National Collaborating Centre forWomen’s and Children’s Health

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Setting standards in antenatal care

Jane ThomasDirector NCC-WCHHon consultant Obstetrics and gynaecology, Oxford

30.April 2003

National Collaborating Centre forWomen’s and Children’s Health

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Overview

1. NCC-WCH

2. National Standards ANC Children’s National Service Framework National screening committee NICE

Technology appraisals Clinical guidelines

3. Clinical Guidelines

4. ANC guidelines

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NCC-WCH

RCOG Evidence Based Clinical Guidelines

RCOG CESU

RCOG Manchester Audit Unit

2002RCOG, RCM, RCPCH, FFPRHC,

AGUM, MSSVD

Consumer

HSR

Funded to produce

guidelines and audit for the NHS

by NICE

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NCC-WCH guidelines

Publication

1. Antenatal Care Oct ‘03

2. Infertility Nov ‘03

3. Caesarean section Mar ’04

4. Type 1 Diabetes in children Feb ‘04

5. Long acting reversible contraception Dec 04

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National standards for ANC

1. National screening committee

2. National Service Framework

3. NICE Technology appraisals Clinical guidelines National

Service Framework

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National standards for ANC

1. National screening committee

2. National Service Framework

3. NICE Technology appraisals Clinical guidelines National

Service Framework

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First Class Service 1998

CHI

National Standards

National Monitoring

NICENational service frame works

Clinical Governance

Lifelong Learning

Continued Professional Development

Local

National Collaborating Centre forWomen’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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Aim of guidelines 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

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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

Scope

GDG1.Develop questions

4. Apply evidence

Stakeholder comment

1st Draft Final Draft

Submit

Evidence

GUIDELINE

NCC-WCH2.Systematic review3.Evidence appraisal

DH remit6

12-18

6

Time months

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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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GDG:Group leader: Peter Brocklehurst

2 midwives2 GP’s2 obstetricians a paediatrian a radiolographer2 consumer representatives

NCC-WCH methodological support

ANC guideline group

1st GDG meeting June 021st Draft consultation: Apr 03Publication: Oct 03

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Classification of Evidence Levels

Ia Evidence obtained from meta-analysis of randomised

controlled trials

Ib Evidence obtained from at least on randomised controlled

trial

IIa Evidence obtained from at least one well-designed

controlled study without randomisation

IIb Evidence obtained from at least one other type of well-

designed quasi-experimental study

III Evidence obtained from well-designed non-experimental

descriptive studies, such as comparative studies, correlation

studies and case studies

IV Evidence obtained from expert committee reports or

opinions and/or clinical experience of respected authorities.

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Grades of Recommendations

A Requires at least one randomised controlled trial as part of a body of

literature of overall good quality and consistency addressing the specific

recommendation.

(Evidence levels Ia, Ib)

B Requires the availability of well controlled clinical studies but no randomised

clinical trials on the topic of recommendations.

(Evidence levels IIa, IIb, III)

C Requires evidence obtained from expert committee reports or opinions

and/or clinical experiences of respected authorities. Indicates and absence

of directly applicable clinical studies of good quality. (Evidence level IV)

Good Practice Point

Recommended best practice based on the clinical experience of the

guideline development group

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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