Guidelines in the United kingdom and how they are used.

The main sources of guidelines in kidney disease in the United Kingdom are the National Institute of Health and Clinical Excellence (NICE), the UK Renal Association, and the Scottish Intercollegiate Guideline Network (SIGN). These groups now all adopt similar methods of guideline development, but implementation methods differ and also vary in their effectiveness. The structure of UK health care lends itself to an integrated implementation strategy, and the United Kingdom is almost unique in being able to introduce simultaneously related changes that aid implementation nationally, thereby enabling implementation locally. Use of these strategies is variable with possibly too much reliance on existing systems that deliver predictable suboptimal results and a failure to embed implementation strategies into routine organizational structure. The next steps for us in the United Kingdom are to use service improvement methods to improve and sustain consistently implementation of evidence-based practice.