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Audit-Based Education to implement NICE Do-Not-Do recommendations

National ARC Projects 

Audit-Based Education  to implement NICE Do-Not-Do recommendations in people with cardiometabolic multimorbidity (MONITORY): a cluster randomised trial

Lead: NIHR ARC Oxford and Thames Valley

Why the research is needed?

The national guidance body, “NICE” (National Institute for Health and Care Excellence), has produced ‘Do-Not-Do’ recommendations to reduce waste in the NHS. These include clinical practices that should be discontinued or not used routinely. However, their use is not widespread. We have designed a study where we have selected five of the ‘Do-Not-Do’ recommendations that can be applied to people who have multiple long-term conditions.  We are focussing on people with pre-existing cardiovascular disease (heart attack and stroke) and those with risk factors for cardiovascular disease (raise blood pressure, chronic kidney disease, and/or diabetes).

What we will do?

This programme will investigate if a quality improvement technique called Audit-Based Education (ABE), can  improve uptake of the ‘Do-Not-Do’ recommendations. An ABE package will be delivered to GP practices via an online platform, which will include a personalised practice dashboard and online education tools such as webinars. We aim to improve uptake of the NICE ‘Do-Not-Do’ recommendations in our target group.

GP practices within the Oxford-Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) network will be invited to participate. Clinicians in these practices will be trained on five selected NICE ‘Do-Not-Dos’, with emphasis on those related to cardiometabolic multimorbidity. The proportion of patients who have had potentially inappropriate prescribing before and after the intervention will be assessed.

In addition to looking at the impact on care, we also want to check that our approach does not widen existing inequalities in who receives care. We will also feedback whether ethnicity or deprivation is associated with different quality of care.

What will be achieved?

The programme expects to show that the use of an ABE package can lead to a change in the proportion of adult patients with multiple long-term conditions receiving inappropriate prescriptions as per the NICE ‘Do-Not-Do’ recommendations. If shown to be helpful, this approach could be embedded into GP computerised medical record systems and run nationally.

When the findings will be available? 

October 2023

Collaborating ARCs:

  • NIHR ARC East Midlands
  • NIHR ARC Kent, Surrey & Sussex

Other Collaborating Institutions for Implementation:

  • Effective Diabetes Education Now

Contribution to National Priority Aims:

Cross-regional implementation of an intervention with evidenced potential to reduce the burden of multiple long-term conditions (multimorbidity).

Contact: Professor Simon de Lusignan,