Background A NICE GC is a multidisciplinary group, supported by a technical team (systematic reviewer, information specialist, health economist). It is an advisory group to NICE and sits independently. As a minimum, a GC comprises: healthcare professionals, and for relevant topics, public health or social care practitioners (both specialists in the topic and generalists)patients, carers or members of the public. The role of a GC chair should be rooted in the cultural norms of an organisation in terms of its identity and the methodological approaches it takes to guideline development. The wider legislative and policy framework within which the guideline agency operates is also relevant to the chair’s role. For example, legislative and policy imperatives to promote equality. NICE’s GC chairs are responsible for running independent groups, but knowledge of the methodological and process expectations of NICE is crucial in ensuring the chairs can run a group effectively. Chairs must focus on their main objective, delivering a high-quality guideline, within the resource and time constraints allowed. If a guideline developer has yet to establish explicit methods and processes, the chair should apply core principles that are recognised as key to good quality guideline development (such as the AGREE II criteria [Brouwers at al. 2010]). We strongly believe that the underlying philosophy of involving patients and the public in guideline development is important. It may well support guidance development organisations when convening such groups, and in chairing them in a facilitative and inclusive manner. Training for chairs In May 2006, the World Health Organization (WHO) conducted a review of NICE’s guidelines development programme (de Joncheere et al. 2006), and made several recommendations. One was that chairs of GCs should be recruited through a standard process, preferably through open advertising, and that NICE should develop standardised training for GC chairs. The first of these recommendations was quickly adopted. NICE developed an ‘induction’ programme, discussed more fully in the section on NICE’s chairs’ induction programme. It addresses, among other things, the involvement of the patient/public members of the GC. This approach reflects the results of reviews carried out by NICE’s Public Involvement Programme, which identify the role of the chairs of GCs as crucial to the success of the way the GCs function and how well GC patient/public members feel integrated into the group and its workings. GC patient/public members have variously described characteristics of ‘good’ chairs as: ‘inclusive’‘skilled’open’‘honest’‘able to influence’‘encouraging healthy rivalry’. One patient/public member said of their chair ‘He went to some length to draw out or ensure that the patient/lay view and information was given to the group, and that the patient/public members were on an equal footing to the professionals’. Another said ‘The Chairman was very accommodating to the patient/public members but not so awfully PC [politically correct] that he was not averse to arguing with them; in short he behaved like a reasonable human being’. The PIP’s evaluations revealed that the patient/public members felt that the chairs could either be ‘weak’ or ‘skilled’. This perception depended on how well they managed their guideline group and how well they offered appropriate support to the patient/public members of the group. As found in studies of other kinds of small group work (such as in Elwyn et al. 2001), the PIP’s evaluations found a relationship between the skills of the chair and the success of the group. The chair is clearly a key element determining how well a GC functions. Success, or otherwise, of a group rests on the skills of the chair. Recruitment of chairs Each guideline agency will have different models for chairing their GCs. NICE recruits external independent chairs whereas other agencies may recruit skilled moderators from the agency’s staff or well-known topic experts. This section details NICE’s approach to recruiting chairs. To ensure transparency, NICE adopts an open recruitment process, whereby anyone with an interest can apply to chair a group. NICE’s appointments to advisory bodies policy and practice, a corporate recruitment policy, has been developed to support this (2020). Potential chairs must submit an application (as they would for a position of employment), and then a formal process for selection and recruitment follows. Applicants are assessed against criteria in a ‘role description’, and then short-listed. Short-listed candidates are interviewed by a panel comprising senior staff members and a member of the NICE Board. Further information on vacancies for chairs of NICE groups can be found on NICE’s join a committee webpage. GC chairs are most often health or social care professionals with extensive commitments, although NICE has experience of recruiting lay people to chair its committees. This process, although transparent, carries a significant administrative burden, for drafting recruitment paperwork, short-listing the applicants, and the interview process itself. But, because this follows a standardised process, after the template recruitment documents have been developed, they only require minor amendments to tailor them to each new recruitment. NICE’s chairs’ induction programme Because of the WHO report and the subsequent reviews, a programme for inducting GC chairs was developed jointly by NICE’s Centre for Guidelines and NICE’s Public Involvement Programme. It was specifically tailored to NICE’s needs and the context in which it works. NICE operates a mixed model of guideline development in which many of its guidelines are developed by 2 external contractor organisations, according to methods and processes set out in the publicly-available NICE guidelines manual. A new chair is recruited for each GC addressing each new guideline topic but some chairs are recruited to a broad topic area, such as diabetes, obstetrics, weight management. Alongside the work contracted externally, some of NICE’s guideline development work is undertaken ‘in-house’. These guidelines are developed by GCs with a pool of chairs who oversee the development of a variety of guidelines on different topics. NICE invites both newly recruited GC chairs and chairs from this pool to attend induction sessions with their peers. The induction process for NICE’s GC chairs is constantly reviewed and refined, reflecting the accumulated experience of GCs, their chairs and members, and, importantly, changes in the guideline development methods and processes. During the COVID-19 pandemic, NICE’s chairs’ training was adapted for the online environment. At NICE, the chair’s role in supporting the patient/public members of the GC is part of the overall induction programme, and discussion of this is woven into the different sessions. This emphasises that patient/public member involvement is an integral part of the guideline development process and of the work of the GC. If there were a separate section of the induction programme, specifically focusing on patient/public involvement, it might suggest that patient/public involvement is an ‘added extra’ and not an integral and essential part of the process. The day-long programme comprises a mix of presentations, discussions and interactive sessions, intended to introduce chairs to the NICE guideline development methods (NICE 2014). (During the COVID-19 pandemic this was reduced to a half-day videoconference session with training material sent in advance.) It also covers practical issues related to running GCs, such as declaring and managing interests (NICE 2021), good facilitation skills, the importance of NICE’s duties under equalities legislation (see the NICE equality scheme), and the NICE policy on participation of patient/public members of GCs. The session also expands on the role of NICE as commissioner, and how that sits alongside and independently of the guideline development staff and GC. Presentations are given by methodological and process specialists, and patient and public involvement specialists, thereby reinforcing the importance of an inclusive approach to guideline development. Participants also benefit from the contribution of an experienced chair (someone who has chaired 1 or more NICE GCs) who discusses their experience and offers tips and strategies for effectively chairing a GC in the NICE context. Overall objectives of the day are to: provide a specific opportunity for GC chairs and NICE staff to meet, share experiences and discuss the work of NICE in contextprovide an overview of key NICE processes and methodsidentify key resources and support. The format is flexible and interactive, with structured presentations designed both to inform and to act as the basis for discussion. The day gives chairs the opportunity to work collaboratively with their peers, as well as with the guideline development professionals from NICE. Additional resources General information about the role of chairs in running groups on which patient/public members sit can be found in 2 key additional resources: Patient and Public Involvement Toolkit, Chapter 4 Building relationships (Cartwright and Crowe 2011)Patient and public involvement in research groups – Guidance for chairs (TwoCan Associates for the UKCRC and NCRI 2010). Other useful information to support the chair’s role on guideline development groups: Supporting effective participation in health guideline development groups: The Guideline Participation Tool (Piggott et al. 2020)Checklist for Guideline Panel Chairs (Department of Health Research Methods, Evidence and Impact, McMaster University 2017)Groups. A guide to small group work in healthcare, management, education and research (Elwyn et al. 2001). Resource and planning requirements Inducting and supporting GC chairs needs to be planned and sufficient resources allocated. Some of these are financial, but the most significant is the staff time to deliver the induction and provide ongoing support. Organisation of induction Given the large number of guidelines that NICE develops at any one time, it can be difficult to identify suitable times and dates for induction sessions. NICE has therefore appointed a dedicated person within the Centre for Guidelines to lead and coordinate the chairs’ induction. Financial commitment At NICE, either the chair’s employing organisation is re-imbursed or payment is made directly to the chair for each GC meeting. In addition, travel and subsistence expenses are covered, according to NICE’s non-staff reimbursement policy. It is a requirement for all GC chairs to attend the induction session (see section 3.7 of NICE’s guidelines manual 2014). NICE does not provide remuneration for attending the induction, but other agencies might consider it worth doing to encourage attendance.