Although guidelines play an important role in clinical governance their limitations are well known. This publication examines the problem of implementation by evaluating Assisting Clinical Effectiveness programmes at 13 sites in the South Thames Region where guidelines were implemented. Six of these projects are reported at length.

A number of conclusions are reached. Unsurprisingly, implementation was limited by inadequate practical guideline development. There were problems with critical appraisal skills when guidelines were produced without adequate methodological rigour. The financial costs of implementation and appraisal were often considerable and there were problems in matching project facilitator skills and salary scale available to the needs of the project. There are problems in finding an appropriate educational strategy; in particular, it was difficult to get general practitioners together. A one-to-one approach is recommended, although clearly labour intensive. The project team, unsurprisingly, has to be credible clinically to the target practitioners.

This publication inevitably reflects parochial and personal interests at the sites involved. Many of the problems faced in the introduction of guidelines and their assessment, both initially and those that attempt to close the audit loop, are not unexpected. The book will be of interest mainly to those in both primary and secondary healthcare who are faced with implementation of guidelines.