1. 1 National Collaborating Centre for Women’s and Children’s Health Setting standards in antenatal care Jane Thomas Director NCC-WCH Hon consultant Obstetrics and gynaecology, Oxford 30.April 2003

2. National Collaborating Centre for Women’s and Children’s Health 2 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

3. National Collaborating Centre for Women’s and Children’s Health 3 NCC-WCH RCOG Evidence Based Clinical Guidelines RCOG CESU RCOG Manchester Audit Unit 2002 RCOG, RCM, RCPCH, FFPRHC, AGUM, MSSVD Consumer HSR Funded to produce guidelines and audit for the NHS by NICE

4. National Collaborating Centre for Women’s and Children’s Health 4 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

5. National Collaborating Centre for Women’s and Children’s Health 5 National standards for ANC 1. National screening committee 2. National Service Framework 3. NICE  Technology appraisals  Clinical guidelines National Service Framework

6. National Collaborating Centre for Women’s and Children’s Health 6 National standards for ANC 1. National screening committee 2. National Service Framework 3. NICE  Technology appraisals  Clinical guidelines National Service Framework

7. 7 First Class Service 1998 CHI National Standards National Monitoring NICE National service frame works Clinical Governance Lifelong Learning Continued Professional Development Local National Collaborating Centre for Women’s and Children’s Health

8. National Collaborating Centre for Women’s and Children’s Health 8 National standards for ANC  National Service Framework  National screening committee  NICE  Technology appraisals  Clinical guidelines

9. National Collaborating Centre for Women’s and Children’s Health 9 NICE TA and guidelines  NHS clinical guidance based on Clinical effectiveness Cost effectiveness  Products Clinical guideline ( ⇒ Collaborating Centres) Technology appraisals

10. National Collaborating Centre for Women’s and Children’s Health 10 Clinical guidelines

11. National Collaborating Centre for Women’s and Children’s Health 11 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

12. National Collaborating Centre for Women’s and Children’s Health 12 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

13. National Collaborating Centre for Women’s and Children’s Health 13 Key components for guideline validity 1. multi-disciplinary working groups 2. systematic review 3. explicit link of evidence to recommendations 4. explicit methods

14. National Collaborating Centre for Women’s and Children’s Health 14 Antenatal care guideline

15. National Collaborating Centre for Women’s and Children’s Health 15 NICE guideline development process Scope GDG 1.Develop questions 4. Apply evidence Stakeholder comment 1 st DraftFinal Draft Submit Evidence GUIDELINE NCC-WCH 2.Systematic review 3.Evidence appraisal DH remit 6 12-18 6 Time months

16. National Collaborating Centre for Women’s and Children’s Health 16 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".

17. National Collaborating Centre for Women’s and Children’s Health 17 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

18. National Collaborating Centre for Women’s and Children’s Health 18 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

19. National Collaborating Centre for Women’s and Children’s Health 19 ANC scope-what’s excluded  The investigation and management of complications arising in pregnancy  Any aspect of intrapartum and postpartum care

20. National Collaborating Centre for Women’s and Children’s Health 20 GDG: Group leader: Peter Brocklehurst 2 midwives 2 GP’s 2 obstetricians a paediatrian a radiolographer 2 consumer representatives NCC-WCH methodological support ANC guideline group 1st GDG meeting June 02 1st Draft consultation: Apr 03 Publication: Oct 03

21. National Collaborating Centre for Women’s and Children’s Health 21

22. National Collaborating Centre for Women’s and Children’s Health 22

23. National Collaborating Centre for Women’s and Children’s Health 23 Timetable ANC  1st GDG meeting June 02  1st draft consultation: 14 Apr-11 May  2 nd draft consultation:16 Jun-11 July  Publication: 23 rd Oct 2003

24. National Collaborating Centre for Women’s and Children’s Health 24 Guidelines and NICE TA  Guidelines incorporate NICE’s TA recommendations, Rhesus anti D prophylaxis.

25. National Collaborating Centre for Women’s and Children’s Health 25 Guideline + NSF  Complement the recommendations of the NSF.  It will support the implementation of the NSF.

26. National Collaborating Centre for Women’s and Children’s Health 26 NICE guidelines  3 formats Full NICE short form Patient version  Audit standards  CHAI  Research recommendations

27. National Collaborating Centre for Women’s and Children’s Health 27 Up to date information about the NCC-WCH and guidelines is available from http://www.nice.org.uk/ Thank you