Changes

March 2026 — minor update. Revised the sepsis six to encompass paediatric guidance.  

Update

Goals

To support primary healthcare professionals to:

• Be aware of when to suspect a diagnosis of sepsis in primary care.
• Be aware of risk stratification tools that can be used to assess the risk of clinical deterioration, severe illness, or death from sepsis.
• Arrange emergency transfer to hospital if sepsis is suspected and the person is judged to be at high risk of severe illness or death, or at moderate-to-high risk and the person cannot be managed in primary care.
• Provide appropriate emergency management in primary care, if necessary, prior to hospital transfer.
• Provide advice and information to survivors of sepsis and their families/carers, and arrange follow-up as needed.

Outcome measures

Audit criteria

QOF indicators

QIPP - Options for local implementation

NICE quality standards

No current NICE quality standards were found during the review of this topic. 

What is it?

• According to the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3), sepsis is a syndrome defined as life-threatening organ dysfunction due to a dysregulated host response to infection [Shankar-Hari, 2016; Singer, 2016].
  • Septic shock is a subset of sepsis, which describes circulatory, cellular, and metabolic abnormalities that are associated with a greater risk of mortality than sepsis alone.
    • People with septic shock can be identified using the clinical criteria of persisting hypotension requiring vasopressor therapy to maintain a mean arterial pressure of 65 mmHg or more, and serum lactate level greater than 2 mmol/L despite adequate volume resuscitation [Singer, 2016; NICE, 2024].

What causes it?

The exact pathophysiology of sepsis is not known, but it is thought to be a multifactorial response to an infecting pathogen that may be amplified by host factors (such as genetics, age, and comorbidities), the pathogen (type, virulence, and burden), and the environment  [Singer, 2016; Cecconi, 2018].

• Activation of the immune system results in the production of both pro-inflammatory mediators (leading to cellular and tissue damage) and anti-inflammatory mediators (leading to immunosuppression). The resulting tissue hypoxia, mitochondrial dysfunction, macrovascular and microvascular dysfunction, and apoptosis are thought to be mediators of organ dysfunction [Cecconi, 2018; Poston, 2019].
• The most common sites of infection leading to sepsis are the respiratory, gastrointestinal, renal and genitourinary tracts, as well as blood, skin or soft tissue sources [Cecconi, 2018; Gauer, 2020].
  • The most common causative organisms are Gram-negative and Gram-positive bacteria — Staphylococcus aureus, Pseudomonas species, and Escherichia coli are the most frequently identified organisms [Cecconi, 2018; Gauer, 2020].
  • In children, Neisseria meningitides and Haemophilus influenzae may also be involved [Plunkett, 2015].
  • Rarely, fungal, viral, or parasitic infections are causative [Gauer, 2020].
  • In around 50% of people treated for sepsis no causative pathogen is identified [Gauer, 2020].
  • About 80% of hospital-treated sepsis cases originate from community-acquired infection [Cecconi, 2018].

What are the risk factors?

Risk factors for sepsis include:

• Infants (aged under 1 year) and older people (aged over 75 years). 
• People:
  • Who are very frail. 
  • Who are immunocompromised due to a comorbid condition (such as diabetes mellitus, HIV, cirrhosis, sickle cell disease, or asplenia). See the CKS topics on Diabetes - type 1, Diabetes - type 2, HIV infection and AIDS, Jaundice in adults, and Sickle cell disease for more information.
  • Who are immunosuppressed due to drug treatment (such as anticancer treatment, oral corticosteroids, or other immunosuppressive drugs). See the CKS topics on Corticosteroids - oral, DMARDs, and Neutropenic sepsis for more information.
  • Who have had repeated antibiotic treatment.
  • Who have experienced trauma, undergone surgery, or other invasive procedures in the past 6 weeks. 
  • With any breach of skin integrity (for example cuts, burns, blisters, or skin infections). See the CKS topics on Burns and scalds and Cellulitis - acute for more information. 
  • Who misuse drugs intravenously or alcohol.
  • With indwelling lines or catheters. 
  • Who have communication difficulties such as cognitive impairment, or those who need an interpreter. 
  • Who are homeless or living in a deprived area. 
• Women who are pregnant, are post-partum, or have had a termination of pregnancy or miscarriage in the past 6 weeks, including those who have:
  • Had a Caesarean section, forceps delivery, or removal of retained products of conception. 
  • Had prolonged rupture of membranes. 
  • Or have been in close contact with people with group A streptococcal infection, for example, scarlet fever. See the CKS topic on Scarlet fever for more information.
  • Ongoing vaginal bleeding or an offensive vaginal discharge. See the CKS topic on Vaginal discharge for more information.

[Gotts, 2016; BMJ Best Practice, 2023; NICE, 2024]

How common is it?

The true incidence of sepsis in the UK is uncertain due to varying definitions, data sources, diagnostic criteria, study populations, and other confounding factors. As a consequence, the reported incidence varies widely in the literature [Singer, 2016; Cecconi, 2018; AoMRC, 2022]. 

• During 2011-2015, each year on average there were 39,544 sepsis admissions to intensive care units in England and Wales [AoMRC, 2022].
• A change in national sepsis coding guidance in 2017 and an increase in hospital reimbursement for sepsis diagnoses led to an artificial 300% increase in reported sepsis numbers, however up to 40% of people initially diagnosed as having sepsis were later judged as not likely to be infected [Sepsis, 2019].  
• An analysis by the UK Sepsis Trust of hospital episode statistics (HES) data for England for 2017/18 showed around 200,000 people were admitted to hospital with sepsis [Daniels, 2024].
• In 2022, sepsis was the underlying cause of 3770 deaths in England and Wales, and was the underlying cause or contributory factor in 25,542 deaths [ONS, 2023, Deaths from sepsis in the UK 2001 to 2022] 
• A study of patients admitted with a 'suspicion of sepsis' in the Oxford region in 2013-14 estimated 17 admissions per 1000 adults per year, with a mortality of 7.2% — for the whole of the UK this would be 918,000 adult admissions per year and 66,096 deaths. The Academy of Medical Royal Colleges advises that the true number of confirmed bacterial sepsis admissions is lower than this [AoMRC, 2022].
• A systematic review of 23 international observational epidemiological studies of neonates and children found an estimated incidence of 48 cases per 100,000 person-years. The authors noted, however, considerable heterogeneity in study designs and settings with minimal data from low-income settings, leading to a likely underestimate of the true burden of sepsis in this age-group [Fleischmann-Struzek, 2018]. 
• In most epidemiological studies sepsis is found to be more common in men than in women [BMJ Best Practice, 2023].
• Sepsis can affect any age, however, it is most common in the elderly and the very young [NHS England, 2015].

What are the complications?

Sepsis is a leading cause of morbidity and mortality. Around 40% of sepsis survivors following hospital admission experience long-term sequelae ('Post-Sepsis Syndrome'). Possible complications of sepsis include [NHS England, 2015; Singer, 2016; Evans, 2021; Daniels, 2024]:

• Death 
  • In 2022, sepsis was the underlying cause of 3770 deaths in England and Wales, and was the underlying cause or contributory factor in 25,542 deaths [ONS, 2023, Deaths from sepsis in the UK 2001 to 2022] 
  • More than 25–30% of people with sepsis die from the condition [Cecconi, 2018].
  • The UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2019–21 notes that sepsis is one of the most frequent direct causes of maternal death in the UK [MBRRACE-UK, 2023].
• Organ dysfunction and failure 
  • This may be multi-system and includes acute kidney injury (AKI), cholestasis, heart failure, acute respiratory distress syndrome (ARDS) or acute lung injury [Gotts, 2016; Cecconi, 2018; BMJ Best Practice, 2023]. See the CKS topics on Acute kidney injury, Jaundice in adults, and Heart failure - chronic for more information.
    • Up to 60% of people with sepsis have AKI, which is an independent risk factor for mortality [Poston, 2019].
    • Organ dysfunction is an important predictor of patient outcome and multiple organ dysfunction is associated with a high risk of death. 
• Recurrent and secondary infection
  • People who survive early sepsis may develop hospital-acquired infections with atypical organisms, and may have reactivation of latent viruses, due to an impaired ability to mount an appropriate immune response to superadded infections [Gotts, 2016; Cecconi, 2018].
• Coagulopathy
  • This may cause thromboembolism or disseminated intravascular coagulation (DIC) characterized by microthrombosis and haemorrhage [Cecconi, 2018; BMJ Best Practice, 2023]. Coagulopathy is associated with a worse prognosis. See the CKS topics on Deep vein thrombosis and Pulmonary embolism for more information.
• Reduced quality of life [Cecconi, 2018; Daniels, 2024]
• Neurological sequelae [BMJ Best Practice, 2023] 
  • Focal neurological deficits and hearing loss occur in up to 30% of patients with bacterial meningitis. 
  • Polyneuropathy occurs in 70% of people with sepsis and multi-organ failure.
• Cognitive and functional disability [Cecconi, 2018; Gauer, 2020]
• Psychological sequelae
  • These may include anxiety about recurrent infection and sepsis, post-traumatic stress disorder, loss of confidence and self-esteem [Gauer, 2013; Daniels, 2024]. See the CKS topics on Generalized anxiety disorder and Post-traumatic stress disorder for more information.

What is the prognosis?

The reported prognosis of sepsis and septic shock varies in the literature, depending on the definitions used and the population studied [Singer, 2016].

• More than 25–30% of people with sepsis die from the condition, with hospital mortality for septic shock approaching 40–60% [Cecconi, 2018]. However, in high- and middle-income countries, deaths from sepsis are primarily in the elderly, frail, people with comorbid diseases, and the immunocompromised, many of whom are at or near the end of life [AoMRC, 2022].
  • Around 77% of sepsis-related deaths in England are in people aged 75 years or older, while approximately 150 sepsis-related deaths occur annually in children aged 0–18 years — a hospital mortality of 0·075% [Sepsis, 2019].
  • In a point prevalence study in Welsh hospitals including 521 people with sepsis and 136 deaths, 40 deaths were directly or possibly attributable to sepsis. Of these 40 deaths, 77·5% were in people who had substantial frailty, and 70% were in people who were not suitable for cardiopulmonary resuscitation in the event of cardiac arrest [Sepsis, 2019].
  • Organ dysfunction is an important predictor of prognosis and is associated with a higher risk of mortality [Cecconi, 2018]. 
• In children with community-acquired sepsis admitted to European paediatric intensive care units (PICUs), mortality was 6%, increasing to 10% in the presence of septic shock. A third of survivors admitted to PICU were discharged with disability [AoMRC, 2022]. 
• Compared to non-sepsis admissions, sepsis survivors have a greater risk of re-admission.
  • Between 19–32% of sepsis survivors are re-admitted within 30 days [Daniels, 2024].
  • Almost 40% of sepsis survivors are re-hospitalized within 3 months, often for preventable conditions [Evans, 2021].
• People who survive sepsis may have long-term physical, psychological, and cognitive impairments [Singer, 2016].
• Factors associated with a poor prognosis in people with sepsis include [Poston, 2019; Gauer, 2020; Daniels, 2024]:
  • Acute kidney injury.
  • Disseminated intravascular coagulation.
  • Hepatic failure. 
  • High lactate levels — the higher they are the worse the prognosis. 
  • Renal failure.

When should I suspect sepsis?

Be aware that sepsis can be challenging to identify, as the clinical presentation is variable depending on the underlying cause and the person's age and comorbidities.

• Suspect sepsis in any person who presents with:
  • Symptoms or signs indicating possible infection causing significant illness or deterioration. This includes people who are deteriorating unexpectedly, or failing to improve as expected.
  • One or more risk factor(s) for sepsis, and who looks unwell.
  • Concern from a relative or carer that there is a change in appearance or behaviour.
• Be aware that:
  • People with sepsis may present with non-specific, non-localized clinical features — for example, general malaise, agitation, or behavioural change.
    • Older children may present with a focus of infection, while infants and neonates usually present with non-specific symptoms and signs. 
  • People with sepsis may not present with a raised core temperature, and may present with a lowered core temperature.
  • Sepsis may result from infection with almost any pathogen, therefore it may present with a wide range of clinical features depending on the site of infection and host response.
• Suspect neutropenic sepsis in any person who becomes unwell who is receiving anticancer treatment, and manage appropriately. See the CKS topic on Neutropenic sepsis for more information.

How should I assess a person with suspected sepsis?

If a person with any infection presents with suspected sepsis, arrange urgent assessment to identify markers of increased risk of severe illness or death, and manage appropriately.

• Assess people who might have sepsis with extra care if they cannot give a good history — for example, people with English as a second language or people with communication difficulties (such as neurodiversity, cognitive impairment, learning difficulties, severe mental health conditions, or brain injury).
• Ask the person (or carers):
  • About any recent fever or rigors.
  • How often they have urinated in the past 18 hours.
  • About any symptoms suggesting specific infection, such as dysuria or rash.
  • If they have recently presented to their GP (or other healthcare setting) with symptoms or signs that could indicate sepsis.
  • About clinical features suggesting dehydration, such as reduced urine output in the past 18 hours.
  • If there has been any change in cognitive function, behaviour, or mental state — such as not responding normally to social cues or waking only with prolonged stimulation, new irritability in children, or new-onset confusion in adults. See the CKS topic on Delirium for more information.
  • If there has been any sudden change or deterioration in functional ability.
  • About possible risk factors for sepsis, including comorbidities and drug treatments. 
  • About possible risk factors for antibiotic resistance, such as recent or previous antibiotic therapy, recent hospital admissions, and residency in a care home, for example. 
  • About their immunization status (particularly in infants and young children). 
• Examine the person to assess for:
  • General appearance, level of consciousness and cognition.
    • Cognitive assessment should include recognition of new-onset confusion, disorientation, and/or agitation. See the CKS topic on Delirium for detailed information on performing a cognitive assessment. 
  • Temperature.
    • Fever is the most common presentation of sepsis, but the absence of fever or hypothermia does not exclude sepsis. See the CKS topics on Feverish children - risk assessment and management for more information on assessment.
    • Hypothermia and absence of fever are more likely in older adults and in people with chronic alcohol abuse or immunosuppression.
    • Take into account that some groups of people with sepsis may not develop a raised temperature (for example, people who are older or very frail, having treatment for cancer, severely ill with sepsis, with a spinal cord injury, and young infants or children).
    • Take into account that a rise in temperature can be a physiological response (for example, after surgery or trauma).
  • Heart rate, respiratory rate, and blood pressure.
    • Signs of respiratory distress include nasal flaring, grunting, and apnoea in children less than 5 years of age.
    • In children aged under 12 years, measure blood pressure and oxygen saturation if facilities, including a correctly-sized cuff or pulse oximeter, are available, and taking a measurement does not cause a delay in assessment or treatment. 
    • Hypotension is a presenting feature in 40% of people with sepsis, but be aware that a normal blood pressure does not exclude sepsis.
  • Capillary refill time and oxygen saturation (abnormal results may indicate poor peripheral perfusion).
  • Skin changes or damage.
    • Mottled or ashen appearance; pallor or cyanosis of the skin, lips, or tongue; or cold hands or feet.
    • A non-blanching petechial or purpuric rash which may suggest meningococcal disease. See the CKS topic on Meningitis - bacterial meningitis and meningococcal disease for more information on assessment and emergency management.
    • Any breach of skin integrity (for example cuts, burns, or skin infections) or other skin signs suggesting infection, such as erythema, swelling or discharge at a surgical site, or wound breakdown. See the CKS topics on Burns and scalds and Cellulitis - acute for more information.
  • A weak high-pitched or continuous cry (in children under 5 years of age). 
  • Dry mucous membranes or other signs of dehydration. See the CKS topic on Feverish children - risk assessment for more information on assessment.
  • The possible underlying source of infection. 
• Grade the risk of severe illness or death from sepsis using the person's history, physical examination and criteria based on age. 
  • The following UK Sepsis Trust general practice sepsis screening and action tools may be useful:  
    • Children aged under 5 years. 
    • Children aged 5–11 years.
    • Children and young people aged 12-15 years. 
    • Adults and young people aged 16 years and over.
    • Women who are pregnant or up to 6 weeks postpartum.
• Consider using an early warning score (for example, NEWS2) to assess people who are:
  • Aged under 16 years, in any setting.
  • Pregnant, or who have recently been pregnant, in any setting.
  • Aged 16 years or over, in a community or custodial setting.

Risk stratification for adults, children, and young people with suspected sepsis

• People with suspected sepsis are at:
  • High risk of severe illness or death from sepsis if they meet any of the relevant high risk criteria.
  • Moderate to high risk of severe illness or death from sepsis if they meet any of the relevant moderate to high risk criteria.
• People with suspected sepsis who do not meet any high or moderate to high risk criteria are at low risk of severe illness or death from sepsis.
• See Tables 1, 2 and 3 for details of clinical features and risk categories. 

Table 1. Children aged under 5 years

Table 2. Children aged 5–11 years

Table 3. Children aged 12 to 15 years, people aged over 16 years, people who are currently or recently pregnant 

Source: [NICE, 2024]

What else might it be?

Alternative conditions that may present similarly to sepsis include:

• Acute alcohol withdrawal. 
• Acute blood loss and hypovolaemia. 
• Acute delirium. See the CKS topic on Delirium for more information.
• Acute myocardial infarction. See the CKS topic on Chest pain for more information.
• Acute pancreatitis. See the CKS topic on Pancreatitis - acute for more information.
• Adrenal crisis.
• Diabetic ketoacidosis. See the CKS topic on Diabetes - type 1 for more information. 
• Heart failure. See the CKS topic on Heart failure - chronic for more information.
• Intoxication and poisoning, including carbon monoxide poisoning. See the CKS topics on Poisoning or overdose and Carbon monoxide poisoning for more information.
• Pulmonary embolism. See the CKS topic on Pulmonary embolism for more information.
• Thyrotoxicosis. See the CKS topic on Hyperthyroidism for more information.
• Trauma and tissue injury, burns. See the CKS topic on Burns and scalds for more information.
• Drug reactions, including neuroleptic malignant syndrome (an idiosyncratic complication of antipsychotic drug use, characterized by hyperthermia, rigidity, sweating, and labile blood pressure). See the CKS topics on Bipolar disorder and Psychosis and schizophrenia for more information.

Management

From age 1 month onwards.

Search strategy

Scope of search

A literature search was conducted for guidelines and systematic reviews on primary care management of sepsis.

Search dates

April 2019 - February 2024

Key search terms

The terms listed below are the core search terms that were used for EBSCOhost MEDLINE (searched 3rd April 2019). These were combined with filters to identify guidelines, systematic reviews and primary care relevant literature in EBSCOhost MEDLINE. The strategy was adapted for The Cochrane Library databases.

S3    S1 OR S2
S2    AB ( (sepsis or septicaemi* or septicemi* or (septic shock)) ) OR TI ( (sepsis or septicaemi* or septicemi* or (septic shock)) )
S1    (MH "Sepsis+")

Sources of guidelines

• National Institute for Health and Care Excellence (NICE)
• Scottish Intercollegiate Guidelines Network (SIGN)
• Royal College of Physicians
• Royal College of General Practitioners
• Royal College of Nursing
• NICE Evidence
• World Health Organization
• Guidelines International Network
• TRIP database
• Agency for Healthcare Research and Quality
• National Health and Medical Research Council (Australia)
• Royal Australian College of General Practitioners
• British Columbia Medical Association
• Canadian Medical Association
• Alberta Medical Association
• Michigan Quality Improvement Consortium
• Singapore Ministry of Health
• National Resource for Infection Control
• RefHELP NHS Lothian Referral Guidelines
• Medline (with guideline filter)
• Driver and Vehicle Licensing Agency
• NHS Health at Work (occupational health practice)

Sources of systematic reviews and meta-analyses

• The Cochrane Library:
  • Systematic reviews
  • Protocols
  • Database of Abstracts of Reviews of Effects
• Medline (with systematic review filter)
• EMBASE (with systematic review filter)

Sources of health technology assessments and economic appraisals

• NIHR Health Technology Assessment programme
• The Cochrane Library:
  • NHS Economic Evaluations
  • Health Technology Assessments
• Canadian Agency for Drugs and Technologies in Health
• International Network of Agencies for Health Technology Assessment

Sources of randomized controlled trials

• The Cochrane Library:
  • Central Register of Controlled Trials
• Medline (with randomized controlled trial filter)
• EMBASE (with randomized controlled trial filter)

Sources of evidence based reviews and evidence summaries

• Drug and Therapeutics Bulletin
• TRIP database
• Central Services Agency COMPASS Therapeutic Notes

Sources of national policy

• Department of Health
• Health Management Information Consortium (HMIC)

Patient experiences

• Healthtalk
• BMJ - Patient Journeys

Sources of medicines information

The following sources are used by CKS pharmacists and are not necessarily searched by CKS information specialists for all topics. Some of these resources are not freely available and require subscriptions to access content.

• British National Formulary (BNF)
• electronic Medicines Compendium (eMC)
• European Medicines Agency (EMEA)
• Medicines and Healthcare products Regulatory Agency (MHRA)
• REPROTOX
• Scottish Medicines Consortium
• Stockley's Drug Interactions
• TERIS
• TOXBASE
• Micromedex
• UK Medicines Information

Stakeholder engagement

Our policy

The external review process is an essential part of CKS topic development. Consultation with a wide range of stakeholders provides quality assurance of the topic in terms of:

• Clinical accuracy.
• Consistency with other providers of clinical knowledge for primary care.
• Accuracy of implementation of national guidance (in particular NICE guidelines).
• Usability.

Principles of the consultation process

• The process is inclusive and any individual may participate.
• To participate, an individual must declare whether they have any competing interests or not. If they do not declare whether or not they have competing interests, their comments will not be considered.
• Comments received after the deadline will be considered, but they may not be acted upon before the clinical topic is issued onto the website.
• Comments are accepted in any format that is convenient to the reviewer, although an electronic format is encouraged.
• External reviewers are not paid for commenting on the draft topics.
• Discussion with an individual or an organization about the CKS response to their comments is only undertaken in exceptional circumstances (at the discretion of the Clinical Editor or Editorial Steering Group).
• All reviewers are thanked and offered a letter acknowledging their contribution for the purposes of appraisal/revalidation.
• All reviewers are invited to be acknowledged on the website. All reviewers are given the opportunity to feedback about the external review process, enabling improvements to be made where appropriate.

Stakeholders

• Key stakeholders identified by the CKS team are invited to comment on draft CKS topics. Individuals and organizations can also register an interest to feedback on a specific topic, or topics in a particular clinical area, through the Getting involved section of the Clarity Informatics website.
• Stakeholders identified from the following groups are invited to review draft topics:
  • Experts in the topic area.
  • Professional organizations and societies (for example, Royal Colleges).
  • Patient organizations, Clarity has established close links with groups such as Age UK and the Alzheimer’s Society specifically for their input into new topic development, review of current topic content and advice on relevant areas of expert knowledge.
  • Guideline development groups where the topic is an implementation of a guideline.
  • The British National Formulary team.
  • The editorial team that develop MeReC Publications.
• Reviewers are provided with clear instructions about what to review, what comments are particularly helpful, how to submit comments, and declaring interests.

Patient engagement

Clarity Informatics has enlisted the support and involvement of patients and lay persons at all stages in the process of creating the content which include:

• Topic selection
• Scoping of topic
• Selection of clinical scenarios
• First draft internal review
• Second draft internal review
• External review
• Final draft and pre-publication

Our lay and patient involvement includes membership on the editorial steering group, contacting expert patient groups, organizations and individuals.

Evidence exclusion criteria

Our policy

Scoping a literature search, and reviewing the evidence for CKS is a methodical and systematic process that is carried out by the lead clinical author for each topic. Relevant evidence is gathered in order that the clinical author can make fully informed decisions and recommendations. It is important to note that some evidence may be excluded for a variety of reasons. These reasons may be applied across all CKS topics or may be specific to a given topic.

Studies identified during literature searches are reviewed to identify the most appropriate information to author a CKS topic, ensuring any recommendations are based on the best evidence. We use the principles of the GRADE and PICOT approaches to assess the quality of published research. We use the principles of AGREE II to assess the quality of published guidelines.

Standard exclusions for scoping literature:

• Animal studies
• Original research is not written in English

Possible exclusions for reviewed literature:

• Sample size too small or study underpowered
• Bias evident or promotional literature
• Population not relevant
• Intervention/treatment not relevant
• Outcomes not relevant
• Outcomes have no clear evidence of clinical effectiveness
• Setting not relevant
• Not relevant to UK
• Incorrect study type
• Review article
• Duplicate reference

Organizational, behavioural and financial barriers

Our policy

The CKS literature searches take into consideration the following concepts, which are discussed at the initial scoping of the topic.

• Feasibility
  • Studies are selected depending on whether the intervention under investigation is available in the NHS and can be practically and safely undertaken in primary care.
• Organizational and Financial Impact Analysis
• Studies are selected and evaluated on whether the intervention under investigations may have an impact on local clinical service provision or national impact on cost for the NHS. The principles of clinical budget impact analysis are adhered to, evaluated and recorded by the author. The following factors are considered when making this assessment and analysis.
  • Eligible population
  • Current interventions
  • Likely uptake of new intervention or recommendation
  • Cost of the current or new intervention mix
  • Impact on other costs
  • Condition-related costs
  • In-direct costs and service impacts
  • Time dependencies
• Cost-effectiveness or cost-benefit analysis studies are identified where available. 

We also evaluate and include evidence from NICE accredited sources which provide economic evaluations of recommendations, such as NICE guidelines. When a recommended action may not be possible because of resource constraints, this is explicitly indicated to healthcare professionals by the wording of the CKS recommendation.

Declarations of interest

Our policy

Clarity Informatics requests that all those involved in the writing and reviewing of topics, and those involved in the external review process to declare any competing interests. Signed copies are securely held by Clarity Informatics and are available on request with the permission of the individual. A copy of the declaration of interest form which participants are asked to complete annually is also available on request. A brief outline of the declarations of interest policy is described here and full details of the policy is available on the Clarity Informatics website. Declarations of interests of the authors are not routinely published, however competing interests of all those involved in the topic update or development are listed below. Competing interests include:

• Personal financial interests
• Personal family interest
• Personal non-financial interest
• Non-personal financial gain or benefit

Although particular attention is given to interests that could result in financial gains or losses for the individual, competing interests may also arise from academic competition or for political, personal, religious, and reputational reasons. An individual is not obliged to seek out knowledge of work done for, or on behalf of, the healthcare industry within the departments for which they are responsible if they would not normally expect to be informed.

Who should declare competing interests?

Any individual (or organization) involved in developing, reviewing, or commenting on clinical content, particularly the recommendations should declare competing interests. This includes the authoring team members, expert advisers, external reviewers of draft topics, individuals providing feedback on published topics, and Editorial Steering Group members. Declarations of interest are completed annually for authoring team and editorial steering group members, and are completed at the start of the topic update and development process for external stakeholders.

Competing interests declared for this topic:

None.