POS-2026-2001: Evaluating the implementation of NICE gout guidance within the NHS

Background

Clinical guidelines outline how to diagnose and treat medical conditions based upon the best available evidence. However, we cannot easily monitor whether guidelines are being followed within the NHS. Current methods (e.g. collecting data using spreadsheets) take too long and make it hard to build a national picture of quality. Through OpenSAFELY, we can now bring together health data for the whole population of England. This provides a unique opportunity to change how we monitor care quality within the NHS.

To demonstrate this, we have chosen a condition with very effective treatments where guidelines are rarely followed. Gout affects 1 in 30 adults, causing severe pain, joint damage and health problems if not treated well. Medications (e.g. allopurinol) can prevent these complications, but previous studies showed they are not used often enough. In 2022, NICE published its first national guideline for managing gout, but we still do not know whether it is being followed.

Aims

Using OpenSAFELY, we will evaluate uptake of NICE guidance for people with gout in England. We will identify factors linked to good care, and examine how they affect outcomes including hospital admissions. By demonstrating this for gout, the approach we develop will be adaptable for many other guidelines and diseases.

Methods

Using GP and hospital data in OpenSAFELY, we will evaluate trends in diagnosis and treatment for people with gout in England from 2016-2026. We will map recommendations from the NICE gout guideline, including allopurinol prescribing, monitoring of urate levels, and attainment of urate targets. We will assess whether these standards improved following the publication of NICE guidance in 2022. We will identify predictors of optimal care, and assess impact on complications such as chronic kidney disease and hospital admissions. We will identify where improvement is needed most, and how this could be addressed with future interventions.

Why this is important

By showing how guideline uptake can be monitored at scale within the NHS, this project will pave the way for better oversight of treatment for many long-term conditions. For gout specifically, it will provide much-needed data on whether care has improved since national guidelines were introduced, and how this could be improved further. By sharing our findings openly, including with collaborators at NICE, this project will set a precedent for real-time monitoring of care quality within the NHS.