This paper describes the development of the clinical practice guideline on schizophrenia from the National Institute for Clinical Excellence (NICE) and outlines its main recommendations. It reviews the evidence on effective implementation of guidelines generally and examines issues specific to the schizophrenia guideline. It describes NICE'S approach to supporting implementation alongside that developed by the National Collaborating Centre for Mental Health (NCCMH) and looks at local implementation examples for schizophrenia.

The paper highlights key considerations for the forthcoming revision of the NICE schizophrenia guideline. It makes recommendations concerning the scope of the guideline and the quality and type of data available to the guideline developers: the lack of data on outcomes such as quality of life and social functioning, the challenges presented by unpublished papers and areas where evidence is limited. Since publication of the schizophrenia guideline, the NICE development process has undergone significant methodological improvements. The grading of evidence has been refined and more recently NICE proposed that grading of recommendations be dropped. Consensus methods are increasingly and more effectively used to deal with areas where the evidence-base is limited. NICE and the NCCMH have developed a more implementation-ready range of guideline products.

The initial NICE guideline on schizophrenia was positively received nationally and internationally. This paper highlights challenges that will be involved in updating the guideline and ways to refine the methodology of development. Ultimately the impact of the guideline will be measured not in its methodological rigor but in how its successful implementation improves patient care.

Declaration of Interest: Stephen Pilling in receipt of funding from NICE for the production of clinical guidelines.

Objectives: To determine the relative extent to which the National Institute for Health and Clinical Excellence (NICE) appraises new versus existing technologies, and pharmaceutical versus nonpharmaceutical health technologies.

Methods: We categorized technologies within NICE appraisals published between March 2000 and June 2006 by type and classified them as new or existing using the timeline between launch in the United Kingdom and referral to NICE. We used a 3-year postlaunch cutoff to determine whether a technology was new, with a sensitivity analysis of 1 and 5 years.

Results: We reviewed 159 technologies from 88 appraisals. Of these, 84 (53 percent) were new (sensitivity analysis 36 to 67 percent) and 75 (47 percent) were existing technologies. A total of 119 (75 percent) were pharmaceuticals, 22 (14 percent) were devices, 14 (9 percent) were procedures, and 4 (3 percent) were categorized as miscellaneous. Classification according to newness and technology type showed that 62 percent (42 to 75 percent) of the pharmaceuticals appraised were new.

Conclusions: By developing and applying a definition of new, we have found that the criticism of the bias toward new technologies is unfounded when applied to the appraisal program overall. At the same time, new pharmaceuticals are over-represented in the program compared with devices and procedures. This domination may cause inflationary pressures on the health service, but any wholesale move away from the technological frontier may be more costly.