Introduction/Objective: National evidence based clinical practice guidelines are unusual in UK primary care. The Royal College of General Practitioners has established a programme to develop a limited number of clinical guidelines using a rigorous scientific approach, with a multi-faceted dissemination strategy and an evidence-based implementation programme. Acute low back pain was the development model.

Methods: A multi-disciplinary advisory group was established, including clinicians and methodologists. Systematic reviews carried out by AHCPR to 1993 were used as a basis for the guideline, with additional reviews on bed rest, advice on staying active, manipulation and exercise up to 1996. A dissemination programme targeted 60,000 health professionals and 200 health and quality organisations.

Results: External standardised appraisal identified the guideline's major strengths as its evidence based recommendations. Dissemination to GPs was sometimes problematic (some did not receive the guidelines). A national implementation programme proved impossible because implementation is essentially a local issue.

Discussion: Production of national guidelines demands negotiation between scientific rigor and professional agendas. Dissemination requires a multi-faceted approach to reach target audiences. Effective implementation requires partnership between developers and local quality groups and professional associations.