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What are guidelines?


Clinical guidelines are systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances. Guidelines provide recommendations for effective practice in the management of clinical conditions where variations in practice are known to occur and where effective care may not be delivered uniformly throughout Scotland. There are many guidelines available, but most are based on a consensus of 'expert opinion' or a non-systematic review of the scientific literature. The evidence based guidelines developed by SIGN are derived from a systematic review of the scientific evidence, and are therefore less susceptible to bias in their conclusions and recommendations.


Any group or individual can propose a topic for a SIGN guideline. For a topic to be suitable for the development of a SIGN guideline there must be evidence of variation in practice which affects patient outcomes and a strong research base providing evidence of effective practice. In addition, the potential benefit to patients must be sufficient to justify the resources invested in the development and implementation of a SIGN guideline. If you are interested in proposing a guideline topic, contact the SIGN Executive, for advice on preparing a proposal.


SIGN guidelines are developed by multidisciplinary working groups with representation from across Scotland. The guideline development groups are selected in consultation with the member organisations of SIGN Council. Each guideline is based on a systematic review and critical appraisal of the current scientific literature. This means that the evidence base for the guideline is identified, selected, and evaluated according to a defined methodology. In this way, potential sources of bias in the guideline are minimised and the likely validity of the recommendations is maximised. The guideline recommendations are graded according to the strength of the supporting evidence. This provides groups of practitioners working in NHSScotland with information to help select and prioritise recommendations for local implementation, depending on local needs, priorities, and resources.


A national open meeting is held to discuss each SIGN guideline in draft form. The national meetings are widely publicised and are open to all, providing an opportunity for health care professionals, patients, health service managers, and other interested groups to comment on the draft recommendations and to influence the final form of the guideline.

All SIGN guidelines are also independently reviewed by specialist referees prior to publication. Three years after publication (or sooner if required) the guideline is formally considered for review and is updated where necessary to take account of newly published evidence.


SIGN guidelines are distributed within the NHS in Scotland via a network of Guideline Distribution Coordinators in each NHS Board. All SIGN guidelines can also be downloaded free of charge from this website.

  • Implementation is the responsibility of each individual NHS Board and local ownership of the implementation process is crucial to success in changing practice. However, SIGN is increasingly supporting implementation by getting involved in:
  • raising awareness of our latest recommendations
  • networking with national projects and clinical networks responsible for improving clinical practice to support the implementation of key recommendations
  • developing implementation support tools and resources alongside specific guidelines (such as costing tools, care pathways, algorithms, audit tools and data sets)

SIGN guidelines will continue to provide the evidence base for many outputs developed by Healthcare Improvement Scotland and through working collaboratively with other parts of Healthcare Improvement Scotland we will support getting evidence into practice and to drive improvement of health services.

For more information contact Roberta James.


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