The NHS Plus evidence-based guideline project.

Over the past decade, evidence-based clinical guidelines (EBGs) have become an increasingly familiar part of medicine. The subsequent incorporation of evidence-based health care into every day practice has resulted in improvements in clinical effectiveness [1] as well as efficient allocation and utilization of health resources [2]. When NHS Plus was established in 2001, there appeared to be few EBGs for use in occupational health (OH) practice. A search of guideline databases revealed only five guidelines relevant to OH practice, and only one of these, the OH management of low pain back pain, produced by the British Occupational Health Research Foundation had involved occupational physicians in its development. Factors that were thought to have prevented the development of EBGs in OH included lack of funding, a perceived lack of research base and a perception that OH practice differs from other medical specialities in the type of guideline required. However, an EBG programme in OH had been established by Nederlandse Vereniging voor Arbeids—en Bed-rijfsgeneeskunde in the Netherlands [3] and the British Occupational Health Research Foundation had produced several evidence-based reviews [4]. Verbeek et al. [5] had established that the evidence base relevant to OH was sufficiently extensive to practise evidence-based OH in a clinical setting. It was with this background that the NHS Plus evidence-based guideline project commenced in 2003. The EBG project has two principle aims: (i) To review and collate existing guidelines relevant to OH practice in the UK. (ii) To develop new EBGs to assist OH units in raising the evidence base and quality and consistency of their work. As of April 2007, 15 evidence-based and 17 consensus-based guidelines relevant to OH practice have been identified and published on the NHS Plus website (Tables 1 and 2). A range of OH professionals submitted proposals for new guidelines and six were selected for funding and development directly by NHS Plus and the Occupational Health Clinical Effectiveness Unit is developing a further two. Topics were selected for new guideline development using the following criteria: (i) Evidence of variation in practice, which affects management or clinical outcomes. (ii) A strong research base providing evidence of effective practice. (iii) The potential benefit to employees/employers must be sufficient to justify the resources invested EDITORIALS 307