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[British National Formulary Publications:British National Formulary, British National Formulary for

Children]: Final Accreditation Report

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Guidance

producer:

British National Formulary

Publications

Guidance

product:

British National Formulary, British

National Formulary for Children

Date: 21 November 2016

Version: 1.3

Final Accreditation Report

[[British National Formulary Publications:British National Formulary, British National Formulary for


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Contents

Introduction ..................................................................................................................... 3

Accreditation recommendation ........................................................................................ 3

Background to the guidance producer............................................................................. 3

Summary…………………………………………………………………………………………4

Implementation ................................................................................................................ 7

Appendix A: NICE Accreditation analysis ........................................................................ 8

Appendix B: Bibliography .............................................................................................. 23

Appendix C: NICE Accreditation Advisory Committee, external advisers and NICE

Accreditation team......................................................................................................... 25



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Introduction

The NICE Accreditation Programme recognises organisations that demonstrate high

standards in producing health or social care guidance. Users of the accredited guidance

can therefore have high confidence in the quality of the information. Organisations may

publicly display a seal of approval called an Accreditation Mark for 5 years after their

processes have been accredited. The process for accrediting producers of guidance

and recommendations for practice is described in the process manual.

Accreditation recommendation

NICE has accredited the process used by British National Formulary Publications

to produce British National Formulary and British National Formulary for

Children. Accreditation is valid for 5 years from 13 September 2016 and is

retrospectively applicable to guidance produced using Appendices 1 – 28 of the

process to develop BNF.

Background to the guidance producer

The BNF is a joint publication of the British Medical Association and the Royal

Pharmaceutical Society. It is published under the authority of a Joint Formulary

Committee which comprises representatives of the two professional bodies, the UK

Health Departments, the Medicines and Healthcare products Regulatory Agency

(MHRA), and a national guideline producer. The Dental Advisory Group (DAG)

oversees the preparation of advice in the BNF on the drug management of dental and

oral conditions; the group includes representatives of the British Dental Association and

a representative from the UK Health Departments.

The BNF for Children (BNFC) is a joint publication of the British Medical Association,

the Royal Pharmaceutical Society, the Royal College of Paediatrics and Child Health,

and the Neonatal and Paediatric Pharmacists Group. BNFC is published under the

authority of a Paediatric Formulary Committee which comprises representatives of

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these bodies, the Department of Health for England, and the Medicines and Healthcare

products Regulatory Agency.

The majority of printed copies are sold to the National Institute for Health and Clinical

Excellence for distribution within the NHS in England and to the Departments of Health

for distribution within the NHS in Northern Ireland, Scotland, and Wales. The publishers

also sell the publication in both printed and electronic formats in the UK and the rest of

the world.

The Nurse Prescribers Formulary for Community Practitioners (NPF) is designed for

use with the BNF and BNFC; preparation of NPF content is overseen by the Nurse

Prescribers' Advisory Group (NPAG). The NPAG advises on the content relevant to

nurses and includes representatives from different parts of the nursing community and

from the UK Health Departments. The NPAG also advises UK health ministers on the

list of preparations that may be prescribed by Community Practitioner nurse prescribers.

Developed and evolved over a number of years since 1980 in response to changing

deliverables (e.g. the advent of electronic products) and the changing face of medical

information; during 2014–2015 there was a wide-ranging restructuring and process

improvement project in BNF Publications, which has led to BNF Publications being

reformatted to allow a wider digital strategy to be pursued. A number of key content

creation processes have consequently been updated and implemented during 2016; it is

these processes that form the basis of this application.

The last edition of the NPF was produced in 2015 and is published every 2 years. As

NPF content has not yet been updated using the new 2016 BNF processes there is

currently no evidence of implementation. The NPF is derived from the content of the

BNF and BNFC and uses the same identical process in its creation. Evidence of

implementation from monographs will be available in 2017 when the next edition of the

NPF is produced.



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Summary

The Accreditation Advisory Committee considered that the processes used by British

National Formulary Publications to produce the British National Formulary and British

National Formulary for Children demonstrated compliance with 24 of the 25 criteria for

accreditation.

The scope and purpose of the publications are clear. The overall objectives, questions

addressed, intended users and target population are all clearly stated within both the

printed and online versions. The specific clinical circumstances in each monograph or

treatment summary is clear with links to the supporting evidence.

The process includes relevant multidisciplinary professionals throughout the

development process and lay representatives are included on the Joint Formulary and

Paediatric Formulary Committees. Consultation allows stakeholders, users and lay

representatives to comment.

There are clear documented processes for performing searches of a range of

databases and guidelines. Clear inclusion and exclusion criteria are applied and all

relevant evidence is assessed using a range of templates to ascertain the strength of

the evidence and recommendations and this is clearly presented in the content. Health

benefits, side effects and risks are considered and external peer review is undertaken

although the processes describing how primary guideline recommendations are

reworded is not currently documented. Recommendations are agreed by consensus or

voting if consensus cannot be achieved. All content is updated on a 3-4 year cycle with

processes in place to enable updates in response to new evidence.

The guidance provides clear recommendations and options for treatment or

management where appropriate. The dates of publication and the proposed date for

review are clearly stated in the guidance. The content and format of the guidance is

suitable for the specified target audience.

The BNF and BNFC are available in a range of formats to enable ease of use.

Organisational and financial barriers have been considered and included where



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appropriate within the content. Monitoring of website usage and market research is

performed.

The funding source is clear and transparent to users. Editorial independence is

maintained. A documented policy is available for declaring and managing interests and

applies to all individuals involved in development.

A recommendation to improve the process used to produce British National Formulary

Publications is:

Documentation of the process for rewording and review of recommendations

derived from other sources, for example guidelines.

Professor Martin Underwood

Chair, Accreditation Advisory Committee

November 2016



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Implementation

Following accreditation, guidance from the accredited producer will be identified on

NICE Evidence Search by the Accreditation Mark. The accredited guidance producer is

also granted a royalty-free, worldwide licence to use the NICE Accreditation Mark in

accordance with the Conditions and Terms of Use. Providing these conditions are met,

a guidance producer's accreditation will last for 5 years from the date of the

accreditation decision.

Accredited guidance producers must take reasonable steps to ensure the accredited

processes are followed when generating the type of evidence for which they are

accredited. Accredited guidance producers should have quality assurance mechanisms

in place and must inform NICE accreditation within 30 days if any significant change is

made to a process.

Figure 1: The NICE Accreditation Mark

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Appendix A: NICE Accreditation analysis

The Accreditation Advisory Committee considered the following analysis of the guidance producer’s compliance with NICE

Accreditation criteria, which covers 6 discrete domains. The full analysis leading to the accreditation decision is shown

below.

Criterion Evidence for meeting the criterion Accreditation

decision

Scope and

purpose

Does the guidance producer have a policy in place and adhered to that requires them to explicitly detail:

1.1 Overall objective BNF Publications have the same stated overall aim - to provide

prescribers, pharmacists and other healthcare professionals with up to

date information about the use of medicines. This objective is described in

the Preface to BNF Publications1, and summarised on the back cover of

print editions of BNF Publications2. The objectives are also contained

within the ‘About the BNF’ and ‘About the BNFC’ pages of the online

editions3.

Criterion met

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decision

1.2 The clinical, healthcare or social questions covered

The publications address questions of drug safety, dosage, effectiveness

and adverse effects via clear medicines information. This is facilitated by

clinical information on conditions and classes of medicines to answer

questions around management of conditions and the appropriateness of

prescribing different types of medicines. The content creation policy4

contains a description of using PICO to develop focussed questions and

the document ‘How to use BNF Publications’5 describes the questions and

content within different standard sections of the monographs. There are

examples of ‘use cases for BNF Publications’6 which show how different

clinical scenarios and questions can be answered using the monographs.

Criterion met

1.3 Population and/or target audience to whom the guidance applies

The target audiences for all publications are detailed in the preface1, on

the rear covers2 and on the online versions of the BNF and BNFC3. The

populations covered by the BNF and BNFC are broad (adults and

children). Specific populations are defined in the entries for individual

drugs or drug class5,7,8.

Criterion met

1.4 Guidance includes clear recommendations in reference to specific clinical, healthcare or social circumstances

The clinical settings in which a medicine is recommended or not are

defined through information included as standard on indications,

contraindications and cautions, with extra clinical information provided for

some conditions and classes of medicines5,7,8.

Criterion met


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decision

Stakeholder

involvement

Does the guidance producer have a policy in place and adhered to that means it includes:

2.1 Individuals from all relevant stakeholder groups, including patient groups, in developing guidance

All committees have a chairperson and are comprised of multidisciplinary

committee members and lay representatives. On the Joint Formulary

Committee (JFC) and Paediatric Formulary Committee (PFC) each

professional group is represented by between 2 and 4 individuals. Two lay

members were therefore thought to provide an appropriate balance to the

make-up of the committee as a whole. When required members with

backgrounds from nursing, medicine, paediatrics, pharmacy,

representatives of NICE, the Department of Health, and MHRA are

recruited9,10. The names, job roles and contact details of the 2015-16

membership are available showing the membership of stakeholder and

patient groups11.

Criterion met

2.2 Patient and service user representatives and seeks patient views and preferences in developing guidance

Patients and service users are recruited as members of both the JFC and

PFC9,10. They are also able to comment during the external peer review

stages as part of the public consultation. The 2015-2016 membership of

the committees confirms that lay members are included on both the JFC

and PFC11. Lay members receive an induction document12 that explains

their role within the committee and other supporting information to enable

them to perform the same functions as the rest of the committee

members.

Criterion met


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decision

2.3 Representative intended

users in developing

guidance.

It is clear that target users of the BNF publications (health professionals

involved with prescribing, monitoring, supplying and administering drugs)

are representative of the membership of the JFC and PFC9. They are also

able to contribute as part of the peer review process. Evidence that target

users are representative of those developing guidance is apparent

because the occupational titles and qualifications, listed in the

membership11, of the target users and committees are very similar.

Criterion met

Rigour of

development

Does the guidance producer have a clear policy in place that:

3.1 Requires the guidance

producer to use

systematic methods to

search for evidence and

provide details of the

search strategy

The process9,13,14,15 for searching, selecting, and assessing evidence, as

well as the various search strategies, including filters to apply, search

terms used, and references identified are detailed within a range of

appendices and an example search16 showing the use of these processes

was provided. If relevant NICE or SIGN guidelines are identified and fully

answer the clinical question, a limited literature search can be carried out

to identify any further key evidence published since the guideline was

produced or updated. If the search does not identify any relevant NICE or

SIGN guidance, and/or the clinical question is not fully answered, a

complete literature search is performed and includes other high quality

clinical guidelines and primary literature.

Criterion met


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decision


producers to state the

criteria and reasons for

inclusion or exclusion of

evidence identified by the

evidence review

The literature search procedure13 details any exclusions that are used in

the searches for evidence or guidelines. All relevant evidence or

guidelines that are identified during the searches undergo assessment

against defined criteria. The literature search and assessment of the

retrieved literature is completed by a single clinical writer. A second

clinical writer then independently evaluates the search strategy employed

and that assessment of the literature is correct. The example search16

shows the filters that were applied to the databases searched, the studies

considered for inclusion and the reasons for exclusion of any studies or

guidelines.

Criterion met

3.3 Describes the strengths

and limitations of the

body of evidence and

acknowledges any areas

of uncertainty

The process18 requires a range of different tools to be used to assess the

different types of evidence used in the development of BNF publications.

For each type of evidence there is a standard template18 which is used to

assess the validity and quality of the source. Guidance notes18 are

available for each template to reduce variability between reviewers. The

example16 shows the use of both the AGREE tool to assess a non-NICE

accredited guideline and checklist to assess a meta-analysis study.

The SIGN grading system9,17 is used to assign a level of evidence (1++

through 4) and grade of recommendation (A through E). The grade of

recommendation is clearly indicated in the example18.

Criterion met


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decision

3.4 Describes the method

used to arrive at

recommendations (for

example, a voting system

or formal consensus

techniques like Delphi

consensus)

The Standing Orders of the committees of BNF Publications10 states that

consensus is the method of choice to set recommendations. When

consensus cannot be reached the Chair of the committee will indicate that

a vote is required. The votes for and against the amendment are

recorded in the minutes. Committee members reserve the right to abstain

and the side with the majority of votes will win. In instances where there

are equal numbers of votes the Chair has the casting (deciding) vote.

Minutes supplied from a combined meeting of the Paediatric and Joint

Formulary Committees19 confirm that voting was used to help decide to

provide a link to a NICE guideline to help with diagnosis.

Criterion met


producers to consider the

health benefits against

the side effects and risks

in formulating

recommendations

It is a fundamental objective of the BNF publications to consider and state

health benefits, side effects and risks. The Monograph control sheet14

requires the authors to tick off each section as it has been considered for

inclusion. These sections include side-effects, safety considerations,

contraindications and cautions. Consideration is also required for these

different sections in special patient populations including pregnancy and

renal insufficiency. The content creation policy4 instructs authors to

consider several factors including the impact of treatment and symptom

management. The example monographs7 and summaries clearly show

sections considering the side effects, health benefits and risks.

Criterion met


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3.6 Describes the processes

of external peer review

The process19,20 for peer review of recommendations requires content

containing recommendations to be passed to the JFC and/or PFC for a

first validation step. Following this if the recommendation is not directly

derived from guidelines, the evidence base is of insufficient quality to

allow a moderate or high strength grade of recommendation or there was

significant debate at the committee stage then the recommendations are

sent for further external peer review either by open or restricted

consultation depending on the content. Potential stakeholders or special

interest groups are notified, the BNF website is updated with information

of the consultation and notification is included in the BNF e Newsletter.

Responses are collated by the BNF publications team for review and any

actions documented and changes made if required as seen in the

example supplied18.

When content from high quality sources for example NICE or SIGN

guidelines is used to develop recommendations, the original

recommendations may be reworded when incorporated within the BNF

publication. The rewording is performed by two independent pharmacists

and checked by a third. The content is then presented to the JFC or PFC

for review to ensure the rewording accurately represents the meaning of

the primary guideline. These recommendations do not usually then go for

further peer review. This process is currently not explicitly documented

within the process so it may be unclear to users how these

recommendations are developed.

Not fully met


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decision

3.7 Describes the process of

updating guidance and

maintaining and

improving guidance

quality

Development and maintenance of BNF Publications9,21 is both proactive

where there are aims to revalidate all content over a rolling 3- to 4-year

period or reactive and designed to address significant changes to the

body of medical evidence, such as a Drug Safety Alert or the licensing of

a new drug. Print editions of the BNF are released every 6 months and

new editions of the BNFC every year; while online they are updated each

month. Medicines information is reviewed every 3 years or sooner if new

evidence becomes available.

The BNF and BNFC state how often they are updated online and in hard

copy versions. Important changes since the last edition are clearly stated

in the publications. Monographs state the date of last update7.

Criterion met

Clarity and

presentation

Does the guidance producer ensure that:

4.1 Recommendations are

specific, unambiguous

and clearly identifiable

The layout of information in each monograph and treatment summary

follows a standardised structure as described by a number of process

documents4,9,22 that explain how medicines information including product

characteristics, warnings and side effects should be presented across the

different BNF products. Example monographs7 show that

recommendations are clear, unambiguous and easily identifiable, and in a

standard format.

Criterion met


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decision

4.2 Different options for the

management of the

condition or options for

intervention are clearly

presented

The content creation process4 guides the writers to consider both drug

and non-drug options for management. Example treatment summaries for

diverticular disease16 and Irritable bowel syndrome18 show different

options including non-drug interventions if appropriate.

Criterion met

4.3 The date of search, the

date of publication or last

update and the proposed

date for review are clearly

stated

The month and year of publication along with the timeframe for review of

the BNF and BNFC printed publications are shown on the cover2. The

online versions3,22 of the BNF Publications provide the month and year of

the current version and offer monthly updates as specified on the website.

Monographs and treatment summaries published from 2016 are each

individually dated with the date of last update7,16.

Although the search dates are not provided explicitly the updating

frequency for each publication is clearly stated in the process

documentation9 and in the publications. This allows users to be aware of

the timeliness of any new evidence assimilated into the latest edition

(monthly for the BNF and BNFC online, 6 months for the BNF in print, 1

year for the BNFC). As content is based on regular scanning of key

sources rather than one-off searches this is considered appropriate for

this type of guidance producer.

Criterion met


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decision

4.4 The content of the

guidance is suitable for

the specified target

audience. If patients or

service users are part of

this audience, the

language should be

appropriate.

The processes4,9 ensure the layout of information in each monograph and

treatment summary follows a standardised structure. The BNF

publications style guide22 ensures the language used in content is

consistent. Example monographs7 show that the language is technical in

nature but is appropriate for the target audiences. The wording of the

cautionary and advisory warnings for patients appears clear and is jargon

free24.

Criterion met

Applicability Does the guidance producer routinely consider:

5.1 Publishing support tools

to aid implementation of

guidance

The BNF Publications can be considered as concise reference tools which

assist clinicians to implement the recommendations. Online versions of

the BNF Publications are available to subscribers which contain recent

updates and provide a fast way to find medicines information. The BNF is

also available for smart-phones. Any changes, including content changes

are highlighted for quick reference both in monthly newsletters25 and

within the front pages1 of the BNF printed versions to aid users.

Criterion met


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decision

5.2 Discussion of potential

organisational and

financial barriers in

applying its

recommendations

The BNF Publications section entitled ‘Taking medicines to best effect’

provides advice for clinicians in overcoming barriers when implementing a

medicines treatment plan. The price of a medicine would only influence

the development of recommendations when cost effectiveness had been

assessed. It is beyond the remit of the BNF products to assess the cost

effectiveness of medicines. However, the results of NICE appraisals and

SIGN reviews are provided where available7.

Criterion met

5.3 Review criteria for

monitoring and/or audit

purposes within each

product.

Usage of the BNF is monitored through a range of market research

activities26. Google analytics are used to monitor website usage and is

helpful for determining trends and patterns of usage of BNF Publications

online26.

Criterion met

Does the guidance producer:


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decision

Editorial

independence

6.1 Ensure editorial

independence from the

funding body

Standing Orders of the Formulary Committees of the British National

Formulary Publications10 states, the BNF is ‘independent of government

and industry’ and is a joint publication of the British Medical Association

(BMA) and Royal Pharmaceutical Society (RPS). The BNFC is a

collaborative publication of the BMA, RPS, Royal College of Paediatrics

and Child Health (RCPCH) and Neonatal and Paediatric Pharmacist

Group (NPPG) which are all organisations independent of the NHS. All

external advisers and committee members declare any conflicts of

interest. The NHS is the main funding source but it would not be possible

to guarantee adequate professional stakeholder involvement without

including a variety of NHS employees in the development of the BNF. In

practice, the NHS employees who sit on the committees are not

responsible for buying the BNF, so editorial independence is preserved.

Criterion met

6.2 Demonstrate

transparency about the

funding mechanisms for

its guidance

A statement on the BNF Publications website27 explains that the BNF is

entirely funded from sales made by the joint publishers, the BMJ Group

and Pharmaceutical Press. The majority of printed copies are sold to the

National Institute for Health and Clinical Excellence for distribution within

the NHS in England and to the Departments of Health for distribution

within the NHS in Northern Ireland, Scotland, and Wales. The publishers

also sell the publication in both printed and electronic formats in the UK

and the rest of the world.

Criterion met


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decision

6.3 Record and state any

potential conflicts of

interest of individuals

involved in developing

the recommendations

The Standing orders of the formulary committees10 and the Monitoring and

managing conflicts of interest policy28 provide detailed requirements for all

individuals, including committee members, editorial staff and peer

reviewers, involved in development to declare interests. The interests that

need to be declared and how they are managed is described within the

policy. The policies are freely available and the declarations made are

available upon request.

Criterion met

6.4 Take account of any

potential for bias in the

conclusions or

recommendations of the

guidance

The process ensures that development of BNF publications is systematic

and includes a range of multidisciplinary professionals and lay

representatives. It is clear how recommendations are reached. All

individuals involved in development including peer reviewers must declare

any interests and there is a clear process for managing any interests.

Criterion met


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decision

Documents referenced above:

1 Appendix 1 – Front Matter

2 Appendix 2 – Book covers

3 Online version of BNF & BNFC

4 Appendix 23 - BNF content creation policies

5 Appendix 3 - How to use BNF Publications

6 Appendix 4 - Use cases for BNF Publications

7 Appendix 5 - Monographs

8 Appendix 6 - Guidance sections

9 Appendix 8 - How BNF Publications are constructed

10 Appendix 9 - Standing Orders of the Formulary Committees of BNF Publications

11 Appendix 10 -BNF Committees - members, disciplines and affiliations

12 Appendix 12 - Lay member support documentation

13 Appendix 14 - Literature search procedure for content creation

14 Appendix 15 - Monograph control sheet

15 Appendix 16 - Evidence table for Literature search

16 Appendix 17 -Development of the diverticular disease and diverticulitis treatment summary


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decision

17 Appendix 18 -Evidence assessment documentation

18 Appendix 7 - Development of the Irritable bowel syndrome treatment summary

17 Appendix 20 - Minutes from the combined meeting of the Paediatric and Joint Formulary Committees 4.11.15

18 Appendix 21- Peer review proforma

19 Appendix 19 -BNF Standard Operating Procedures

20 Appendix 22 - BNF Publications style

21 Appendix 24 - BNF homepage on MedicinesComplete

22 Appendix 11 - Cautionary and advisory labels

23 Appendix 25 -BNF February newsletter

24 Appendix 26 -Monitoring and analysis

25 BNF Publications website

26 Appendix 27 -Monitoring and managing conflicts of interest

https://www.bnf.org/about/

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Appendix B: Bibliography

Appendix B lists the additional information taken into account in the analysis and

considered by the committee.

Document name Description Location

Appendix 1 - Front matter Process documentation Supplied Appendix 2 - Book covers Process documentation Supplied Appendix 3 - How to use BNF Publications

Process documentation Supplied

Appendix 4 - Use cases for BNF Publications


Appendix 5 - Monographs Implementation evidence Supplied Appendix 6 - Guidance sections


Appendix 7 - Development of the Irritable bowel syndrome treatment summary


Appendix 8 - How BNF Publications are constructed


Appendix 9 - Standing Orders of the Formulary Committees of BNF Publications


Appendix 10 - BNF Committees - members, disciplines and affiliations


Appendix 11 - Cautionary and advisory labels


Appendix 12 - Lay member support documentation


Appendix 13 - Content creation flowchart


Appendix 14 - Literature search procedure for content creation


Appendix 15 - Monograph control sheet


Appendix 16 - Evidence table for Literature search




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Document name Description Location

Appendix 17 -Development of the diverticular disease and diverticulitis treatment summary


Appendix 18 - Evidence assessment documentation


Appendix 19 - BNF Standard Operating Procedures


Appendix 20 - Minutes from the combined meeting of the Paediatric and Joint Formulary Committees 4.11.15


Appendix 21- Peer review proforma


Appendix 22 - BNF Publications style


Appendix 23 - BNF content creation policies


Appendix 24 - BNF homepage on MedicinesComplete


Appendix 25 - BNF February newsletter


Appendix 26 - Monitoring and analysis


Appendix 27 - Monitoring and managing conflicts of interest


Appendix 28 - Training tools




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Appendix C: NICE Accreditation Advisory Committee,

external advisers and NICE Accreditation team

NICE Accreditation Advisory Committee

The NICE Accreditation Advisory Committee operates as a standing advisory committee

of the Board of the National Institute for Health and Care Excellence (NICE). The

Committee provides advice to NICE on a framework for accrediting sources of evidence

that should be recognised as trusted sources of information for the NHS. The Chair of the

Committee is appointed by the NICE Board and the meetings are conducted by the chair

or in his/her absence the vice chair. The current Chair is Martin Underwood. A full list of

the Accreditation Advisory Committee membership is available on the NICE website.

Members are appointed for a period of 3 years. This may be extended by mutual

agreement for a further 3 years, up to a maximum term of office of 10 years.

The decisions of the Committee are arrived at by a consensus of the members present.

The quorum is set at 50% of committee membership. The Committee submits its

recommendations to the NICE Publication Executive which acts under delegated

powers of the NICE Board in considering and approving its recommendations.

Committee members are asked to declare any interests in the guidance producer to be

accredited. If it is considered that there is a conflict of interest, the member(s) is

excluded from participating further in the discussions. Committee members who took

part in the discussions for this accreditation decision are listed below.

Title Name Surname Role Organisation

Ms Judy Birch Lay Member N/A

Dr Adrian Brown Principal Screening Advisor, Public Health

Mr Richard Brownhill Self employed - Independent health care improvement manager

Royal Bolton Hospitals Trust

Mrs Lynda Cox Knowledge and Information Lead

NHS England

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Ms Joyce Epstein Lay Member N/A

Dr Elvira Garcia Consultant in Public Health Medicine - Health Protection Lead

NHS Ayrshire & Arran

Ms Barbara Graham Information Consultant/Senior Health Economist

Public Health Intelligence, NHS National Services Scotland

Dr Steve Hajioff Director of Public Health Hillingdon Borough Council

Dr Anthony Larkin General Practitioner The Alexandra Practice

Ms Mandy Sainty Research and Development Manager

College of Occupational Therapists

Mr Duncan Service Evidence Manager SIGN

Dr Sara Twaddle Director of Evidence Healthcare Improvement Scotland

Prof. Martin Underwood

Professor of Primary Care Research, Director of Warwick Clinical Trials Unit

The University of Warwick

External Advisers for this accreditation application

Dr Andrea Hilton, Lecturer and practising pharmacist, University of Hull, UK

Professor António Vaz Carneiro, Head of the Centre for Evidence Based Medicine,

Director of Cochrane Portugal, Lisbon, Portugal

NICE Accreditation team for this accreditation application

John Huston, Accreditation Technical Analyst, National Institute for Health and Care

Excellence, Manchester, UK

Victoria Carter, Senior Accreditation Technical Analyst, National Institute for Health and

Care Excellence, Manchester, UK

Deborah Collis, Associate Director, National Institute for Health and Care Excellence,

Manchester, UK