Evidence Review Process
This process was signed off by the UK NSC Director of Programmes in July 2009 and last updated in November 2011.
The UK NSC has over a hundred screening recommendations on conditions ranging from anaemia in pregnancy to vision in adults. Sometimes the UK NSC will recommend that screening for a condition should be offered and other times that, based on the current available evidence, screening should not be.
All the recommendations can be viewed, together with the evidence they are based on.
New evidence from research is being published all the time and it might be that even if screening for a condition could not be recommended in the past, new evidence suggests otherwise. This means that it is important for the UK NSC to review all its recommendations on a regular basis.
The information on this page describes that process in more detail.
Evidence review flowchart
Summary of the steps taken to review each UK NSC recommendation. Click on the image to enlarge it.
2. The Review Process
The process is shown in the flowchart to the right and has 4 main steps:
- Stakeholder review
- Knowledge update
- External review
- UK NSC recommendation
An evidence review is likely to take between 6 and 24 months, depending on the amount of new evidence to review and the number of stakeholders involved.
3. The process in more detail
The stakeholder identification process is based on the Single Technology Appraisal process guide developed by NICE and can be summarised as follows:
- A list of stakeholders will be put together, comprising patient or professional groups working at a national level (covering the UK, one of the home nations or a UK branch of an international organisation) and representing patients or healthcare professionals related to the condition being considered
- Stakeholders are identified in various ways, including suggestions from DH clinical leads, internet searches and by asking existing groups
The knowledge update is a summary of relevant research that has taken place since the last review. Producing this is a specialist job and is carried out by the UK NSC’s information scientist. The knowledge update is included in the external review document so stakeholders can understand how the evidence was identified and whether anything is missing.
The UK NSC Director of Programmes decides whether an external review is required on the basis of the knowledge update: if no significant new research has been carried out in the areas where new research is needed then the recommendation to the UK NSC will be for the policy to remain unchanged. If the UK NSC felt that a full external review was warranted, however, then this would take place.
The external review culminates in a detailed report, based on the evidence from the knowledge update, on whether screening for the condition being considered meets the UK NSC’s criteria for assessing a new screening programme. It is carried out by a recognised national expert or academic institution in the field, as identified by the UK NSC Director of Programmes. A template for this report is available below.
The report is shared with stakeholders as part of a 3 month consultation phase. If there are a large number of stakeholder groups or the condition or external review is particularly controversial or has generated media interest then a stakeholder workshop would also be arranged to present and discuss the findings of the external review.
During the consultation period the draft external review will be available on the UK NSC website. This means that anyone, including individuals or groups not previously identified as stakeholders, can provide their feedback. If comments are received from a group that meets the criteria for being a stakeholder then they will be added and their comments fed in appropriately. Other comments will be considered more circumspectly.
After the consultation period is completed, the external review document will be updated by the original author if significant new information (usually peer reviewed literature) has come to light. This final report will also be made available on the website.
The comments sent by the stakeholders will be summarised as a paper to the UK NSC to accompany the final report. All comments will be kept and all will available to UK NSC members should they wish to see them in full. Unless a stakeholder requests not, it is expected that the summarised comments would also be published on the website.
Once the consultation period has closed, the UK NSC is unable to accept further submissions or correspondence.
UK NSC recommendation
The external review will be considered at the next meeting of the UK National Screening Committee (these take place around every four months). The committee will consider the review and its recommendations, any stakeholder submissions and the view of UK NSC Director of Programmes and make a recommendation. The date for the next scheduled review will also be agreed (though if significant new evidence comes to light prior to the next scheduled review then the UK NSC Director of Programmes can take the decision to initiate the review early).
Recommendations are usually published around four weeks after the UK NSC meeting.
The UK NSC is an advisory committee and as such it only makes recommendations. It is up to Ministers in the four UK countries to set screening policy based on the UK NSC's recommendations and determine whether, and how, to introduce new screening programmes.
The ongoing, cyclical nature of UK NSC evidence reviews means recommendations should always be seen as being the current position based on the current best evidence. As new evidence and technology emerges over time, the balance of harm and good and change and with it the ecommendation.
In England, the UK NSC itself oversees programme implementation and, if Ministers decide to roll out a new screening programme, will set up an implementation group. Introducing a new programme is a significant and costly undertaking but the UK NSC is committed to ensuring that screening is of a high and uniform quality. This means that it may take a number of years to roll out a new screening programme.
4. Requesting the UK NSC to make a recommendation on a new topic
Requests are sometimes made to the UK NSC to consider screening for a condition on which a recommendation does not currently exist. The UK NSC is happy to accept such suggestions from stakeholder organisations, on the basis that an initial attempt is made to assess the condition against the screening criteria.
A template submission is available below.
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