ABSTRACT
This chapter sketches the early implementation and impact of National Institute of Clinical Excellence (NICE) appraisals in one health community in England. It explores certain approach with qualitative data collected from semi-structured interviews and participant observation combined with quantitative data collected to assess the measurable impact of the NICE publications. The HA members were concerned that a system to implement NICE needed to be fair and consistent in covering guidance issued towards the end of the financial year and balancing secondary and primary care interventions. All organisations saw the prime responsibility as resting with a clinician-manager but stressed the need for corporate ownership through links between clinical, financial and planning teams. The 'culture' of the health community was alluded to by all interviewees and the degree of trust between organisations and their respective views about risk, especially financial risk, were seen as crucial to the approach to implementation.
