This guidance is addressed to CCGs, to assist them in fulfilling their duties
relating to securing continuous improvements in the quality of services for
patients and in outcomes, particularly regarding appropriate clinical interventions.
This guidance is issued as general guidance under S14Z8 of the NHS Act 2006.
The objective of this guidance is to support CCGs in their decision-making, to
address unwarranted variation, and to provide national advice to make local
clinical decision-making more appropriate.
2. We expect CCGs to have regard to this guidance in formulating local policies and
for clinicians to reflect this guidance in their clinical practice. This guidance does
not remove the clinical discretion of clinicians in accordance with their
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