Ensuring new procedures are introduced safely and effectively to the NHS

The NICE interventional procedures programme produces guidance to ensure that new procedures are introduced to the NHS in a way that is both safe and effective.

Our guidance covers a wide range of treatments and some diagnostic tests. These include surgical operations, many endoscopic procedures, ones carried out through arteries and veins, and those done using ultrasound or X-ray. We aim to support healthcare professionals who are in the process of introducing new procedures. We also aim to ensure patient safety is protected. The majority of the procedures we evaluate are new, but we also evaluate more established procedures if there is any uncertainty about their safety or how effective they are.

So far we have published more than 500 pieces of guidance on treatments, surgery and diagnostic tests that involve a cut or puncture of the skin, endoscopy, or energy sources such as X-ray or ultrasound.

This year we produced 33 pieces of guidance on procedures such as:

500th IP guidance deems ‘bionic jaw’ procedure deemed safe and effective

In August 2014, we published our 500th piece of interventional procedures guidance on jaw replacement surgery to help cure a painful mouth disorder that can be caused by arthritis or trauma.

Around 1 in 6 people will have problems with 1 or both of their temporomandibular joints. Symptoms include pain and difficulty opening the mouth. They can occur at any age and although most cases are not serious, a few people will need surgery.

First line treatment involves lifestyle changes such as eating soft foods and avoiding chewing gum, the use of mouth guards, non-steroidal anti-inflammatory drugs and physiotherapy.

Our 500th interventional procedures guidance says that if these measures do not help then total prosthetic replacement of the temporomandibular joint should now be considered for patients.

Previously, NICE was only able to recommend the procedure under special arrangements for clinical governance, consent and audit or research because of a lack of evidence on long-term efficacy and on safety. Since the first guidance was produced in 2009 the published evidence had increased enough to change the recommendation to use with “normal arrangements”.

The guidance recommends that patient selection should be carried out in specialist units by a team with regular practice and specific expertise in the conservative and surgical management of temporomandibular joint problems, and should include consideration of all relevant medical and surgical options. The British Association of Oral and Maxillofacial Surgeons (BAOMS) has produced guidelines on patient selection.

The procedure should only be done by clinicians with specific training and experience in total prosthetic replacement of the temporomandibular joint.

Professor Bruce Campbell, Chair of the Interventional Procedures Advisory Committee at NICE, said: “Total prosthetic replacement of the temporomandibular joint is only intended for people who are experiencing extreme pain or disability. It is one of a number of surgical options, which specialists will always discuss in detail with people who might need this operation.

“We are pleased to be able to recommend normal arrangements for this procedure. When we originally looked at this prosthetic replacement of the temporomandibular joint in 2009 there was not enough evidence for us to advise that it worked well enough and was safe enough to use in a routine way. At the time, we encouraged clinicians to collect more data to provide us with further evidence of the procedure’s long-term safety and effectiveness.

“We’re pleased that specialists took notice of our recommendation by recording and publishing this information – this has directly led to NICE revising its guidance.”

Interventional procedures timeline