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Discusses the feasibility of disseminating and implementing guidelines in routine practice, informed by discussions with senior actors in the field of guidelines implementation. Comments about the lack of protected budgets to support guideline dissemination and implementation strategies and common strategies of using “soft money” or resources for specific initiatives to support such activities. The “opportunity costs” of strategies need to be considered. In addition there are implications for the implementation of the NHS information strategy. For clinical governance as a whole, not only is it likely that widespread cultural change is required, but also the capacity of the system still needs considerable expansion if sufficient educational activities are to become routine.

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