr 03

Publication: Oct 03


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Timetable ANC

  • 1st GDG meeting June 02

  • 1st draft consultation: 14 Apr-11 May

  • 2nd draft consultation:16 Jun-11 July

  • Publication: 23rd Oct 2003


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Guidelines and NICE TA

  • Guidelines incorporate NICE’s TA recommendations,

    • Rhesus anti D prophylaxis.


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Guideline + NSF

  • Complement the recommendations of the NSF.

  • It will support the implementation of the NSF.


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NICE guidelines

  • 3 formats

    • Full

    • NICE short form

    • Patient version

  • Audit standards  CHAI

  • Research recommendations


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Up to date information about the NCC-WCH and guidelines is available from

http://www.nice.org.uk/

Thank you


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